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When Your Body Hurts… Fears, Myths & the Truth about Pain Agenda What is pain How many people have it What causes it Barriers to effective treatment Assessing & treating pain Consequences of unrelieved pain Where to get more information What Is Pain?

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When your body hurts l.jpg

When Your Body Hurts…

Fears, Myths & the Truth about Pain


Agenda l.jpg
Agenda

  • What is pain

  • How many people have it

  • What causes it

  • Barriers to effective treatment

  • Assessing & treating pain

  • Consequences of unrelieved pain

  • Where to get more information


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What Is Pain?

“Pain is what the person says it is and exists whenever he or she says it does.”

-Margo McCaffery, RN, MS, FAAN

1968


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Clinical Definition of Pain

“…an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

  • International Association for the Study of Pain

    In other words, pain is any sensation that hurts.


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Clinical Type

Nociceptive

Neuropathic

Duration

Transient

Acute

Chronic

Breakthrough

Types of Pain


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Stabbing

Dull

Aching

Throbbing

Cramping

Gnawing

Squeezing

Sharp

Burning

Shooting

Numbness

Tingling

Common Words Used to Describe Pain


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How Many People Have Pain?

“…within the past year three in every four Americans surveyed (76%) either personally have experienced chronic or recurrent pain themselves or have a close family member or friend who has suffered from chronic pain.”

-Research!America, 2003




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Pain in Vulnerable Populations

“Whatever affects one directly, affects us all indirectly.”

-Dr. Martin Luther King, Jr.

December 1967


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Pain Tends to Occur More Often in Vulnerable Populations

  • Racially, ethnically & culturally diverse

  • Women

  • Children

  • The poor

  • The elderly


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Barriers to Effective Treatment

“Human health does not depend only on treatment by physicians. Social & political circumstances profoundly influence the health & well-being of all people.”

-American Academy of Pain Medicine

Ethics Charter, 2003


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Structure of the Healthcare System

  • Low priority given to pain

  • Access Issues

  • Cost Issues


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Regulatory Barriers

  • Laws, statutes, rules, & regulations

  • Regulatory scrutiny of pain practitioners

  • Law enforcement issues


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Healthcare Professional Barriers

  • Knowledge

  • Attitude

  • Practice


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Patient/Family Barriers

Common Concerns

Myths and Fears

Associated with Pain


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Myths and Fears about Pain

  • Pain is inevitable

  • Pain cannot be relieved

  • Increased pain means disease is getting worse

  • Taking strong medicine early means fewer options later

  • Strong pain medicines cause addiction


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Myths and Fears about Pain

  • Pain with incurable disease cannot be controlled

  • “No pain, no gain”

  • Reporting pain will distract from treating the disease

  • The medical team will know about my pain

  • The medical team learns a lot about pain in school


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In Search of Treatment

“Reflection on the meaning of pain and the meaning of nursing's responsibility to respond to pain is a challenging endeavor.”

-Betty J. Ferrell, PhD, FAAN


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Assessment Tools

  • Brief Pain Inventory

  • Memorial Symptom Assessment Scale

  • Edmonton Symptom Assessment Scale

  • M. D. Anderson Symptom Inventory

  • Numerical rating scale

  • Visual analog scale

  • Wong-Baker Faces Scale


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Visual Analog Scale

No

pain

Worst

possible

pain

Numeric Rating Scale

0

1

2

3

4

5

7

8

9

10

6

No

pain

Mild

pain

Moderate

pain

Severe

pain

Visual Analog and Numeric Rating Scales


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Methods for Managing Pain

“In the depth of winter, I finally learned that there was within me an invincible summer.”

-Albert Camus


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Knowledge

  • Accurate information

  • Good resources for learning the facts about pain & its treatment

  • Understanding your role


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Medical Interventions

  • Medications

  • Procedures and Surgery

  • Non-drug interventions

    • Physical therapy

    • Psychological approaches

    • Integrative approaches

  • Chemotherapy / Radiation therapy


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Medicines to Control Pain

Long & Short Acting Medicines

Side Effects

Concerns about Safety


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Long & Short Acting Medicines

  • Long-acting medicines

    • Are used for on-going, constant pain

    • Provide constant pain relief around the clock

  • Short-acting medicines

    • Are used for breakthrough pain

      • Intermittent pain that “breaks through” regular pain control plan


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Side Effects Can Be Controlled

  • Constipation

  • Nausea & vomiting

  • Drowsiness

  • Confusion

  • Respiratory depression


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Concerns about Safety

  • Pain medications are most safe & effective when taken

    • By mouth whenever possible

    • By the clock

    • When pain is still mild

    • As prescribed


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Pain Medicine & Breathing

  • Pain elevates metabolism

  • Pain medicines are usually increased in strength & amount gradually prior to high doses of strong opioids

  • Opioid medications rarely have significant effects on breathing in patients taking opioids for cancer pain


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Concerns about Addiction

  • Addiction is a disease characterized by

    • Impaired control over drug use

    • Compulsive use of drugs

    • Continued use of drugs despite harm

    • Craving for drugs


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Physical Dependence Means

  • The person is dependent on the drug & will experience withdrawal symptoms

    • If the drug is discontinued abruptly

    • The dose is reduced too rapidly


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Tolerance Means

  • The person has adapted to the drug so that over time the person needs to increase the dose of the drug to get the same benefit


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Pseudoaddiction

  • When a person seeks pain medicines for control of persistent pain

    • May display “drug-seeking” behaviors (early refills, requesting higher doses of opiates)

  • Reflects inadequate pain control, not addiction

    • “Relief-seeking, not drug-seeking”



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Complementary Therapies for Managing Pain Addiction

Mind/body Therapies

Physical Therapies

Movement Therapies

Nutritional Approaches


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Self-Management Strategies Do Work Addiction

  • Usually easy to learn

  • Enjoyable to do

  • Effective when used regularly

  • Provide a sense of control

  • Can involve family or other loved ones

  • Can be combined with medicines


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Need Professional Help to Learn or Do Addiction

Biofeedback

Self-hypnosis

Guided imagery

Massage

Acupuncture

Progressive relaxation

exercises

Practice on Your Own

Heat/cold application

Music

Distraction

Rhythmic breathing

Work w/ Trained Professional & on Your Own


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Consequences of Unrelieved Pain Addiction

“Pain is a more terrible lord of mankind than even death itself.”

-Albert Schweitzer, MD


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Unrelieved Pain Means Major Lifestyle Changes for 20% of Americans

  • Employment

  • Residence

  • Personal freedom


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Impact on Daily Life Americans

  • Severe pain can prohibit even the most basic activities of daily living

    • Bathing

    • Dressing

    • Toileting

    • Eating

  • Persistent pain can alter mood & immune function affecting both mental & physical health


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Increasing Pain Results in Decreased Activity and Impaired Quality of Life

Cleeland, C.S. (1989). Measurement of pain by subjective report. In: Chapman CR, Loeser JD, editors. Issues in Pain Measurement. Advances in Pain Research and Therapy, 12, 391-403. New York: Raven Press.


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What You Can Do to Help the Person with Pain Quality of Life

  • Be present

  • Believe reports of pain

  • Communicate

    • Healthcare providers & treatment professionals need to know if treatment is not effective

  • Advocate

    • On behalf of your loved one

    • For people with pain everywhere

  • Vote


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Alliance of State Pain Initiatives Quality of Life

(608) 265-4013

http://aspi.wisc.edu/

American Cancer Society

Toll free: (800) ACS-2345

www.cancer.org

American Pain Foundation

Toll free: (888) 615-PAIN (7246)

http://www.painfoundation.org/

Texas Cancer Info

www.texascancer.info

info@texascancer.info

Texas Pain Advocacy & Information Network

www.txpain.org

Texas Partnership for End-of-Life Care

www.txpec.org

Texas Pain Society

http://www.texaspain.org/

For More Information


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Thank you! Quality of Life