Pain management a comprehensive review

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14. Educating patients

The prevalence of pain is high, and as a result exacts quite a large toll on society. Unfortunately though, both public and professional knowledge regarding pain falls short, particularly because, although pain should be a public health issue, it is remarkably underaddressed. States Brown, “If pain was formally recognized as part of our national public health policy, public awareness campaigns would highlight pain prevention and cover risk factors for the development of the disease” [142]. However, since pain is not a public health priority, the burden remains on practitioners, patients, and caregivers to educate themselves and to advocate for better pain management techniques.

Education strategies and tools for patient and caregivers should be presented in a variety of mediums that enhance wider learning. These include pain-specific brochures being displayed in-office; newsletters; videos; audio content; posters; the use of pain notebooks to track pain progression; referrals to credible web sites; structured education, and; web-based tools to educate and manage pain.

There are several key objectives that practitioners should keep in mind as they work to educate patients and caregivers. These objectives are:

  1. Increase understanding of pain;

  2. Address disparities and cultural differences with care;

  3. Discuss the goals of treatment;

  4. Address more than just the physical aspects of pain; psychosocial and spiritual aspects should be addressed as well;

  5. Empower individuals to advocate for themselves by providing tools, handouts, or other tips;

  6. Teach how to use pain treatment options appropriately;

  7. Create an environment in which people can discuss pain openly and ask questions; provider-patient communication is essential.

Educating patients is a central tool in improving the management of pain. Therefore, practitioners should be prepared to offer educational tools to patients that present pain in a way that the individual will understand. Additionally, it is essential that practitioners work to dispel myths and misperceptions about pain to provide a better educational experience. This can be done through dispelling the six most common myths about pain. These are [143]:

  • Pain is “all in your head” [142]. It is true to an extent that pain resides in the head, as the individual’s brain is responsible for processing the pain perception. However, this does not indicate that pain is an imaginary occurrence, even if the source of the pain is not understood that well. The pain is real to the person experiencing it; therefore, it must be adequately addressed.

  • Pain is an occurrence that one simply must live with. Traditionally views on pain state that pain is the inevitable consequence of a disease or condition. However, the fact is that most pain can be avoided or relieved through careful pain prevention or management.

  • Pain is just a natural part of growing older. It is true that pain becomes more common as people age, mostly because the conditions that cause pain, such as arthritis, shingles, or osteoporosis, are more common in older adults. However, regardless of age, pain is not something that anyone should have to endure untreated.

  • The practitioner is the best judge of pain. There is not much of a relationship between what the practitioner judges the pain to be and the actual patient experience. This means that the patient must have the final word on pain existence and severity. The most reliable pain indicator is self-report.

  • Seeking medical care for pain means that the patient is weak. Seeking medical care for pain often has a stigma attached because patients don’t want practitioners to view them as whiners, or bad patients. For this reason, patients don’t always mention pain and how it affects their life.

  • Using strong pain medications leads to addiction. It is important to remember that drugs such as opioids are not universally addictive. There are risks associated with their use, but risks may be managed through properly prescribing and monitoring the use of the medication (i.e. taking the medication as it is prescribed).

There are several things that patients who experience pain want to know about their pain. It is therefore important to keep these things in mind when educating the patient or caregiver. These include:

  • How to understand the pain, most specifically, how to understand the cause of the pain;

  • What to expect in terms of when the pain may be experienced and what it will feel like;

  • Treatment options, which include options involving medication, surgical treatments, and nonpharmacological approaches;

  • The best way to cope with pain;

  • How pain can negatively impact the individual’s life in a variety of ways, including physical, psychological, and social impacts;

  • How to connect with other people experiencing the same kind of pain to gain understanding of their pain through peer experience;

  • Where to find specialists to help manage pain, as well as who should be consulted;

  • How to effectively describe pain [144].

How to enhance pain communication:

  1. Utilize pain questions that are kept handy for each appointment. These questions include:

    1. Where is the pain located?

    2. How is the pain characterized?

    3. When and how did the pain start?

    4. Is the pain intermittent or continuous?

    5. What makes the pain feel better or worse – factors would include medication, activity, rest, stress, or the application of hot or cold to the affected area.

    6. Has the patient experienced any sleep disturbances as a result of their pain?

    7. Does the patient have any ongoing medical concerns that could have caused or could be exacerbating pain?

    8. How is the individual functioning at school or work?

    9. Does the pain affect certain quality of life activities, such as sex or recreation?

    10. What does the patient expect from pain treatments?

  2. Instruct the individual to keep a pain diary and to utilize pain intensity scales to measure pain. Pain diaries not only help patients keep track of and measure their pain experiences and the effects of the pain on a variety of functions; they also offer practitioners the opportunity to educate the patient about their pain.

  3. Encourage the individual to reach out for support. Support groups, whether they are in person or online, offer patients the opportunity to connect with others who are suffering in the same way as well as provide an opportunity for education through peer information exchange.

15. Conclusion

Pain is considered a “universal disorder” [1] that comes in many forms. Up to 80% of visits to physicians are for treatment of pain. Regardless of the form that pain is seen in, everyone experiences pain, with the perception of pain occurring differently in each individual.

At its simplest, pain serves to warn the individual that something is not quite right. Pain can, however, be so severe that it disrupts productivity, well-being, and indeed, the entire life of the individual experiencing the pain. At its core, pain is complex and differs greatly among individuals, including those who seem to have identical injuries or illnesses.

Pain today is a costly and very serious public health issue. It is also a challenge for friends and family as well as health care practitioners to offer support to the individual suffering from the pain. In order to offer this support, both practitioners and friends and family must be willing to try a variety of pain management methods, or even a combination of methods. Further, both practitioners and friends and family must listen carefully as symptoms are described in order to ensure that the pain is treated effectively.

Finally, it is also important to address the education of both the individual as well as their friends and family in order to ensure effective pain management. Pain that is not managed effectively can alter the physical and psychological state of the individual experiencing the pain. Understanding how to effectively manage pain is therefore essential. Additionally, it is important as well to be mindful of the treatment gap that exists in pain management. Women, children and older adults are at greater risk of being negatively affected by chronic pain and frequently end up receiving treatment that falls short. Through education, careful listening, and exploration of the variety of treatment methods available to practitioners, successful pain management may be attained.


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