Managing Chronic Pain

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Managing Chronic Pain

http://www.medicalnewstoday.com/medicalnews.php?newsid=15673

30 Oct 2004 From Medical News Today

Pain is the patient complaint most frequently encountered by healthcare

professionals. Estimates of those suffering some form of chronic pain

range as high as 90 million (USA). Although so often presenting, most

experts agree pain is less often adequately relieved.

It's been roughly 400 years since Sir Francis Bacon was credited with

saying knowledge is power. In the present-day context of pain

management, B. Carr, MD suggests knowledge is also analgesic. Or

more precisely, it allows the barriers to effective treatment to be more

easily and more frequently overcome. The patient issue is often one of

understanding that pain can be treated and should be openly discussed.

Enduring Pain

“The barriers to treating chronic pain are not limited to any one group

of patients,” says Dr. Carr. “Some patients view their pain as a

character flaw and will try to endure the pain rather than seek

treatment. Others are reluctant to be a burden to their families or

their physician so they'll suffer in silence. Some patients may be

unaware of the effective interventions that are available to manage

their pain, or they may be worried about taking a particular medication

because of the potential for developing an addiction.”

Time and Communication

Primary care physicians, says Carr, are on the front lines of chronic

pain management, where time and communication are vital to clinical

success. “As physicians, we sometimes tend to focus more on the disease

than on the patient, and pain and quality of life issues are sometimes

brushed aside. The demands of running a practice today leave primary

care physicians with an average of six minutes to spend with each

patient. With business pressures or financial incentives for time

efficiencies, some physicians can develop 'chronophobia'-a word I coined

to mean the terror of having to spend more time with the patient than

you are allotted. We need to change our way of thinking to adjust for

these barriers and open the communication lines with our patients so

they will openly voice their concerns to us. It's a time-intensive

process, but it is an essential step to improving the undertreatment of

the condition.”

Pain Medications

“Some physicians may be uncomfortable with prescribing pain medications.

I think there is a certain stigmatization of people with pain in

general. And there's also a stigmatization of opioid consumers, whether

or not they are mostly legitimate; some people feel very intimidated

about writing for controlled substances. My own theory in regards to

opioids is that 90% of the reluctance on the part of the prescribers

relates to chronophobia. It can be difficult to determine which patients

legitimately need these medications and which do not, and it takes time

to make that determination.”

Pharmacotherapy for pain may involve NSAIDs, acetaminophen, opioids, and

adjuvants including antidepressants and anticonvulsant or antiepileptic

drugs. But the optimal pharmacologic approach prescribed in the clinical

setting does not necessarily translate to patient “real world”

relief-according to the Americans Living with Pain Survey, over 60% of

those taking prescription medications for pain are non-compliant in

taking it exactly as prescribed. Other survey findings suggest a “casual

attitude” on the part of patients with respect to pain. Of those who did

talk to their doctor about their pain, 71% were not immediately

proactive about seeking medical advice and 30% delayed over three

months….. CONTINUES……..www.physweekly.com