Learning to Live with Pain
Recently I had the opportunity to attend the annual clinical meeting of the Western Pain Society and Pain Society of Oregon (PSO). The theme of the two day meeting was “Conquering Pain Together Empowering Providers and Patients.” Listening to presentations from national experts in the field of pain management reminded me that all of us continually have new things to learn.
Below are some basic facts that were shared at the PSO event. Let me point out that while these facts are essential to understanding and treating chronic pain, many healthcare professionals and individuals with pain don’t understand how this information impacts their lives.
At a recent local discussion about pain, a physician asked, “And since when did chronic pain become a disease?” Dr. Scott Fishman has a very definite answer to this question. Dr. Fishman is Chief of the Division of Pain Medicine at University of California, Davis, the President of the American Pain Foundation and spoke at the PSO meeting. Dr. Fishman says, “Ninety-eight percent of doctors still say pain is a symptom, not a disease. Yes, pain is usually a secondary disease stemming from an underlying problem, just as blindness can be caused by diabetes. But that doesn’t mean it isn’t real and doesn’t need to be treated. And over time, it becomes the primary disease.”
It may seem obvious why this is an important fact to understand, but let me highlight the obvious with information from other speakers at the PSO meeting. Just as diabetes or another disease can affect all aspects of a person’s life, so too can chronic pain. Dr. Navnit Kaur is a pain management consultant at St. Vincent’s Hospital in Portland, Oregon. Her discussion identified the ways in which chronic pain are consistent with a disease:
chronic pain affects the quality of life (physical functioning, the ability to perform activities of daily living (ADLs), work and recreation);
chronic pain has psychological affects (depression, anxiety, anger, sleep disturbances, loss of self-esteem);
chronic pain has social consequences (affects marriage/family relations, intimacy/sexual activity, and can create social isolation);
chronic pain has socioeconomic consequences (increases healthcare costs, disability, and lost workdays, etc.).
Just as many diseases—think diabetes, congestive heart failure, emphysema, etc.—have no cure, chronic pain may not be resolved with “one magic pill” or one easy treatment plan. But all of the speakers at the PSO event emphasized that even if the underlying cause of chronic pain cannot be identified, a reasonable goal is to reduce pain and suffering.
Dr. Margaret Caudill-Slosberg is an Adjunct Associate Professor of Community and Family Medicine at Dartmouth Hitchcock Medical Center in New Hampshire. After years of working with chronic pain patients, she wrote the book “Managing Pain Before It Manages You.” When she spoke at the PSO meeting, Dr. Caudill-Slosberg emphasized that the therapeutic goals for chronic pain are different than the goals for acute pain. (Think of this as the difference between the treatment goals for an acute pain condition—a broken arm—and and the treatment goals for a chronic pain condition—diabetic neuropathy.) She identified the following therapeutic goals of chronic pain treatment:
manage, not cure the pain;
reduce and relieve stress;
improve and sustain the individual’s function (think ADLs, etc.);
increase and empower the individual’s quality of life.
Dr. Caudill-Slosberg said that at her medical center, patients are encouraged to seek information to assist them in collaborating in their treatment. There are three questions that she encourages all patients to ask: “What is my main problem?” “What do I need to do?” “Why is it important for me to do this?” She believes the answers to the third question will give individuals a realistic understanding of the expectations and treatment for chronic pain and help them to self-manage their care to reduce disability and suffering.
Michael Schatman, PhD, of Pacific Northwest University of Health Sciences and the Executive Director of Foundation for Ethics in Pain Care in Bellevue, Washington, reinforced Dr. Caudill-Slosberg’s view point. He emphasized that self-management education includes the opportunity for individuals to learn problem-solving skills in addition to technical skills. He revealed that there is data to suggest that while physicians are focused on “diagnosis and treatment,” patients with chronic pain want “to be understood as individuals;” they also want improved quality of life. He noted that chronic pain sufferers need more than medications; quality of life depends upon looking at the social and emotional issues that are linked to their chronic pain.
Perhaps my favorite speaker at the PSO event was Dr. Robert Djergaian. He is the Physician Director of Rehabilitation Services at Southwest Washington Medical Center in Vancouver, Washington. He gave a presentation titled “Compassionate Pain Care: Lighting a New Path.” The title of his talk will tell you much about Dr. Djergaian and his approach to treating individuals with pain.
Among the slides and quotes that Dr. Djergaian shared, I found the following thoughts—from the book “Full Catastrophe Living” by Jon Kabat-Zinn, PhD—to be some of the most moving and significant. In seeking relief, many patients go through a drawn out and exasperating search to end their pain—this may include visiting many healthcare providers, enduring surgery and other therapies and trying numerous types of medication. Then they are told they must “learn to live with their pain.” But they are never told or taught how to “live with their pain.” (The emphasis on this statement is mine.) “Being told that you have to live with pain should not be the end of the road—it should be the beginning.” Kabat-Zinn believes that individuals can become aware (“mindfulness) in a way that will help “in giving your life back to you and your body, too, in ways that may allow you to befriend your body in spite of its limitations and to appreciate your body in its fullness and learn to live inside it once again.”
If there are future topics about which you would like me to write to help you “learn to live with your pain,” please contact me: firstname.lastname@example.org
Kathy Kirk, RN