Originally published June 2, 2018
The first rule of medicine is “Do no harm” yet we seem to take pain management as trivial. We are a tough set of people, we should suffer, suffering makes the illness real, it makes us learn our lessons.
Pain Management is an important part of medicine, and while I could fill this blog post with statistics, research, quotes and all that fancy smanchy medicine talk, it won’t change anything unless we take pain management seriously and be empathetic with our patients.
When we are sick and lying in a hospital bed ,we want the pain to go away. We want to not be able to feel anything, whether its getting stitches, having a child or after surgery, we want to not feel the pain.
Then why is it ok for our patients to grin and bear it?
There are a few approaches to pain that we take that impact patient care negatively.
- We are skeptical to pain
- We are reactive to pain management.
- We are selfish with pain management
- We are impatient with pain management
We are skeptical to pain
The truth is sometimes we are skeptical to how much pain our patients are having.
But here’s the thing pain is subjective, pain is relative. All the pain scales we use have no science or art to them, they’re all in relation to that patient’s worst ever felt pain.
So why not just treat the pain the patient is having? The opioid epidemic is a scary one, but it is avoidable once we follow protocol and stay on top of patient care. In fact, if we look at how pain is treated, it is a multimodal approach. So morphine addiction should come on the bottom of the list when we think of pain management in the acute setting.
Once we go into primary care our method of pain management must become more complex and patient orientated.
We are reactive to pain management
As a whole, our society is pretty reactive and never truly proactive. A lot of times we know pain is going to occur or we know that the pain medication is going to wear off in 4 – 6 hours.
So why are we treating pain when the patient complains? That’s improper pain management! We must aim to become proactive with pain management especially in the hospital setting. What is the sense of knowing how long the medication is suppose to work if we don’t use that to our advantage?
We are selfish with pain management
The World Health Association actually has a very simple guideline on how to treat pain. WHO’s main takeaway message is: multimodal management. Often times one drug is simply not enough to ease the pain.
This is where our knowledge of how and where each drug works comes into play. A multimodal approach is preferred because you get to use less of each drug while getting a synergistic positive effect without worrying about toxicity.
I’ve seen this for myself, I have terrible headaches at times and taking an ibuprofen or panadol never worked until one day I thought about the pharmacology… I said why not lessen the dose in half but use both pills. And guess what, it worked! Why did it work? Because both of the drugs have a different area where they work, but have the same common end goal.
We are impatient with pain management
Sometimes, we don’t wait long enough for the medication to work. We are so pressed for time that we sometimes never give the medication time to work.
We give patients stitches with them still sometimes feeling the stick only for the pain to disappear halfway through, or we give an injection pain medication at the same time of the procedure, which means by time the injection works the procedure is done, but the patient was biting their lip in pain.
All we need to do is take our time. Slow down.
Pain management is something I’ve very passionate about and like to play with it, as I suffer from chronic pain. I think that it can be treated effectively and safely once we take interest in it.
Once we see it as important we will do a much better job of managing the pain of our patients.
Pain management must take a multimodal approach. In both primary and secondary care it may include other methods apart from pharmacology. This is an area we all can strive to do better in by taking the time to learn more and be proactive.
Samantha C. Johnson