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ILLUSTRATION: Digital Vision |
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Pain Management
No matter how badly your day is going, Esther Reiter's is probably worse. Reiter, now in her early 60s, had a stroke in 1984 that permanently damaged her thalamus—the pain message center in the brain—leaving her with a little-studied condition called thalamic pain syndrome, in which pain signals are sent almost constantly to the side of the body affected by the stroke. To cope, she takes several medications, including a narcotic (for pain relief), a central nervous system depressant (to ease spasms), and an anticonvulsive (to help treat certain types of neuropathic pain). She's seen a psychotherapist to fight depression, so common in chronic pain patients, and has tried alternative therapies such as biofeedback, meditation, acupuncture, and massage. Her case is extreme, but hardly unique.
Think you're alone?
"Medical and nursing schools don't teach enough about pain management or symptom management," says Guadalupe Palos, a member of the clinical research faculty of the MD Anderson Cancer Center in Houston, Texas. In addition to her doctorate in public health, Palos is a registered nurse and a licensed social worker. Moreover, doctors and nurses may withhold pain medication unless patients display their pain in a particular manner. Some providers underestimate its severity and may dismiss a patient's complaint because certain procedures or surgeries "aren't serious enough" to result in the kind of pain the patient describes, explains Palos. Pain management and cultural roots And many new treatment methods may seem confusing. For example, some patients remember the era when an injection was the fastest, most effective medicine for any condition—including pain. "When a doctor recommends a pill or patch, these patients may be skeptical," says Palos. For Hispanic immigrants from heroin- and cocaine-exporting countries, Palos observes, there is such a stigma associated with taking drugs that they hesitate to take pain medication of any kind, regardless of whether the medication is narcotic-based. People from Latin American countries typically trust their pharmacist more than their doctor. Says Palos, "In their home countries, they relied on pharmacists to diagnose and treat them." In the U.S., health care teams may gain patients' trust by emphasizing the pharmacist's role. Persuading some Hispanic patients to take an antidepressant can be a challenge. Even though antidepressants, in combination with painkillers, help control some types of pain (such as the shooting pains that diabetics can experience), Hispanic patients commonly deny depression and resist taking antidepressants. "Such patients announce, 'I'm not crazy and I'm not depressed,'" Palos says. Their doctors may do better, she notes, by asking whether the patient is "sad." The attitude of some patients also contributes to the problem of adequate pain management. "Some people are notoriously reluctant to report their pain," says Matthew Loscalzo, a social worker and co-director of the Center for Cancer Pain Research at Johns Hopkins University. "It's the same everywhere. Admitting you're in pain tells the world that you're vulnerable." Older people tend to assume that pain is an inevitable part of aging. "We're tough, proud, and have been taught to keep a stiff upper lip," Loscalzo adds. Further complicating treatment issues, "many actually lie about pain rather than admit that the initial treatment didn't work." Most people suffering from chronic and acute pain are 50 and over, says John Giglio, executive director of the American Pain Foundation. "It's underreported, under-treated, and under-appreciated." Chronic pain has been shown to weaken the immune system, rewire the nervous system, impair healing, and disturb sleep patterns, while simultaneously increasing depression, anxiety, and social isolation—which invariably lead to more pain. "The more depressed and debilitated a patient becomes because of pain, the less able he or she is to seek help," says researcher Loscalzo. Alternative Options
And the medical establishment is finally recognizing the value of alternative therapies, noting that patients often improve faster when they add complementary therapies to their regimen; acupuncture, for example, works well to relieve certain types of pain. Pain management for all pain patients, especially Hispanics, is best handled by the full team of health care professionals working with each patient and his or her family, Palos says, pointing out that all aspects of patient care must be addressed: medical, emotional, and spiritual. "The full team should include not just doctors and nurses, but social workers, pharmacists, physical therapists.even members of the clergy. The patient needs to have faith that treatment can work." Remember, medication is not the only way to combat pain. Nowadays there are many alternative methods and therapies that include breathing exercises, meditation, as well as prayer. Never be afraid to have an open and frank discussion with your doctor, as many times as you feel it is needed. Do not ignore what your body is telling you and speak openly about your pain. Now, review our checklist to ensure proper pain management and study our glossary of pain-management terms. |
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