Pain Management

Would you ever under-treat a patient’s pain because you were concerned about repercussions or because you believe that a patient – even a terminal patient- might become addicted? 

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This was a question asked to doctors in a survey. 84% said no, they would give their patients the pain medication, and one of the most striking reply to the question was this: “Pain should not be undertreated, and what’s the problem with a terminal patient being addicted and comfortable?”

A patient’s perspective

Struggling with immense pain, especially pain that severely impairs quality of life is a problem. A huge problem.  I found 3 quotes very useful in getting an idea about how detrimental pain can be:

“The most frightening, the most humiliating, and the most difficult ordeal of my life . I became withdrawn, completely disabled by my terrible, relentless pain. I was unable to function professionally. I was unable to be much of a wife or a mother, a daughter or a friend.”

“Pain is my biggest fear, it puts me in a darkness, you can’t find peace in that darkness of pain. Pain blinds you to all that’s positive.”

“They wanted to know why the medication was not working? Why are you still in pain? If you are crying, why are you crying; if you are not crying, how can you be in pain? You are not only experiencing your pain, you are experiencing other peoples’ opinions and feelings; that makes it worse.”

Pain now seems much more than a ‘highly unpleasant physical sensation caused by illness or injury’. True pain is much deeper than that, it’s more like a torment of one’s entire being, physically, emotionally and spiritually. Most people would do almost anything to relieve their pain in some way, even if it was just a small amount.

A doctor’s perspective

Most medical professionals would do as much as they could for patients to be comfortable, but some won’t because they are scared of the possible legal implications. We were taught to always have the patient’s best interests at heart, and thus  the relief of pain is a core ethical duty in medicine.

But why then is pain not always correctly dealt with? Some medical professionals do not treat pain sufficiently, patients lie about pain and most people do not know what to do with chronic pain.

I was told a story once of a patient who was diagnosed with chronic pain after a car accident. A physiotherapist had convinced her that she needed physiotherapy everyday to help her with her pain, she was told if she did not get her knots worked out everyday it would snowball and the pain would become unbearable. This is a perfect way to ensure your patient will believe they have pain and to make sure you get money every day. But completely unethical.

Another example is a patient who was previously a drug addict and lost everything. He then decided to make up a story about an accident he had a few months ago and he has been is such pain ever since, hoping the doctor would prescribe narcotics to give him his fix.

How do we deal with this problem?

I think with experience you can pick up on small signs that the pain is real or not, but there is a fine line there. I also believe that chronic pain is more psychological than just physical and needs to be handled properly. It is easy to jut handle the chronic pain patient by prescribing them the medication they need every month and sending them on their way, but it needs to be addressed at a deeper level and that is why a multidisciplinary approach is a good idea. Sometimes all a patient needs is somebody to explain what chronic pain is and how it works and the pain already decreases.

Real pain should not be pushed aside, underestimated or undertreated. Treatment for pain can be quite complex, but it is possible. Personal and professional accountability for failing to treat patients competently and compassionately is critical, but so is creating environments that make effective care for patients in pain the norm.

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One thought on “Pain Management

  1. Hi Kristen. This was an interesting idea that I think you could have explored in more depth and with a stronger conceptual framework. If you had looked at the ethical issues in more depth, rather than just touching on them, I think you would have been able to cover the topic really nicely.

    There’s a range of literature that looks at the different aspects of pain management, including the psychological components. As physios we tend to focus on the structures that cause pain and we think that if the structures are not damaged (or we can’t identify the damage) then the pain can’t be real. You could have explored this bias a little bit and looked at how we sometimes treat patients with pain unethically because of our beliefs about our own skills.

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