Wednesday, June 22, 2011

Pain; The Fifth Vital Sign and the Prevention of Chronic Pain


Pain is the one of the biggest reasons patients seek the help of a physician. When you go to your physician's office for a visit, they generally take your vital signs. These vital signs include your heart rate, blood pressure, respiratory rate, and temperature. Physicians specially trained in managing pain (Pain Management Specialists) have emphasized the importance of treating pain as a fifth vital sign. These pain management specialists have been including pain questionnaires and rating scales with each doctor visit for some time, and they believe that patients who suffer from pain should always have their pain assessed on these scales. Since pain is impossible to "see", it is important that physicians have some kind of a benchmark that can help them to document the level of each patients pain and how that pain changes over time in order to help them in properly treating their patients.

When it comes to pain, it is important to understand that pain specialists categorize pain into two broad categories – acute and chronic pain. Acute pain is considered as any pain that lasts for less than 3 months. This is an arbitrary designation meant to refer to the immediate pain after a specific event, usually injury. Pain that lasts longer than 3 months is considered to fall into the category of chronic pain.

The reason that physicians make this distinction is because the way the human body manages acute pain can be different from the way it manages chronic pain. While acute pain will generally resolve once the acute injury is healed (or physical problem repaired), chronic pain can lead to the nervous system (brain and spinal cord) actually creating reflex pathways that perpetuate the feeling of pain even after the initial triggering event has been removed. Thus, these reflex pathways may continue to signal pain in the brain despite the resolution of the acute injury or problem.

Additional symptoms can develop as the onset of chronic pain continues. The stress of dealing with constant pain is a difficult burden on not only body, but mind as well. Depression and anxiety are quite common in chronic pain patients. In addition, many patients report impairment in attention, memory, speed and general difficulty of completing tasks. As frustration sets in, the symptoms of chronic pain can worsen, creating a reinforcing cycle of chronic pain and frustration, each contributing to the other.

Chronic pain can cause a reinforcing cycle
of pain and frustration.
It is extremely important to immediately and thoroughly treat any acute pain problem aggressively to prevent development of the complications of chronic pain. Acute pain can transition into chronic pain if not treated correctly, and can become increasingly difficult to treat as time goes on.

Physicians and health care practitioners have many modalities for dealing with pain problems. Look for safe, low intervention options that can offer relief, but if these methods are not offering prompt relief then it is important to seek out the assistance of a qualified Pain Management Specialist to look for more aggressive options. Furthermore, to maximize the benefits of treatment, consider combining Western Allopathic treatments with Complementary and Alternative (CAM) approaches.

Ask your Pain Management Specialist about how to maximize your treatment plan by integrating multiple complementary approaches (massage, acupuncture, meditation etc.) into your care. Also, accept the assistance of a qualified mental health practitioner who specializes in helping patients suffering with chronic pain. Patients suffering with chronic pain invariably also suffer some degree of depression and/or anxiety as secondary symptoms. These problems  need to be addressed or, just like the reflexes that can perpetuate physical pain, these symptoms of anxiety and depression may become entrenched and create a long-term problem even after there may be resolution of the originating physical pain problem.

Acute and chronic pain should be considered serious problems. They cause much suffering to patients, a lot of time lost at work, as well as being financially costly to individuals, the health care system, and society as a whole. The sooner acute pain can be appropriately treated in the safest and most complete way possible, the less likely that chronic pain will develop and the less it will cost everyone physically, emotionally and financially.

The take home message here is that if you, or someone you know is suffering, from pain, make sure to immediately tell your health care practitioner about your pain and any other symptoms you are suffering.  This is not the time to be stoic, ask for help and advice from your health care provider about what you can do to relieve your pain and what specialists and practitioners you should see to get expert advice and care in order to diagnose and  relieve your pain as quickly and safely as possible. Also, it is important to understand that correctly communicating the amount of pain that you are experiencing is important. Physicians can be misled if you either overstate or understate your pain level and this could lead to an incorrect diagnosis or improper care. Keeping a pain log or journal from the start and throughout your progress will allow you to, without exaggeration or understatement, to better convey your condition to your physician and allow both you and your caregivers to monitor your long term progress.

A final piece of advice in choosing health care providers who are familiar with treating and managing pain problems. It is very important to seek out practitioners who have extensive experience and training in this area. Even though the last thing you probably want to be doing while you are suffering in pain is to be doing research, it is crucial that you or your family take the time to ask questions and research how to find the most highly qualified pain specialists in your area.

Also, while it is important to seek out Pain Management Specialists who have a familiarity with Complementary and Alternative (CAM) treatment options, it is also important that if you undertake any of these treatments that your CAM practitioner is open and willing to work with your Pain Management Specialist. The synergy of multiple complementary modalities working together can be very powerful, however, these should only be undertaken under the supervision of a qualified health care practitioners who specialize in specifically treating pain so that they are in a position to understand your condition and the risks and contraindications that may apply to your particular situation.

Finally, it is always wise to learn as much as you can about your condition and to research the potential risks and benefits of any particular treatment you are considering. Well qualified and open minded practitioners should be willing to help you with obtaining information and research so that you can feel confident that you are choosing the most helpful and safest treatment options for your care. Once you and your health care team have decided on the best course of treatment, it is important to pursue these potential treatments as quickly as possible in order to prevent the development and complications of chronic pain.

Links and References: for general information on Chronic Pain

National Institute of Health - Chronic Pain site

TED Talks – The Mystery of Chronic Pain by Elliot Krane

(technical) Neuronal and Neural-Glial Signaling Mechanisms in Pain Neuroplasticity by Michael W. Salter
Great article about pain and how it transitions from acute to chronic.

Organizations for Patient or Practitioner Information:

American Academy of Pain Management

Organizations for Practitioners:

American Pain Society

International Association for the Study of Pain

Researched and written by Dr. Rebecca Malamed, M.D. with assistance from Mr. Malcolm Potter.

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