When Your Body Hurts…

1. When Your Body Hurts… Fears, Myths & the Truth about Pain

2. Agenda • What is pain • How many people have it • What causes it • Barriers to effective treatment • Assessing & treating pain • Consequences of unrelieved pain • Where to get more information

3. What Is Pain? “Pain is what the person says it is and exists whenever he or she says it does.” -Margo McCaffery, RN, MS, FAAN 1968

4. Clinical Definition of Pain “…an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” • International Association for the Study of Pain In other words, pain is any sensation that hurts.

5. Clinical Type Nociceptive Neuropathic Duration Transient Acute Chronic Breakthrough Types of Pain

6. Stabbing Dull Aching Throbbing Cramping Gnawing Squeezing Sharp Burning Shooting Numbness Tingling Common Words Used to Describe Pain

7. How Many People Have Pain? “…within the past year three in every four Americans surveyed (76%) either personally have experienced chronic or recurrent pain themselves or have a close family member or friend who has suffered from chronic pain.” -Research!America, 2003

8. How Many People Have Pain?

9. Diseases and Conditions that Produce Pain

10. Pain in Vulnerable Populations “Whatever affects one directly, affects us all indirectly.” -Dr. Martin Luther King, Jr. December 1967

11. Pain Tends to Occur More Often in Vulnerable Populations • Racially, ethnically & culturally diverse • Women • Children • The poor • The elderly

12. Barriers to Effective Treatment “Human health does not depend only on treatment by physicians. Social & political circumstances profoundly influence the health & well-being of all people.” -American Academy of Pain Medicine Ethics Charter, 2003

13. Structure of the Healthcare System • Low priority given to pain • Access Issues • Cost Issues

14. Regulatory Barriers • Laws, statutes, rules, & regulations • Regulatory scrutiny of pain practitioners • Law enforcement issues

15. Healthcare Professional Barriers • Knowledge • Attitude • Practice

16. Patient/Family Barriers Common Concerns Myths and Fears Associated with Pain

17. Myths and Fears about Pain • Pain is inevitable • Pain cannot be relieved • Increased pain means disease is getting worse • Taking strong medicine early means fewer options later • Strong pain medicines cause addiction

18. Myths and Fears about Pain • Pain with incurable disease cannot be controlled • “No pain, no gain” • Reporting pain will distract from treating the disease • The medical team will know about my pain • The medical team learns a lot about pain in school

19. In Search of Treatment “Reflection on the meaning of pain and the meaning of nursing's responsibility to respond to pain is a challenging endeavor.” -Betty J. Ferrell, PhD, FAAN

20. Assessment Tools • Brief Pain Inventory • Memorial Symptom Assessment Scale • Edmonton Symptom Assessment Scale • M. D. Anderson Symptom Inventory • Numerical rating scale • Visual analog scale • Wong-Baker Faces Scale

21. Visual Analog Scale No pain Worst possible pain Numeric Rating Scale 0 1 2 3 4 5 7 8 9 10 6 No pain Mild pain Moderate pain Severe pain Visual Analog and Numeric Rating Scales

22. Methods for Managing Pain “In the depth of winter, I finally learned that there was within me an invincible summer.” -Albert Camus

23. Knowledge • Accurate information • Good resources for learning the facts about pain & its treatment • Understanding your role

24. Medical Interventions • Medications • Procedures and Surgery • Non-drug interventions • Physical therapy • Psychological approaches • Integrative approaches • Chemotherapy / Radiation therapy

25. Medicines to Control Pain Long & Short Acting Medicines Side Effects Concerns about Safety

26. Long & Short Acting Medicines • Long-acting medicines • Are used for on-going, constant pain • Provide constant pain relief around the clock • Short-acting medicines • Are used for breakthrough pain • Intermittent pain that “breaks through” regular pain control plan

27. Side Effects Can Be Controlled • Constipation • Nausea & vomiting • Drowsiness • Confusion • Respiratory depression

28. Concerns about Safety • Pain medications are most safe & effective when taken • By mouth whenever possible • By the clock • When pain is still mild • As prescribed

29. Pain Medicine & Breathing • Pain elevates metabolism • Pain medicines are usually increased in strength & amount gradually prior to high doses of strong opioids • Opioid medications rarely have significant effects on breathing in patients taking opioids for cancer pain

30. Concerns about Addiction • Addiction is a disease characterized by • Impaired control over drug use • Compulsive use of drugs • Continued use of drugs despite harm • Craving for drugs

31. Physical Dependence Means • The person is dependent on the drug & will experience withdrawal symptoms • If the drug is discontinued abruptly • The dose is reduced too rapidly

32. Tolerance Means • The person has adapted to the drug so that over time the person needs to increase the dose of the drug to get the same benefit

33. Pseudoaddiction • When a person seeks pain medicines for control of persistent pain • May display “drug-seeking” behaviors (early refills, requesting higher doses of opiates) • Reflects inadequate pain control, not addiction • “Relief-seeking, not drug-seeking”

34. Comparison of Attributes between Physical Dependence and Addiction

35. Complementary Therapies for Managing Pain Mind/body Therapies Physical Therapies Movement Therapies Nutritional Approaches

36. Self-Management Strategies Do Work • Usually easy to learn • Enjoyable to do • Effective when used regularly • Provide a sense of control • Can involve family or other loved ones • Can be combined with medicines

37. Need Professional Help to Learn or Do Biofeedback Self-hypnosis Guided imagery Massage Acupuncture Progressive relaxation exercises Practice on Your Own Heat/cold application Music Distraction Rhythmic breathing Work w/ Trained Professional & on Your Own

38. Consequences of Unrelieved Pain “Pain is a more terrible lord of mankind than even death itself.” -Albert Schweitzer, MD

39. Unrelieved Pain Means Major Lifestyle Changes for 20% of Americans • Employment • Residence • Personal freedom

40. Impact on Daily Life • Severe pain can prohibit even the most basic activities of daily living • Bathing • Dressing • Toileting • Eating • Persistent pain can alter mood & immune function affecting both mental & physical health

41. Increasing Pain Results in Decreased Activity and Impaired Quality of Life Cleeland, C.S. (1989). Measurement of pain by subjective report. In: Chapman CR, Loeser JD, editors. Issues in Pain Measurement. Advances in Pain Research and Therapy, 12, 391-403. New York: Raven Press.

42. What You Can Do to Help the Person with Pain • Be present • Believe reports of pain • Communicate • Healthcare providers & treatment professionals need to know if treatment is not effective • Advocate • On behalf of your loved one • For people with pain everywhere • Vote

43. Alliance of State Pain Initiatives (608) 265-4013 http://aspi.wisc.edu/ American Cancer Society Toll free: (800) ACS-2345 www.cancer.org American Pain Foundation Toll free: (888) 615-PAIN (7246) http://www.painfoundation.org/ Texas Cancer Info www.texascancer.info info@texascancer.info Texas Pain Advocacy & Information Network www.txpain.org Texas Partnership for End-of-Life Care www.txpec.org Texas Pain Society http://www.texaspain.org/ For More Information

44. Thank you!