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Effective Pain Management

By Cheryl Ellis, Staff Writer
(Page 1 of 5)

In both acute and chronic health conditions, pain is top on the list of concerns for patients, caregivers and physicians.  Effective pain control improves the individual’s state of mind and ability to move through the healing process.  There are a variety of options for pain control, and doctors work toward addressing side effects that can occur with pain medications.
Coming to terms with being in pain, acute or chronic, is a hurdle for many folks who grew up learning to “put aside” pain.  Individuals who have been vocal about pain levels and received negative responses may feel angry, refusing treatment as an expression of emotional pain.
Fortunately, pain control centers, physicians and other healthcare personnel have become more aware over the years.  Asking about pain levels during office visits is as common as checking vital signs. 
Acute pain can occur at the same time chronic pain is experienced.  The euphemism “breakthrough pain” is one type of acute pain an individual can undergo.  This pain can occur because of movement or activity, but it can also happen when the body has involuntary movements, such as expelling gas or muscle twitches.  Medication can be prescribed for the “break” in pain that around the clock medicating provides.
Breakthrough pain may occur in the same area as the chronic pain, but not always.  Noting the events leading up to the episode of breakthrough pain can help caregivers adjust activity levels if needed.  In some cases, the area in pain and/or the event that contributes to it cannot be pinned down.  Recording episodes, including seemingly random incidents, will still help when pain management is reviewed.
When pain resurfaces before the next scheduled dose of medication and isn’t associated with a voluntary or involuntary action, the physician can be notified to examine the timing and amount of around the clock medication.  Noticing the time of pain onset and keeping a record can help the doctor make a decision about keeping pain relief consistent.  Caregivers will find their loved one complains at or about the same interval of time prior to their next dosage.
Chronic pain is consistent and “stable”.  While there may be some fluctuating of intensity, it is “reliable” in its characteristics.  Medication for this type of pain is generally around the clock to provide continuity of relief.  Over time, medications are adjusted to account for changes in the pain cycle, including a patient’s tolerance to a given dosage.
Children and adolescents with cancer or AIDS experience pain just as deeply as an adult.  They may be better equipped to admit to pain and track where they are hurting, as opposed to adults who may have dementia as a hindrance to assessment.
Physicians have a specific protocol, or pathway, to follow when managing pain for adults and children.  When dealing with “pain psychology”, caregivers will learn to watch facial expressions, body positions and other gestures to determine if their loved one is understating their pain level.  Kids may not want to worry their parents, or be afraid of a visit to the doctor or hospital.  As the healthcare experience continues, parents become more attuned to what their child is feeling, and may find that personnel involved in their child’s care are able to help them understand what is typical at different stages of treatment.
While the same is true for caregivers of adults, the adult-to-adult psychology can have a wider range of variation.  Children helping their parents through a health crisis may take time to relate to them on an adult-to-adult level, and parents may attempt to mask their fear and pain by amplifying “Parent Mode”.  When possible, ask the doctor to allow for some time alone with the parent, to allow them to express their needs without feeling “weak”.

Relationships of every kind are challenged when there is a health problem, and relationship dynamics should be evaluated at the time of diagnosis by loved one and caregiver. Understanding that there will be changes in any relationship is a first step toward coping with those changes, and making them positive ones.

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