Feel the Pain – Empathy and Treatment in Pain Management
Around 1 in 5 people will experience moderate to severe chronic pain at some point in their life. Half of all adult Americans consult a doctor with “pain” as their chief complaint. The cost of treating chronic back, joint, muscle and nerve pain runs to hundreds of billions of dollars each year. In Western countries 70% of people regularly use pain killers. In the UK alone, over 70 million prescriptions are written every year for anti-inflammatory drugs and analgesics.
Acute pain acts as an alert to bodily damage, so it doesn’t last long and resolves with healing. That’s not the case with chronic pain, which typically serves no useful function and persists after healing. It has an unpredictable pathology and prognosis. Chronic pain is a leading cause of global disability, especially pain in the spine or resulting from arthritis.
In the Middle Ages, people believed that pain originated outside the body - as punishment from a higher entity or a test of character. The concept of pain as a disturbance, one that is passed along nerve fibres and interpreted by the brain, was only established in the 17th century.
Today we conclude that our perception of pain mixes stimuli from neuropathic (nerve damage) and nociceptive (tissue damage) factors with biological, psychological and environmental predisposing factors. But this approach isn’t new. Hippocrates may have unwittingly foreseen it when he wrote, “It is more important to know what sort of person has a disease than to know what sort of disease a person has.”
One way of understanding how to genuinely feel someone’s pain is to recognise that sensation and sensitivity may differ hugely between individuals. Some people feel pain from things that are not normally painful - the result of a sensitization of the nervous system called allodynia. Others experience actual pain stimuli with heightened intensity, a hypersensitivity termed hyperalgesia.
Today pain management approaches build from the diagnosis and recognition of symptoms, using a multidisciplinary response (e.g. counselling with psychotherapy and acupuncture) and holistic treatment with drug and physical therapies.
A treatment continuum is now also established. A first tier uses painkillers, including nonsteroidal anti-inflammatory drugs (NSAIDS) and transcutaneous electrical nerve stimulation (TENS). The second tier uses opioid drugs, and the third involves advanced pain therapies, including implantable drug pumps, neuro-stimulation and surgical intervention.
Research attention has shifted towards clinically relevant pain syndromes and away from the triggers of autonomic responses or nociception that result in pain. New therapeutic developments include non–narcotic drugs that work on opioid receptors and transdermal skin patches that provide continuous drug delivery over 72 hours. Simpler dosing is facilitated by providing drugs that simply dissolve in the mouth or come in lollipop form.
The notion of treating the person and his or her pain holistically is of equal importance in disability claims management as it is in a modern clinical setting. “Pain is whatever the experiencing person says it is, existing whenever (he) says it does,” McCaffery and Beebe (1989) stressed in an outline of clinical nursing practice. In claims, the assessment of pain, based on careful history taking and examination, should take account of its subjective sensation and the importance of believing the claimant implicitly.