Susan E. Mazer, Ph.D. Blog

Thoughts and ideas on healthcare

Hi, and welcome to my blog! I'm Susan E. Mazer -- a knowledge expert and thought leader on how the environment of care impacts the patient experience. Topics I write about include safety, satisfaction, hospital noise, nursing, care at the bedside, and much more. Subscribe below to get email notices so you won't miss any great content.

Pain Management: Life-Supporting or Life-Threatening?

October 14, 2016

stethescopes-and-pills-comWithout question, pain is the only symptom that crosses all ages, diagnoses, and specialties.

One of the best solutions ever developed for pain management was aspirin, followed by every other pill that came from the realization that pain could be treated, if not eliminated, by using drugs.

But now we’ve realized that using morphine and other miraculous narcotics for pain management has become lethal rather than healing.  The abuse of Oxycontin has created a whole world of users served by the prescription drug system and the black market.

H&HN Online explored the realities of the opioid epidemic and the industry that created it in depth this week. Over 100 million Americans experience chronic pain, it reported. The “first line of defense,” pushed by the healthcare system itself (drug companies, doctors, payment schedules and more) is the pill.

So much money to be made, and such a loyal marketplace.

Well, death and addiction are the two outcomes that are now motivating clinicians to find another way. The whole system wants to detox.

There Are Alternatives for Pain Management

Non-pharmacological pain management strategies such as acupuncture, meditation, and guided-imagery have been available for years.  However, their use was still considered “alternative,” and was not embraced by the larger medical community.

Now, these alternatives are being trialed, researched, and included among patient options. Looking for more than mere incidental use, however, the success of non-pharmaceutical pain management strategies has been strong enough to move the conversation to a national call for new policies.

The challenge, however, is two-fold.

One, given the billions of dollars being made by Big Pharma companies from pain meds, it will be interesting to see how they manage to deal with slower sales. We can assume that while we have become addicted to their meds, they have become addicted to our money.

Second, and perhaps more importantly, patients who have come to be fully dependent on doctors to provide the pills and the pills to do the work, will have to change their behavior.

No Instant Gratification, Other Than Your Wallet

HH&N‘s article points out the success of acupuncture, cognitive/behavioral therapies, and exercise for pain management. But these are protocols that are hardly instantaneous in their effectiveness.

Not only do they work, and work for a lifetime, but most of these alternatives cost either no money or pennies compared to costs of the drugs those who suffer from pain have come to know and love.

This isn’t news to most people. We know that often, a pain in the leg feels better after moving around. We also know that a headache caused or worsened by stress can be eased or stopped by meditating, listening to music, or taking a walk in nature.

While the HH&N article offered more detail, the bottom line is that patients must do more work on their own behalf, rather than taking a pill and then swallowing another four hours later.  John Combes, M.D., the retiring chief medical officer of the American Hospital Association, suggests that the goal should be to make patients comfortable rather than take their pain down to an unrealistic zero.

Positive Distractions Can Help

We’ve long suggested using The C.A.R.E. Channel to support pain management protocols for hospital and hospice patients. This is based on theory of positive distraction, perhaps best demonstrated in Political Journalist and Author Norman Cousin’s book, “Anatomy of An Illness.”

Cousins, who suffered from a crippling irreversible disease, got two pain-free hours after watching one episode of the “Three Stooges.”

This is supported by Psychologist Ronald Melzak’s gate control theory of pain, which identifies two phenomena:  1) focusing on pain makes the pain worse and 2) positive distractions can bring relief, even if temporary.

How to Detox

I wish we could all just decide to use music instead of narcotics for pain management.  I wish doctors would prescribe time in our gardens, tell us to see the current Star Wars movie, or better yet, encourage us to make our list of what works and when.

Given the immediacy of our culture these days, physicians are going to struggle with having to spend more time with their patients (either on the phone, in person, or online) to reframe pain management.  They will probably think that the pill was so much easier.  But it was so much deadlier.

Like any addiction, withdrawing from the use of narcotics and replacing it with slower, more sustainable, and less expensive alternatives takes time.  Immediacy will have to be replaced with a deliberate process and different expectations.

This detox process has to be lived in real time, one patient at a time, one physician at a time, and one day at a time.

Begin by offering your patients something other than pills to manage their pain, something that will help them help themselves without killing them.

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