Fwd: The Faces of Pain

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From: byrd45 (Original Message) Sent: 6/25/2005 10:17 AM
THE FACES OF PAIN Part 1
University of Miami Comprehensive
Pain and Rehabilitation Center
"THE FACES OF PAIN"


by Renée Steele Rosomoff MBA, RN, CRRN, CRC, CDMS

Historically health care providers -- especially in hospitals--have always prided themselves on knowing a patient's room and bed number, the diagnosis, pertinent vital signs, and lab results. Yet, often they did not know the patient's name, their marital status, whether they had children, what were their hopes, fears, dreams, occupation, educational background and what the impact of the medical problem was to the patient and significant others. In, short, they did not know the PERSON in bed who was the object of their care and whose life was entrusted to them.

Those of us who treat people in pain would like to think that we have come a long way. We now pride ourselves on treating the whole person. We understand the importance of the mind-body connection as well as the significance of familial, occupational, and socioeconomic aspects of the patient's universe.

I am a past board member of APS, President of SPS, and Programs Director of a large multidisciplinary pain team. And yet I continue to broaden my knowledge of the many diverse disciplines required and the breadth of the expertise needed to treat that most devastating and ubiquitous consequence of trauma or illness--PAIN!

Those of us who are trained in this specialty are aware of the complexity of pain. We know that the treatment cannot be "one size fits all". We know there is acute pain, chronic pain, cancer-related pain, pediatric, geriatric, post-op, labor pain, as well as head, neck and back pain, and phantom pain--the list is almost unending.

In addition to my long forgotten encounter with unrelenting pain, when I bargained with the Almighty for just one pain-free minute, I have been professionally involved for over twenty years with the impossible quest to annihilate pain or to accept the more realistic goal to ameliorate pain.

Therefore, I though that I fully understood the scope of the problem and the suffering component. However, recently when I had the privilege to serve as a member of the Florida Pain Commission and hear the testimony of the courageous consumers and providers, I truly saw "THE FACES OF PAIN."

I was overwhelmed, aghast, and amazed at the sum total of the suffering and the terribly lonely struggle with this monster "pain" that so many people must endure. While we have heard such histories from our patients, the magnitude of this problem was larger than I imagined.

The testimonies given with quiet dignity were heartrending, frightening, and sobering because it could happen to anyone of us. I experienced a sickening realization that we have all been working for many years to help people in pain, yet we have reached so few! They came to the microphone one by one and quietly told their stories about their decent into the abyss. I remember them...

There was the man in the wheelchair that had a good job and new marriage when his knee and his life were shattered eight years ago in a mugging. After endless treatment he still has dysesthetic pain, which is so intolerable that he once threatened to shoot off his leg and was confined to a psychiatric hospital as a suicide risk. He has lost his job, his wife, and just about everything except his constant companion--PAIN. He cannot find a physician to prescribe the medications he needs for pain. He is treated like an addict and he continues to cry for help. The systems have failed him.

A physician testified that pain medication is not readily available in his county "after hours." Pharmacies, afraid of robbery, will not keep controlled substances on hand. This dedicated doctor spend half the night trying to obtain narcotics for a cancer patient and driving across the county to bring the patient the medications needed.

Hospice nurses told many horror stories about patients living and dying in agony because physicians (including some medical directors of Hospices) were not knowledgeable of pain management and pain medication use, and were unwilling to prescribe proper medication or dosage.

There was a young oncology nurse who testified about her study on the length of time that indigent and very sick cancer patients must wait to receive care. The results were mind boggling--people waiting 8 to 12 hours to see a physician only to wait another 8 hours to have their prescriptions filled! After enduring all of that, some prescriptions given were not much stronger than aspirin and of little use to the patient.

There was the 47-year-old man suffering from back pain since 1979 who had 27 surgeries to his back. Once a long-distance runner, he now spends all of his time seeking pain relief. He attempted suicide twice and was arrested trying to get drugs for pain. He went to a methadone clinic and claimed he was an addict so he could get medication. He is homeless because he cannot afford to buy medication and also pay his rent. He still lives in fear that his medication will be cut off any day.

Many pain sufferers told how narcotics made them functional yet lost them their self-respect. They are stigmatized and treated like addicts who are seeking drugs for recreational purpose.

A former social worker with RSD testified about years of pain and fights with her payor to receive care. She previously had been tried on simulators and methadone. Finally, she was able to have a morphine pump implanted but subsequently had to undergo multiple surgeries to replace the pump due to infection.

The pump helps to keep her functional but she has problems obtaining the medications, which costs $1400.00 a month. The insurance company paid $10,000.00 for the pump but will not pay for the medication that goes into the pump! Therefore, the pump is useless and she now lives with intolerable pain.

Many physicians expressed fear of the medical regulatory boards if they write too many prescriptions for narcotic/controlled substances. One physician reported that the DEA had paid him visit that very morning and how frightening the experience had been.

Many patients expressed fear that their physicians would stop writing prescriptions for pain medications. Many told of previous experiences when they had been cut off. A young anesthesiologist testified about the many insurance plans with little or no coverage to pay for pain treatment or even for an Epidural block for childbirth. Women in labor were told that this type of treatment is a "LUXURY." Oncology nurses told of children with only a few weeks to live who were dying in agony. The parents refused to have narcotics given to their children because of fear of addiction. We heard of cancer patients who must choose between paying for chemotherapy treatments to possible save their lives or paying for pain medication to relive their torture!

The horror stories seemed endless and I realized how evident is the need for all of our services. Yet our challenge is even greater today because we exist in a payor climate where the alleviation of pain may well be considered a luxury.

So I urge each of you, when the stress is great and you want to give up, remember the "FACES OF PAIN" you too have seen. Resolve to continue the fight so we may be able to help the pain sufferers who are legion.