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Pain Management

Patients are all familiar with being asked: “On a scale of 1 to 10, what is your pain?” Over the last 20 years, treatment of pain has been a focus for health care institutions and health care providers.  Unfortunately, there is much that health care providers do not know or understand about pain.  Patients and health care providers often equate the treatment of pain with the prescribing of a pain medication (an opioid).   Health care providers treat pain as if it were the same as high blood pressure or diabetes.  The number on the pain scale is treated just like an elevated blood pressure is treated.

Due to the increased focus on treating pain, opioid type pain medication usage has increased dramatically.  Medicines such as hydrocodone and oxycodone are among the most prescribed medications in the United States.  As the numbers of prescriptions of these medications have increased, so have the numbers of deaths associated with these medications.  Americans are now more likely to die due to an opioid-related death than due to an automobile accident.  According to the CDC, opioid-related deaths have increased five-fold in women over the last 10 years.

Pain is a uniquely individual experience.  All of us experience pain at some point in our lives, whether it is pain due to a broken arm, pain due to surgery, or pain due to the loss of a loved one.  Pain is influenced by prior experiences or thoughts, emotions, and actual or potential tissue damage.  In addition, there is a big difference between acute and chronic pain.  Everyone experiences some type of acute pain, but not everyone experiences chronic pain.  What is painful for one person is not necessarily painful for another.  This is why a one size fits all approach rarely works in the treatment of pain.

In 2011, the Institute of Medicine made some recommendations regarding the treatment of pain.  Recommendations include taking a multidisciplinary approach to the treatment of patients in pain.  Rather than just prescribing a “pain pill” to treat pain, treatments could include other types of medications, procedures to relieve or treat pain, behavioral treatments, and lifestyle improvements.  Both the patient and the health care provider must take an active role in alleviating pain.  Occasionally, treatments that were assumed to be correct may actually make pain worse.  This is especially true with opioid type pain medications.  They have been shown in some cases to make pain worse when used for extended periods of time.