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The Purpose Of Pain Clinics

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Chronic pain is a globally widespread issue; in fact, one out of five individuals grapples with moderate to severe chronic pain worldwide. The intended purpose of this article is to further explore the purpose of pain clinics in the management of chronic pain.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

The Purpose Of Pain Clinics

A commonly used definition for pain, according to the International Association for the Study of Pain (IASP), is the following: "An unpleasant sensory and emotional experience normally associated with tissue damage or described in terms of such damage." Reliable data suggests that pain is an exceedingly common problem on a global scale.

Statistics from the IASP and the European Federation of the IASP Chapters (EFIC) reveal that one out of every five individuals deals with moderate to severe chronic pain, and that one out of every three people struggles with maintaining independence due to their pain. In other words, pain is a distressing part of many peoples' daily lives.

Fortunately, pain clinics have been designed to help patients deal with this widespread issue. These clinics are focused on the overriding goal of practicing the art and science of pain management by including clinicians from different specialties who participate in the treatment of pain.

A multidisciplinary pain center is typically staffed by anesthesiologists, neurologists, physical medicine and rehabilitation doctors, psychologists, physical therapists, and acupuncturists (Warfield, 2008). In addition to physical pain, the clinic also addresses the psychosocial aspects such as the emotional, cognitive, behavioral, and social issues that revolve around the patient's suffering.

Clinicians at pain clinics order a wide array of treatments that may include analgesic medications, nerve blocks, nerve stimulation (TENS), laser treatments, hypnosis, psychological counseling, deep relaxation techniques, biofeedback, acupuncture, massage, acupressure, instruction on guided imagery and distraction, application of heat and cold, and other methods. If surgical intervention is advised, the staff at the pain clinic will arrange for consultations with neurosurgeons, orthopedic surgeons, and other physicians as appropriate.

According to Dureja (2011), the most common diseases managed in the pain clinics include chronic low back pain, cervical spondylosis, joint pains, chronic headaches, migraines, neuralgias, facial pains, muscle pains, causalgia and cancer pain.

In some unfortunate cases, the physicians at the pain clinics may never pinpoint the exact cause of the patient's pain. In those instances where the cause of the pain is unknown, the primary focus is on providing relief and maximizing quality of life for the patient.

The very concept of a pain clinic is based on the conviction that the effective management of difficult pain conditions is possible only through well-coordinated efforts of a specialist possessing knowledge and skills to diagnose and treat pain (Dureja, 2011). Since pain is one of the most common afflictions in society, the professionals who operate pain clinics should be praised because their efforts help to relieve the suffering of countless patients.

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TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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11 Comment(s)

libran1984, ASN, RN

Specializes in Emergency Nursing. Has 4 years experience.

A commonly used definition for pain, according to the International Association for the Study of Pain (IASP), is the following: "An unpleasant sensory and emotional experience normally associated with tissue damage or described in terms of such damage."

And how many people come in to the ED with a lack of said tissue damage?

I absolutely love this topic, it has potential to be so controversial being that pain is terribly subjective, as the calm woman, drinking her frappuccino points to a nearby Faces Scale and plainly states, "My Headache is a 10."

Then it opens to the door to pain killers causing more pain, potential for substance abuse.

Prison nursing, a position I formerly held, emphasized that pain was not a Vital Sign and to only trust objective data.

The ED I now work at, adamantly treats pain. Dilaudid is our best selling drug. Some people just need their fix. Others of course truly need it. Then there are those who it simply has no effect on. I frequently find people with orthopedic problems find it difficult to obtain relief from pain with opioids.

What else... hmmm....

I absolutely love the complexity of pain. I wish we could go more in depth than this simple article ^_^

Some nurses ask patients how many alcoholic beverages or packs of cigs they've had, then multiply it by 2.

Some nurses ask patients how high their pain scale is, then depending on other subjective cues, divide it by 2.

We have no right to judge a persons pain level. If they tell us they are pain, we should treat there pain as they describe it. When working in the veterinary field, animals will never tell you they are in pain, even if their leg is broken and dangling, most are very stoic. The reason is that an injured animal is another animals food, so it is a matter of survival. I am used to treating an animal based on either their injury/disease, or based on very subtle signs that they will show me, if I know what I am looking for. Tightening of the corners fo the lips, blinking, a normally loving pet not wanting to be touched or bothered, hiding and so on...the clues can be many. I have had to treat pets with gun shot wounds, a crushed pelvis, an arrow through the shoulder...and still they purred and did their little happy paws, or licked my face and wanted to be petted.

Take for example women in labor. Some may scream their heads off, some are very quiet...does one feel more pain than the other? A lot has to do with each individual, how they percieve and respond to their pain.

If a person is lying, and only wants their fix, that is not for us to judge or treat. That is for their primary caretaker and/or therapist. Unfortunately it is much easier to get a hold of alcohol or drugs than it is to see a therapist. Many are booked full and most people can't afford to see them.

Additionally, we do not want to treat pain when the symptoms are obvious to us. We want to treat pain before it becomes exacerbated, because we know that pain treatment is more effective if we treat it before it gets out of hand. Better to snuff a small fire than to have to put out a blaze. I too an interested in the process of pain and pain management...it is an issue much more complex than "tell me your pain level".

lovingtheunloved, ASN, RN

Specializes in LTC, home health, critical care, pulmonary nursing. Has 12 years experience.

Unfortunately, where I live, "pain clinic" equals "dilaudid clinic." It's all narcs, all the time.

Most pain clinics are also in areas of lower socioeconomic status, where the population is likely to have numberous mental and physical issue that they are unable to improve, for various reasons, and turn to pain clinics for treatment of chronic or acute pain, as well as mental health problems. What is sad is not that there are so many pain clinics, but that for so many, pain clinics are the only option they have.

opossum

Specializes in ICU/CCU, Med Surg.

If a person is lying, and only wants their fix, that is not for us to judge or treat. That is for their primary caretaker and/or therapist. Unfortunately it is much easier to get a hold of alcohol or drugs than it is to see a therapist. Many are booked full and most people can't afford to see them.

Unfortunately, as care providers we are placed in a position to treat them - and it's true that most people do not have access to proper preventative medical and mental healthcare. So then what better place to obtain free drugs than the ED?

And I do think, in my limited one-year experience as a nurse so far, that there is a difference between stoicism and outright manipulation. Many stoics still exhibit objective signs of pain - tight lips, fixed gaze, limited movement. But when someone is snacking on nachos, texting on their phones, claiming 10/10 pain, I just have a hard time believing it. And I am obligated to treat them based on their subjective rating of pain.

So what difference does it make to me? Who cares if they're just bored, want attention, or want to score some Dilaudid? But it's here where I begin to wonder if we're actually helping anyone in the long run. Does believing them do more harm than good?

I wish I had some answers here...

complex regional pain syndrome (crps, formerly called reflex sympathetic dystrophy) starts with a tissue-damage injury (even an mi can cause this but it's more often some sort of ortho or soft-tissue damage). for reasons that aren't exactly clear, the pain pathways in the brain don't get the message that the tissue damage is healed and they keep on reporting pain, pain, pain to the cognitive part of the brain. it is worse with depression, because those parts of the brain are right next door to the parts that assign meaning to pain; and constant pain is depressing, and it gets to be a vicious circle. the pain is very real, can be excruciating, and can spread to non-injured areas as newer areas of the brain take up the cause. it's a horrible disease, because there are no physical symptoms and sufferers can be mocked, penalized, stigmatized, and have their pain rating arbitrarily downgraded because nobody believes them. they may be sipping their lattes or sleeping (often from exhaustion) but that does not mean they don't have huge pain. people can adjust to anything, and this is sometimes mistaken for fakery.

the treatment is normally meds that work on neuropathic pain, e.g., anticonvulsants and other neuropathic meds. opioids/narcotics are not effective for crps. if someone is taking opioids for chronic pain and they are not helping, opioids should be tapered and withdrawn under medical supervision while more effective meds are trialled. this is a very scary time for patients; suicides from chronic pain are not uncommon. some less-well-established regimens (iv ketamine is one) can be helpful but are not always paid by insurance as they are rated experimental.

whatever the cause and treatment, it's well established that psychotherapy to help with reframing pain perception and dealing with the depression is a vital, non-negotiable component of chronic pain management. insurance carriers are often loath to approve it because they are afraid they'll be paying for it forever. they might, but if the person becomes more functional as a consequence, it's unconscionable to withhold it. physical therapy and regular activity in spite of the pain is also helpful in reducing pain over time. seems contradictory, but it works on the brain's centers for pain sensation and cognition. people can get to the place where they still have pain but it doesn't bother them as much as it did. it's a wonderful thing when they get there.

flares and remissions are part of living with chronic pain. people have to be given the tools (in therapy, both physical and psychological) to understand this, overcome the very real fear that this time the pain will never get better, and if a temporary increase in meds is necessary to overcome a flare, the insurance provider needs to understand that too.

last, it's become known that chronic opioids actually cause more pain in the long run. when some people really do become more functional on opioid doses that would drop a horse, they should be allowed to stay on them without being accused of being addicts. addiction, by definition, is use in ever-increasing doses for the psych effects, the high. habituation is the body's response to long use of opioids; when they are withdrawn the body has withdrawal symptoms but that is not a sign of addiction. tolerance is the body's ability to get used to high doses (see dropped horse, above). the highest morphine dose i ever saw in action was 500mg q2hours. that's not a typo-- five hundred milligrams every two hours. the woman was awake, functional, and working part-time.

the only meaningful side effect of escalating opioids is constipation. the others-- temporary drowsiness, decrease in resp rate, decreased bp-- resolve in 24-72 hours, but constipation is forever. plan for multiple bulk-forming and motility agents.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

Opiates are not the best treatment for bone pain...at least they are not most effective for bone pain in hospice...

libran1984, ASN, RN

Specializes in Emergency Nursing. Has 4 years experience.

What would be a good treatment for bone pain, tewdles? I always feel awful when I have a pt in the ED and I'm loading them up on morphine and dilaudid and they express no relief. Do you have any suggestions in your experience I can speak with our attending ED physicians with regarding pharmacological treatment? Any not obvious nursing interventions to be implemented?

@grntea

thanks for a highly informative post.

tewdles, RN

Specializes in PICU, NICU, L&D, Public Health, Hospice. Has 31 years experience.

What would be a good treatment for bone pain, tewdles? I always feel awful when I have a pt in the ED and I'm loading them up on morphine and dilaudid and they express no relief. Do you have any suggestions in your experience I can speak with our attending ED physicians with regarding pharmacological treatment? Any not obvious nursing interventions to be implemented?

Of course, the comprehensive pain assessment is integral to determining the best treatment options. However, we often use things like acetaminophen or ibuprofen in combination with other meds. Often a steroid will help, or addition of something like gabapentin. Sometimes addition of adjuvant meds like elavil will help. Some bone pain responds better to methadone.

Good luck.