At the global health agenda turns and twists it’s focus to Non Communicable diseases, there is an increasing realization as to the Chronic nature of these diseases. With this chronicity of time there may also come increased duration of pain and suffering. At the UN Civil Society Meeting on Non communicable diseases this week, a number of participants including a medical student commented on the need for our medical education system to move away from teaching in the “Acute” settings, and to focus more on the chronic.
It struck me that this really does have an impact on pain. We, as clinicians, get taught about pain in the acute setting. The person who presents to the ER with chest pain, the kidney stone, the trauma. These people look uncomfortable and often have an associated sympathetic reaction (with a fast heart rate, increased blood pressure, sweating). So we are trained to identify these people as having a problem and are more likely to believe their pain.
How often do we hear this comment about those with chronic pain?
“They don’t look like they have severe pain.”
Teena may look unwell when she comes to the ER with a sickle call crisis but she may continue to have pain between crises, looking relatively well and normal. How can she have a pain of 8/10 when she looks so well?
Bernard and Bob both have other signs of advancing disease and we are often much more willing to accept their reports of pain.
What is Pain? MIchael Cousins gives us the IASP definition.
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
It is essential that we believe a patient’s report.
Believing their pain report does not mean a clinician is making a decision to prescribe opioids, but does raise the questions within the clinician that they do have to consider the appropriate management.
A final comment, I have not used the word “complain” here. Even though we talk about the “Presenting Complaint” in medical history, we tend not to like people who complain. “Reporting pain” is a much less emotive term than the patient “complains of chronic pain.”