Insights on Pain

by Joanna Smith on Jul 26, 2011

I was reading a post at the Center for Advancing Health ( on Chronic Pain that a colleague had posted on LinkedIn.  Because chronic pain is a frequent reason that clients contact Healthcare Liaison, I read with special interest a quote from  Dr. Paul Christo, director of the multidisciplinary pain fellowship program at Johns Hopkins School of Medicine.  He is discussing the frequent referrals that people receive at pain management clinics for psychotherapy:

Dr. Christo:  “A lot of people have the misconception that what I’m telling them [when recommending therapy] is that their pain is a figment of their imagination. That’s not what we mean. Pain has such an emotional component and psychotherapy is extremely useful in terms of helping patients reorganize and rethink how they interpret it and how it affects their lives.”

One of the most frequent comments I hear from clients with chronic pain IS “they told me it was all in my head”.  It seems that the dialogue between consumer and provider about pain is frequently a “mismatch”:  the provider thinks he or she is communicating one view, and the consumer, defensive from experience with healthcare systems,  hears a much different version.  These are times when it is most helpful to have another person in the room, monitoring the conversation so the communication can be corrected at that moment, rather than leading to even more pain–emotional and physical and delayed help–in the future.

Another very frequent comment from families, particularly families coping with end-of-life issues for a relative, is “I don’t want them to have too much medication and become addicted”.  I have always wondered about that comment:  it’s not that people want their family member to die unaddicted but in pain, they simply haven’t considered what that statement means in end-of-life care.  Strong pain medication–like opioids– (e.g. Oxycontin) do carry a risk of addiction, but with people at the end of life, addiction is less of an issues and pain management is the main issue.

In a review of studies on pain management,  Cochrane Review (Cochrane Reviews investigate the effects of interventions for prevention, treatment and rehabilitation in a healthcare setting.) found that:  “for people without a prior history of addiction,  (italics added) less than 3%  of patients who take opioids regularly for pain will become addicted to the drugs.  That means almost everyone without a history of addiction could reasonably talk with a healthcare provider about opioids for relief of pain: addiction is not really the issue.  what IS of importance, especially at end-of-life, is management of pain so people can complete what they need to before they die.  This may mean giving them pain-free time to talk with family, sit up in a chair, eat a favorite food or enjoy music.  Good pain management improves the quality of life for those remaining days, months and years and is a necessary part of a comprehensive plan for anyone.



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