Thanks for joining me as we continue our discussion on easing pain. In the first few modules, we defined pain, we discovered how pain is transmitted, we identified common barriers, and learned how to know if a person is having pain. Today, we will review other things you need to know about the pain experience. Pain is not just a physical experience, it's a very personal one. Take time to find out what the pain means to the person and how it affects quality of life. You might ask, what would you like your caregivers to know to help you manage your pain better? Think back to a time when you or a loved one experienced pain. Unrelieved pain can affect, sleep, appetite, energy level, activity, and ability to concentrate. It can also impact relationships, intimacy, and mood. We know that pain and depression occurs at the same time in about a third of all patients. So, pay close attention to persons with high levels of distress, depression, or other emotional concerns. They may need the help of a professional counselor. Pain does not happen by itself. Find out if symptoms or side effects linked to pain and its treatment are present. These often include nausea or vomiting, constipation, or urinary retention, drowsiness, itching, or dizziness. We will talk more about these side effects in a future course. Some patients may just put up with these symptoms. Others may decide to stop pain medicines or other drugs altogether because the side effects are so bad. Changing the pain medicine, its dose or frequency, or adding a therapy to treat the side effects, such as a laxative for constipation may be all that's needed. Knowing the person's story is key. Finding out about the person's past illness history and symptom experience helps you understand things that may add to pain or affect treatment response. What other health issues is the patient dealing with? What pain treatment has or has not worked in the past? Substance use is common and should be checked for in all persons with pain. The use of nicotine, alcohol, cannabis, recreational drugs, opioids, and other substances can influence the pain management plan. We know that smokers use more opioids and have a harder time stopping opioid therapy. Alcohol can affect how pain is expressed, may increase opioid use, and also can make opioid therapy less safe. Ask about personal or family history of addictive disease, physical, or sexual abuse as these can also affect opioid use. Substance use disorders happen in 15-20 percent of persons with chronic pain. One recent study found that one in 10 advanced cancer patients, mainly men strayed from taking opioids as prescribed by their provider. Balancing the risks of misuse or abuse and the benefits of pain management is vital. Providers worry about patient misuse, abuse, and diversion, these concerns can lead to less pain management. Recognising opioid misuse should be a part of routine care as it helps safe medication use and decreases stigma or bias. These days, it's common for providers to create a contract with patients who take opioids for persistent pain. We call this an opioid contract, and this agreement outlines that the patient only receives pain medicines from one prescriber, and this usually includes random urine drug screening. Healthcare providers must watch for red flags of opioid misuse. Patients may request early prescription refills, they may lose a prescription, or say the medicine dropped into the toilet and I need more. They may also without provider approval increase their drug dose because of unrelieved pain. While all of these things can reasonably happen, if a pattern emerges and these excuses continue, providers may end the opioid contract. While knowing the patient's past healthcare history sets the stage, a good physical examination often gives other useful information. Here are some things health providers can do. Look at skin changes. You could see inflammation, infection, blisters, or lesions. Check for fluid accumulation or swelling. Notice skin coloring changes or abnormal sweating. Check for abnormal responses to touch, poor healing, cold skin, or even goosebumps. These may indicate neuropathic pain. Listen with a stethoscope for breathing issues or slow or absent bowel sounds. These can be a sign of pain or bowel obstruction. Low back pain or knee pain with complaints of aching spasm and increased pain with activities suggests there's a problem with muscles or bones. Provider should check range of motion and mobility. Patients often guard a body part or walk differently to protect against pain and this can make the pain worse. Lastly, diagnostic tests like x-rays of larger joints such as knees, hips, and upper extremities may provide important information for the cause of pain. In some cases, if pain persists, a CT scan may be used. Nerve blocks can also diagnose some pain syndromes such as centrally mediated or peripheral neuropathic pain. Thank you for your interest in learning more about pain. After watching this lesson, you may be a better advocate for yourself, your friends, family, or patients, if and when they experience pain. This extra knowledge will also help you engage more effectively with healthcare providers as they work with patients experiencing pain.
