Painfully Aware

My poor husband. Not only has he had to endure back surgery, a long and painful recovery, and his wife blasting it all over her blog, he developed shingles on top of it. Now, I won’t go into great detail about shingles, but it is a virus—the same virus that gives our young ones the chicken pox. Once you have had chicken pox, that virus can lay dormant in your body and resurface as shingles later in your life. And know this. It involves specific nerve tracks and is INCREDIBLY painful. My hubs is a beautiful beast of a man—large in stature—and this about brought him to his knees. Even as a nurse and a massage therapist, my skills were useless in helping him.

“DON’T. TOUCH. ME.”

I hear ya, honey.

September also happens to be Pain Awareness Month. Just for giggles, I want you all to think back to the worst pain that you have experienced. For many women, childbirth tops the list. Many men compare the famous kidney stone to what they think childbirth might be like (by the way, my hubby passed his first kidney stone in Afghanistan while serving in the Air Force. The poor soul…) I have never had a broken bone, but I did tear a hamstring muscle, and that brought me to an 8/10 on the pain scale.

But what does that mean? How is pain defined? I was taught in nursing school that pain is whatever the person experiencing the pain says it IS, and it exists whenever the person says it does. Some cope with pain better than others; some can distract themselves from pain and tend to heal better than those that convince themselves that their pain is permanent, untreatable, and overwhelming. There is acute pain (and there is nothing CUTE about it!) and chronic pain. Examples of acute pain include pain from cuts, fractures, sprains, infection, or even the pain one feels from a heart attack. This pain usually diminishes over time, but if it persists over a three-month period, it can become chronic pain. My husband’s back pain? He’s been dealing with that for over a year, so that is categorized as chronic. But his shingles pain was definitely acute and thank goodness, that has subsided.

As a nurse, I am asked to assess for pain many times daily, even in the mental health field. A 0-10 pain scale helps me to know the subjective intensity of that pain (zero is no pain, ten is the worst pain you have ever experienced.) Remember, pain is what the patient says it is, and I do not question the number I am given, regardless of the presentation of the patient. I can ask the quality of the pain as well, looking for characteristics like burning, shooting, stabbing, electric shock-like, etc. Pain unfortunately exacerbates other symptoms like anxiety, depression, fatigue, and insomnia.

Keep in mind that pain can have a profound influence on a person’s quality of life and functioning. Think of how difficult it must be to perform work, household duties, engage in physical and social activities, and just overall interact with others and be in a good mood when you are sitting at 8/10 on the pain scale at every moment of the day. On top of that, you barely slept a wink because of said pain. Let’s address some physiologic consequences of unrelieved pain:

Cardiovascular System:

Increased heart rate = Increased blood pressure

Respiratory System:

Shallow breathing = Reduced ability to cough = Increased risk for pneumonia

Urinary System:

Decreased urination = Electrolyte imbalance

Gastrointestinal System:

Decreased GI movement = Constipation

Muscular System:

Muscle spasms = Weakness and fatigue

Neurologic System:

Impaired Cognitive Function = Confusion & Impaired ability to think/make decisions

Immune System:

Decreased immune response = Infection

Check that out! All from pain that goes unaddressed! You know what I am going to say next. Yep! Go see your doctor! There are many types of treatment for pain, and it is important to find the right one for you. EVERY patient deserved adequate pain management, and the treatment plan should be based on your goals. Don’t just focus on medication—it is important to use nondrug therapies as well. Your doctor should use an interprofessional approach, as the perspectives of an interprofessional team are often necessary to provide effective assessment and therapies for both acute and chronic pain. As you work with physicians to manage side effects, regularly evaluate the effectiveness of all therapies to make sure your goals are being met.

Just a quick word about opioids. I know just the word sparks fear in many of you. Know that opioids are safe when used as directed. They come with some hefty side effects, so long term use is not recommended. Those that become trapped in the web of prescription drug addiction start out by using opioids OTHER than as directed by their physician, AND, when the medication is not effective, it is not communicated to their doctor so other therapies can be explored. Again, this is where that tight relationship with your primary care doc comes in handy.

Pain is a pain in the you-know-what. Be respectful and be aware that it is a different experience for everyone. Hats off to those of you who are blessed enough to live each day pain free. To my other friends—please join me as I say…

OW. And…

Be well!