by Sheila Campbell
We’re all familiar with the axiom that there are two things that are certain in life – death and taxes. But I suggest that there is a third – pain. Pain is the most common reason patients seek medical attention, crossing all medical specialities. (Pain Day 2012)
Pain management, therefore, is something that health professionals want to help patients with as much as possible. But it’s not always easy, and there is always more than can be done, according to Dr. Dean Tripp, associate professor in the departments of psychology, anaesthesia and urology at Queen’s University in Kingston Ontario. In the lab he established Dr. Tripp and his associates have been studying pain and pain-related psychosocial factors for the past 10 years.
He acknowledges that patients may feel that their complaints about pain are not taken seriously. He says that some patients may also have unrealistic expectations about their pain being able to be cured, which is not so unusual given that most pain management is based on treatment for acute pain—treatment that doesn’t usually work with chronic pain. “They want to be fixed; they want to be better; they see what’s available for acute pain and want the same for themselves, because no one wants to live in pain,” Tripp says. “We’re getting better at understanding this, and so we’re coming up with different treatments.”
One treatment program that Tripp has developed with urologist Dr. JC Nickel is a cognitive behavioural therapy (CBT) that helps patients manage their pain by engaging in less sedentary behaviours and understanding that while some of those behaviours might be painful, doing them will not cause more pain, and may help the patient to accept the pain, thereby making it less intrusive in their lives.
“It’s not easy for people to make this leap, and get the mind to accept living with a certain amount of pain, and then gently pushing the body to do more and get to the point where you can be more active—which will diminish the amount of pain you have to live with,” Tripp says. “It can be a vicious cycle. The patient has to get over the feeling of ‘I can’t do this’, which is based on emotion, not evidence.”
Taking into account the emotions involved with pain management, Tripp says that another program developed in the last couple of years known as acceptance and commitment therapy is meeting with some success, and is becoming more widely used. It encompasses modalities such as meditation so that there is a better understanding of the pain. Patients are usually asked to monitor and track their pain, rather than try to mask it or ignore it, and get on with their lives. “Understanding that pain is as much a disease of stress and isolation as it is [a disease] of biology helps to look at treatments that will lessen that stress and isolation.”
These can include a practice of mindfulness meditation, which Dr. Kate Patridge incorporates into her psychology practice in London, Ontario. In her article, Teaching Through Practice: Reflections on Mindfulness Mediation (The Health Professional, Winter 2012) Partridge says, “Mindfulness meditation is a systematic way to cultivate mindfulness. Although it is derived from the 2500-year-old practice of Buddhist meditation, it is not a religious practice, nor does it require any particular belief system. In fact, it is more useful to think of mindfulness meditation as a kind of physiotherapy for the mind.” It is important, however, for the physician to practice what she/he preaches.
“For a helping professional to be able to effectively teach clients mindfulness skills, there is a very important prerequisite: the professional herself or himself must have a personal daily practice of mindfulness meditation. Reading about mindfulness meditation is not a substitute for developing the language of awareness that grows with the practice. It isn’t possible to understand the gentle but powerful changes that arise from mindfulness practice without doing it yourself, on a regular basis. When you cannot understand this, you cannot properly support your clients in their practice.”
Using acceptance therapy is extremely valuable in the management of chronic pain. Medication may bring short-term relief but it has its limitations, Tripp says. Health professionals who can help their patients find other ways of managing chronic pain will have a better success rate.
“That won’t be measured by a drop of 50% in the pain scores, but successful programs in the management of chronic pain will show major improvements in the patients’ quality of life, their mobility, and lower rates of depression.”
Sheila Campbell is President of 2Ascribe Inc. 2Ascribe Inc. is a medical transcription services agency located in Toronto, Ontario Canada, providing medical transcription services to physicians, clinics and other healthcare providers across Canada and the US. As a service to our clients and the healthcare industry, 2Ascribe offers articles of interest to physicians and other healthcare professionals, medical transcriptionists and office staff, as well as of general interest. Additional articles may be found at https://www.2ascribe.com.