Pain Management
Definitions of Pain
Common Barriers
Important Terms
Morphine Myths
Duty to Relieve Pain
Five Principles
Fifth Vital Sign
Pain Assessment
Begin with the patient
Types of pain

Symptom Management
Common Barriers to Pain Management

On the part of the Healthcare Provider:
Most of us have heard it or perhaps said it ourselves about a patient that who has depended upon us for care: labeling the patient a “Clock Watcher ” when the patient asks for another dose of pain medication at the exact time that it is due, or more often than it’s ordered; or a “Drug Seeker” when the patient shows up in the emergency room with back pain unrelieved by medication given at the last ER visit.

When a patient has a diagnosis of cancer, or other life-limiting disease, health care providers may believe that pain is inevitable and unavoidable. They then do not look any further into aggressively treating the pain.

The fear of turning patients into addicts — this fear has the health care provider doling out the pain medication as if it were precious jewels, adhering to a strict time schedule, observing the patient for dilated pupils and other signs of developing addiction, or even withholding doses.

There is also the fear of over-sedation with administration of strong pain medications. This mistaken belief has the healthcare provider prescribing or administering lower doses than is recommended so that the patient will not be turned into a “zombie”.

And finally, the fear that morphine will kill patients by causing respiratory depression.

Patients put up barriers, too
Our society puts a high value on stoicism and patients don’t want to be seen as “complainers” if they report they are having pain.

The belief that pain is inevitable with a diagnosis of cancer or other serious disease process; or that somehow they deserve their pain because of past actions; or for religious reasons.

Patients also have a fear of becoming addicted to pain medicine. Many patients will just “tough it out” rather than risk becoming an addict and the shame associated with addiction.

“I want to stay in control.” Patients want to stay alert and dislike the idea of sleeping all of the time, or becoming unable to participate in what time they have left.

“Just say NO to drugs” This popular public service catch phrase reinforces the feeling that taking drugs — any drug — is somehow wrong.

The belief that if strong drugs like morphine are given “too soon”, the drug won’t be as effective later on in the disease process when their pain increases. They want to save the strong drugs until the last minute.

Finally, the Health Care System itself has created barriers to pain management
Many facilities have inadequate pain management policies or policies that are outdated in their understanding of proper pain management. Facilities often do not make pain and it’s management a priority issue.

There is intense and often unwarranted scrutiny of prescribing physicians due to negative publicity surrounding the diversion of pain medications for illegal usage. This scrutiny can cause physicians to write fewer prescriptions for pain medication, prescriptions that could relieve much pain and suffering for those in need.

Society’s judgment of those who need pain medication. Again, the “Just say NO to drugs” campaign has unwittingly led to patients being scrutinized for their pain needs. The pain patient risks being judged unfairly as a potential or actual addict if pain medication is taken on a regular basis. This imposed guilt and shame can prevent pain medication from being taken as prescribed.

Perhaps most importantly of all, health care facilities and educational institutions lack pain management content in their curricula and continuing education programs. This leads to a lack of knowledge and understanding at the very core of the health care profession.