Pain Care: Prevention Before Treatment

Author: Harry J. Gould, III, MD, PhD

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When a patient says, “Doctor, it hurts when I do this,” the immediate thought in response to the implied request is “Don’t do that.”  Unfortunately, in today’s society, this seems to be the best and most effective advice that a physician can provide for their patients in pain.

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The United States is in the midst of what the Centers for Disease Control describes as “The worst public health crisis in American history.”

There are reports, almost daily, to enlighten us about the fact that the over-prescribing of prescription painkillers has led to countless overdose deaths and serious consequences associated with misuse, abuse, addiction, and diversion that plague society in epidemic proportions.

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As a result, there has been a strong push by the community and regulatory agencies to limit the prescribing and dispensing of opioid analgesics across the board, while paying little attention to the underlying cause.

Pain is often under-treated or over-treated, but mostly it is poorly treated.

The system’s response has precipitated a reluctance on the part of many physicians to provide pain care for many in need, further exacerbating the primary cause of the problem.

A frequent response is to change clinical focus and redirect efforts to offer one-dimensional assessment and management that relies on interventional modalities.  Unfortunately, not all patients are identical and interventions, if ordered inappropriately or too often, can be costly and have problems of their own.

The observations and policies have mandated change and have heightened the efforts of healthcare providers to find ways to “do no harm” in their efforts to help those in need.

How then can we improve pain care and overall quality of life?  Perhaps it is time to return to basics.

As a starting point, we should consider some important truths about pain.

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The Truth About Pain

  • Pain is subjective and is different for everyone based on culture, situation, experience, genetics, age and gender.
  • Pain is a modality that is essential for survival. It warns us of present and potential tissue injury so that we can respond and minimize damage.
  • The most important reason that chronic pain is so debilitating is less the uncomfortable sensation that is experienced and more the fact that pain robs us of our ability to control of own lives. Unfortunately, many chronic pain conditions are present for a lifetime.  Thus, the realistic goal should be to minimize the effect of the underlying condition causing the pain and reclaim control of our lives rather than to eliminate pain.

Too often, patients surrender responsibility for controlling their pain to friends, physicians, physicians, drugs or procedures.

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Taking Responsibility for Your Pain

As a patient, it is essential for you to take responsibility for your pain and to participate in your own care. This process can begin by considering and implementing some obvious positive behavior changes that can maximize pain control and minimize both physical and fiscal cost.

Things You Can Do to Control Pain

  • Eat a regular healthy diet, avoiding excess, with a goal to optimize body mass index (BMI).
  • Exercise daily — regular activity from baseline to 30-60 min/day tailored to the patient’s ability to tolerate activity without a backward slide. “No pain, no gain” is not always the best approach.
  • Be sure to get enough restorative sleep.
  • Balance life experiences and schedule time for yourself that allows for participation in hobbies and enjoyable leisure activities.
  • Be aware of habitual activities and positions that add undo ergonomic stress, e.g., poor posture, wearing high heels, wearing shoes that lack adequate support, sleeping on an old or non-supportive mattress or pillow, using inadequately supportive chairs and car seats. Tailor work and living environments to minimize but not necessarily eliminate stressors and eliminate high-risk conditions.
  • Learn and take advantage of alternative forms of coping and pain control, e.g., meditation, guided imagery, self-hypnosis and relaxation.

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With proper perspective and attention to basics, one is likely to realize improved general conditioning that enhances:

  • Healing and the immune system’s ability to fight off infection and disease
  • Improved cardiovascular, pulmonary and gastrointestinal health
  • Reduced stress
  • Improved mental health
  • Increased sense of self and well-being and an overall improved quality of life
  • Reduction in pain at any level

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When setbacks occur, first consider the use of topical heat, cooling or massage and prudent physical activity to improve strength, range of motion and endurance and seek counsel for a comprehensive pain assessment early when the basics have not provided adequate results.

Be a Good Sport: Tips for Preventing Youth Sports Injuries

Author: Patricia Clesi, RN, UMC Trauma Services Coordinator

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Youth participation in organized sports offers excellent benefits socially and physically, including reducing the risk of childhood obesity.

However, almost 1/3 of all injuries incurred in childhood are sports-related.

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In fact, high school athletes account for about 2 million injuries, 500,000 doctor visits and 30,000 hospitalizations each year in the United States according to the Centers for Disease Control and Prevention.

A 2016 report from the U.S. Department of Health and Human Services said knee injuries, ankle sprains and concussions are among the most common outcomes in studies identifying risk factors for sports-related injuries. One study from the National Health Interview Survey even showed that sports, on average, account for 14 percent of all emergency department visits for life-threatening injuries, the majority of which (32%) come from those 18 and younger.

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Despite the scary statistics, more and more American children are participating in youth sports in recent years.

To make sure you or your child are not part of the numbers and prevent injury, consider these 5 simple, but potentially lifesaving, tips during this National Youth Sports Week:

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1. Warm Up

Time should always be set aside for warm up and stretching before playing sports. This will help prevent injury to muscles during play.  All major muscles groups should hold the stretch for 20 to 30 seconds.

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2. Gear Up

Appropriate and properly fitted sports gear should be used always. Helmets should be well maintained, age appropriate, and worn correctly.  There are no “concussion proof” helmets, however, it will help prevent skull fractures and traumatic brain injuries.

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3. Hydrate

Hydration before, during and after practice and games are very important to prevent dehydration, especially in the summer months.

Water is the best option to hydrate athletes.

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4. Rest

Overuse injuries are common, especially in youth playing on multiple teams of the same sport at the same time. Rest will help avoid these injuries.

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5. Report

Players should be encouraged to report any pain, injury or illness to their coaches and parents.

For more child safety tips, visit http://www.umcno.org/injuryprevention.

Season’s Grievings

Author: Sonia Malhotra, MD, MS, FAAP, and Director of Palliative Medicine and Supportive Care at University Medical Center New Orleans

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The Holiday Season is one full of celebration, joy and gathering for so many.  But for many individuals, especially those living with a serious illness, the Holiday Season can seem like more of a burden than a joy. Coordinating appointments, making sure there are enough supplies to last through days when pharmacies and stores are closed, and contacting healthcare providers are only some of the challenges those living with a serious illness have to face.

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Additionally, the Holidays often bring about stressors, anxiety and grief over the inability to travel and the loss of other abilities, the diagnosis of a serious illness, and often the loss of loved ones.

Palliative Medicine is the interdisciplinary care of patients with serious illness such as cancer, blood disorders, heart disease, neurologic disease, liver and kidney disease and advanced lung disease to name a few.

It provides this level of care in 4 areas:

  1. Pain and Symptom Management, including managing symptoms that affect the quality of life
  2. Communication about Healthcare Decisions, Plans of Care and Coordination of Care
  3. Emotional & Spiritual Support for Patients and their Caretakers
  4. Hospice, End-of-Life Decision Making and Support, and Bereavement Services

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November marked the celebration of National Hospice & Palliative Medicine month. 

However, each month in the life of our patients LIVING with serious illness brings awareness of the challenges and struggles we need to celebrate. Serious illness and Palliative Medicine are NOT about end-of-life care. Rather, Palliative Medicine and its care of the seriously ill focuses on finding ways to ensure that our patients and their caretakers are LIVING with the best quality of life they possibly can.2017-NationalHospiceMonth_Logo

So how can patients and their families survive this Holiday season with a Serious Illness?

  1. Establish Priorities: Choose the Holiday traditions and activities that have the most meaning to you. Create and prioritize activities based on your state of mind and energy level.
  2. Depend on Loved Ones to Fill In: This can be especially tough for those who like to do things independently. However, it is important to be realistic about what you will have energy to do. Ask for assistance, take assistance when it is given and be clear about your own limits.
  3. Plan Ahead: This is especially important if you have dietary restrictions while undergoing treatments. Talk to your healthcare team about rescheduling treatments that may leave you feeling under-energized during important family gatherings or traditions.
  4. Be Selective with Your Time: Do things and be with the people who energize you, not those who deplete you. Don’t feel the pressure to fulfill obligations, do the things that matter the most
  5. Acknowledge and Share Your Feelings: It is okay to feel sad, anxious and even angry. Give yourself the permission to have these feelings and share them with trusted loved ones and healthcare professionals. Use support groups and online communities as often or as little as you need.

The Holidays can be a stressful time for those living with a serious illness and those caring for a loved one with a serious illness. Keep in mind that nurturing yourself and allowing others to nurture you will help in the celebration and reflection of these times.

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