Learning to "Live With" Chronic Pain: Lessons From Mrs. Tandy

Paul Arnstein, PhD, APRN, BC

Topics in Advanced Practice Nursing eJournal. 2007;7(1) 

In This Article

Introduction

The Centers for Disease Control and Prevention (CDC) released a report in November 2006 that was based on their findings from a national health survey. According to the report, 1 in 4 American adults experienced pain for at least a full day during the past month, and 1 in 10 adults have pain that has persisted for over a year.[1] Among adults over age 65, an astonishing 60% of Americans have pain that has persisted for over a year. Following nerve damage from illness or injury, chronic neuropathic pain is particularly difficult to diagnose and treat.[2,3] For the person living with chronic pain, daily routines, participation in enjoyable and meaningful activities, and relationships are changed or lost. As severe pain persists, it erodes physical, emotional, and spiritual health, as well as the ability to work and maintain close relationships.[4]

Among the most common forms of chronic neuropathic pain is peripheral diabetic neuropathy, which affects both the physical and mental health, as well as the quality of life, of at least 3 million Americans.[5] Successful treatment plans require more than just pharmacotherapy. The medical management of chronically painful diabetic neuropathy can make monitoring and adhering to complex regimens (for treatment of both pain and diabetes), while engaging in health-promoting activities, a full-time endeavor.

I reviewed the research literature, examining the CINAHL (Cumulative Index to Nursing & Allied Health Literature), Cochrane, and MEDLINE databases in February 2007, which suggested that there are many treatment approaches available. Too often in practice, however, clinicians are unaware or have mistaken beliefs about available treatments and may suggest these patients will just have to "learn to live with the pain."

For 12 years, I have received referrals of patients being sent to a cognitive-behavioral pain treatment program to help them learn to live with their chronic pain. One of those patients, Mrs. Tandy (a pseudonym), stood out as facing both the typical struggles as well as individual challenges as she strived to live fully despite her pain. This manuscript introduces the reader to the principles of assessing and managing patients with chronic pain secondary to peripheral diabetic neuropathy, relaying Mrs. Tandy's story, a 5-year therapeutic relationship, to highlight how nursing practice lends itself to:

  • Knowing the patient;

  • Applying evidence-based approaches; and

  • Modifying treatments based on individual responses.

As a caveat, emerging research is changing this area of practice at an extremely fast pace; clinicians are advised to stay abreast of the latest research and best practices.

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