We Are Failing People With Chronic Pain

Diane M. Goodman, BSN, MSN-C, APRN


March 01, 2022

It could be me or it could be anyone reading this blog. The statistics on Americans suffering from chronic pain are alarming: 1 in 5 adults or 50 million people, according to national surveys. Across the country, providers are doing poorly at recognizing and treating chronic pain.

It should be no surprise that overdose deaths have also risen significantly, national reports show. When pain is unresolved, people may choose any means to ease distress, including avenues that could prove lethal.

Chronic pain also affects worker productivity. The reasons for this are complex, but chronic pain affects three aspects of work: ability to work a planned schedule, individual wages, and worker productivity (days missed due to discomfort).

What is chronic pain?

Chronic pain is defined as pain that continues for greater than 3 months, either with or without a clear etiology. However, there are exceptions. Consider the case of Tiger Woods. While his extensive injuries may eventually cause chronic pain, the initial healing from vehicular trauma, surgery, and compound fractures could take longer than 3 months. His pain, while in the recovery phase, would still be considered acute in nature.

Types of chronic pain may involve cancer pain, musculoskeletal pain, neuropathic pain, and idiopathic — for example, phantom pains post amputation, widespread burns, or pain that lacks a specific origin. Headaches are also a common cause of chronic pain.

The pain may be described as burning, throbbing, shooting, stabbing, radiating, like "pins and needles," or all of the above. Chronic pain may lead to sleepless nights, fatigue, anxiety, and depression. Unresolved, chronic pain may lead to changes in functionality, with sufferers feeling isolated and alone.

Over time, patients may become depressed and/or suicidal, feeling that quality of life has diminished secondary to the pain.

But why is the healthcare community failing people with chronic pain? The first reason is a lack of knowledge related to how pain should look and feel. People experiencing chronic pain may look normal, even relaxed, as opposed to a patient with acute appendicitis in the emergency room, writhing in distress.

Patients with chronic pain may laugh and appear engaged in conversation with others. They may not look like a picture of misery. This can lead to unfortunate interactions with providers.

For example, I have been told that I should not be experiencing tooth pain because the molar I identified as causing pain had already had a root canal. The pain persisted through two hygiene appointments, and I sought further consultation.

It was only after repeated complaints that I was sent for specialty x-rays, which revealed an untreated root in the canal. Following a supplementary procedure, the pain began to abate, but the experience proved an unfortunate example of dialogue that can occur when patients report pain.

No one — I repeat, no one — should tell a patient complaining of pain that something should not hurt. Self-reports of pain should be taken at face value and investigated. Unfortunately, medical professionals have been taught to search binary options in treating pain; either a test is positive (for a diagnosis) or it is not. Chronic pain involves a more subtle approach.

Another example of chronic pain involved a patient I was asked to see as a pain nurse. Hugely overweight, the patient was a poor historian and had difficulty focusing on her symptoms. She was tearful and a bit withdrawn. Her hygiene was neglected, as may happen when patients experience chronic pain with impaired mobility. Her physicians dismissed her symptoms but they asked me to evaluate her and offer an opinion.

I sat down at her bedside and spent about 30 minutes discussing her symptoms. She had been diagnosed with bipolar disorder and had started a medication that resulted in a 100-pound weight gain over an abbreviated period. Her menses were irregular, and she began to experience bloating with abdominal pain. I asked her to describe the symptoms and to point to the exact location of discomfort.

When palpating her abdomen, I felt a hard mass in the right lower quadrant. At the conclusion of my assessment, I contacted her attending physician with the findings.

The next day, when I returned for a shift, I tried to see the young woman. She was in the recovery room, after being emergently transported to surgery to remove a large ovarian mass.

What went wrong with this pain assessment? It is hard to say, but the young lady did not appear to be in pain, although she described her discomfort at level 9-10. Additionally, her demeanor was expressionless. Conversation with her was arduous. These were unfortunate results but should not have precluded a comprehensive pain assessment/diagnosis.

What happened with this young woman demonstrates how difficult it may be for providers to treat chronic pain.

According to the Cleveland Clinic, providers have difficulty with chronic pain because evaluation is complex as well as challenging. While medications may ease symptoms eventually, the types of pharmaceuticals used may take trial and error to be effective, whether relief is achieved with antidepressants, anticonvulsants, muscle relaxers, corticosteroids, topical therapies, medical marijuana, or nonopioid agents.

Additional options, such as alternative therapy (acupuncture, aroma therapy, meditation, biofeedback, nutraceuticals), may be helpful, but patients need to be motivated to adhere to a comprehensive therapy program that will take time. While opioids may prove helpful for short-term acute on chronic pain (eg, sickle cell crisis), they are not advised for the treatment of chronic pain per se, although I offer a caveat:

Chronic pain patients do get sick. They can be hospitalized with acute trauma, nephrolithiasis, cholecystitis, myocardial infarctions, and additional types of acute pain. When this occurs, they should be treated aggressively for pain, as opposed to assuming that they are accustomed to having pain and may therefore require less medication. Yes, this has happened! I worked for years as a certified pain resource nurse, and I cannot say how many times chronic pain patients were given less medication than they needed for relief. People do not get used to having pain.

Chronic pain leads to deleterious effects if left untreated. Hormone levels, aggregate brain volume, and neuroplasticity can decrease, not only from discomfort but also from a lack of therapeutic rest. This creates a vicious cycle, with the patient feeling more discomfort as time elapses. Only through a comprehensive pain management program will people begin to feel more functional.

Help is available, but only if appropriate providers are found. We should not accept the inevitable, that chronic pain cannot be eased.

In the US alone, chronic pain accounts for nearly $80 billion in lost wages per annum. This means we are failing people who suffer from back pain, joint pain, osteoarthritis — diseases that may affect many of us as we grow older.

We can and must do better.

Do you have a story to share regarding chronic pain? Fifty million Americans need to know we are listening.

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About Diane M. Goodman
Diane M. Goodman, BSN, MSN-C, APRN, is a semi-retired nurse practitioner who contributes to COVID-19 task force teams and dismantles vaccine disinformation, as well as publishing in various nursing venues. During decades at the bedside, Goodman worked in both private practice and critical care, carrying up to five nursing certifications simultaneously. Yet she is not all about nursing. She is equally passionate about her dogs and watching movies, enjoying both during time away from professional activities. Her tiny chihuahuas are contest winners, proving that both Momma and the dogs are busy, productive girls!


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