Pain Management

By Janice Hall

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As part of the body's defense system, pain mobilizes people to act in order to minimize physical harm. It's an excellent warning system. Although pain incites fear and dread because of the suffering it produces, it can be successfully managed. Good pain management "eats up the pain, but leaves you still functioning," says Diana Bichel, an RN with South Victoria Home Care.

Sue Morrison of Doveworks Inc., Acute, Chronic and Cancer Pain Management Services, has a passion for it. Encouraged by her discovery "that I wasn't the only one in the world concerned about this, and there were people doing [something]," Morrison earned a masters of nursing at the University of Washington, specializing in the management of physical pain.

She recognizes three distinct kinds of pain: acute, cancer and chronic.

Acute pain originates from a source that eventually heals. "You expect it's going to go away over time and it usually does." There are ways of managing acute pain, such as drugs.

Cancer pain can arise from both a malignancy and its treatment, such as surgery and radiation. It's particularly challenging to manage as "it can be acute and chronic all at once," says Morrison.

Chronic pain frequently begins as acute pain that hasn't been properly cared for. Its source may be difficult to identify, as seen in ailments such as arthritis and fibromyalgia.

"We are beginning to understand that if we get on top of it quickly, [we] can do a lot better than we used to. We're beginning to learn that there are a number of chronic pain conditions that we can make a difference in," she says.

Morrison teaches clients to become more aware of their pain. She alerts them to its many nuances.

"One of the first things I would do, regardless of what type of pain you have, is I would say to you, 'what is the worst that your pain gets?' I usually use the 0 to 10 scale, where 0 is no pain and 10 is the worst imaginable pain. I'd say, 'OK, how good does it ever get on your best days?' I'd [ask], 'how do you get it there?' So many [people] have no idea what the [factors] are. Nobody's worked with them to take a look at it, to teach them how to learn about their pain."

Morrison encourages her clients to be methodical in educating themselves about their pain. Be persistent, she advises. Take notes and keep a pain diary: When the pain is felt, what makes it better, what makes it worse, what foods are eaten, types of activities and activity level, weather, and stress level.

Alternative methods for chronic pain relief focus on calming the mind, body and spirit. Good nutrition and vitamin supplements nourish the body. Relaxation techniques such as meditation, deep breathing and aromatherapy relieve physical tension that can exacerbate pain.

Moderate, low-impact exercise such as walking, swimming and biking yields numerous benefits. Exercise strengthens muscles, increases flexibility, helps restore balance and co-ordination, invigorates the heart and lungs, aids in the maintenance of a healthy weight, improves sleep and promotes a sense of well-being, all of which can diminish pain.

As an adjunct to exercise, massage stimulates blood flow and relaxes muscles. The hands-on, touching aspect of massage is very soothing, says Morrison, particularly when one "connects" with the massage therapist.

Guided imagery taps into the healing power of the imagination. A relaxation technique that can improve one's quality of life, it evokes physiological changes that promote healing. Patients listen to a recorded message that instructs them to relax, close their eyes, breathe deeply and feel the air flowing in and out of their lungs. They are invited to imagine being in a favourite place, and to describe the sights, sounds and smells in order to engage their senses fully.

In studies done among women suffering from osteoarthritis, guided imagery has increased mobility. Cancer clinics in the U.S. use it to relieve pain and nausea. Although a scientific explanation for its efficacy eludes practitioners, the technique has much to recommend it. It's easy to use, inexpensive and has no adverse side effects. All that's required is the ability to visualize images in the mind's eye.

Used for centuries in China, gently swirling needles inserted into acupuncture points in the body have proven effective at relieving chronic pain. Acupuncture points can also be stimulated with deep massage.

To ease the anxiety and depression, which frequently accompany pain, spiritual counselling, psychotherapy, joining a support group, and journalling one's thoughts and feelings are recommended.

Cognitive reframing teaches people to monitor negative, self-defeating thoughts and images and to replace them with positive, more realistic ones. Morrison sees her role as empowering people to learn all that's required to become healthy.

"I want to figure out with them what's going on, what's working, what isn't working. I do a tremendous amount of teaching, not just about pain but about medications, what they are, how to take them, how not to take them."

She addresses the issue of pain and how it can mould one's identity, asking sufferers, "who are you in this world? How do you get on with your pain?" Pain may be a formidable adversary, but with the help of specialists, it can be targeted, tamed and transcended.

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