I have written much about pain management and find it one of the most gratifying aspects of being a care-giver. I feel a little bad that in my last post I made fun of some of my patient’s pain scales – something I will address further in my next post, but I wanted today to reclaim the high road and talk about a book –Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research – I highly recommend to all.

The book is largely about chronic pain, but it does mention acute pain and the need to treat it promptly. Unfortunately there is no mention of the EMS role in the book, but there are still many lessons for us in it.

I am going to quote and comment on the opening paragraph of the book, which I think is beautifully written and drives home much of what I have come to learn and feel about the importance of pain management.

“Protection from and relief of pain and suffering are a fundamental feature of the human contract we make as parents, partners, children, family, friends, and community members, as well as a cardinal underpinning of the art and science of healing.”

The very first role of ancient healers was to treat pain. In the mix of our learning of various diseases and the skills to combat them, we often neglect the very patient in front of us. William Osler, the father of modern medicine said, “Care more for the individual patient than for the special features of the disease.”

“Pain is part of the human condition; at some point, for short or long periods of time, we all experience pain and suffer its consequences.”

I have been giving my pain management talks for a long time and, at times, have been nearly hooted out of the room by old guard medics who followed the “I have to hurt looking at you for me to give you pain meds” philosophy and others who see a drug-seeker behind every person in pain. Over time many of these paramedics have come back to me and apologized, and said they had no idea of what pain was until they tore their shoulder or had a kidney stone themselves, and now they treat patients much more liberally and compassionately, understanding what it is like to be in real pain.

“While pain can serve as a warning to protect us from further harm, it also can contribute to severe and even relentless suffering, surpassing its underlying cause to become a disease in its own domains and dimensions.”

Untreated acute pain can rewire a patient’s body making them more susceptible to pain in the future. For people who think pain is a simple message from the injured part to the brain that goes away when the injury heals should think about amputees who still feel pain in their missing limbs to understand the complexity of our neurons and physiology. We need to think of pain as a disease that attacks the body right from the outset and pain management as a time sensitive intervention that in cases of acute pain, can affect the outcome of patient’s lives. As Dr. R McKenzie writes “The pre-hospital practitioner has the first and perhaps only opportunity to break the pain cascade.”

“We all may share common accountings of pain, but in reality, our experiences with pain are deeply personal, filtered through the lens of our unique biology, the society and community in which we were born and live, the personalities and styles of coping we have developed, and the manner in which our life journey has been enjoined with health and disease.”

Who are we to sit in judgment of others, not having walked in their shoes? Should the judgment of Drug Seeker! and Faker! be gaveled down in the court of the back of the ambulance? I am uncomfortable with that. I would rather err on the side of the patient and let the rest be sorted out in the hospital. How many times can we be wrong about a drug seeker to justify withholding drugs from someone truly in pain? And we must remember often people seek drugs because of their pain. They aren’t all just bored and looking to get a quick high.

“The personal experience of pain is often difficult to describe, and the words we choose to describe pain rarely capture its personal impact, whether it is sudden and limited or persists over time.”

Pain scales I realize are imperfect and better techniques of assessing pain need to be developed. But more about pain scales and their pros and cons in the next post.

“Severe or chronic pain can overtake our lives, having an impact on us as individuals as well as on our family, friends, and community.”

People as young children didn’t dream of growing up to become dependent on pain medicince. The suicide rate for people with chronic pain is much higher than the national norm. 100 million Americans suffer from chronic pain. Many of us will suffer chronic pain at some point in our lives. Let’s hope our care-givers are compassionate with us.

“Through the ages, pain and suffering have been the substrates for great works of fiction, but the reality of the experience, especially when persistent, has little redeeming or romantic quality.”

For most of history people believed that the mind and the body were separate — that people could just soldier on without damage. But we have learned now that mind and body are interlinked by physiology. Pain can destroy both body and mind.

“The personal story of pain can be transformative or can blunt the human values of joy, happiness, and even human connectedness.”

No one should have to sit before another and have to beg to be treated as a fellow human. In EMS we are caregivers. We are the door to compassion – to human connectedness. Open 24/7.

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Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research is a publication of the National Institute of Medicine that came out in 2011 and is available for free PDF download at this site:

Relieving Pain in America

Here is the description of the report:

Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the IOM in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person’s experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

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