Why untreated chronic pain is a medical emergency

Patient education should be an integral part of treatment for chronic pain. It commonly includes:. Suitable written material can be provided. Pamphlets have been developed by the NSW Therapeutic Advisory Group for patients with chronic pain, low back pain, and migraine.

Encourage your patient to check out reliable sources of information such as books, the internet, other health professionals, and support organisations. Although there are many reputable sites on the internet, warn patients that some material on the internet may be incorrect or misleading.

An important component of treatment is a pain management plan. This is a written document agreed upon by the patient, the GP, and the pain management team. A pain management plan should specify the goals of therapy, and a timeframe for reaching each goal. The goals should be realistic and relevant. Examples of goals include: reducing the severity of pain, improving physical function, increasing activity at home or work, increasing participation in social activities, reducing medication use, increasing self-management of pain and related problems, improving mood, improving sleep patterns.

The more specific the goals are written up, the easier they are for patients to comprehend and for the progress of the treatment to be measured. The plan should outline all of the treatments or strategies to be used, when they are to be used, and any possible side effects. The pain management plan can help GPs, Emergency Department physicians and locum practitioners to provide consistent care.

Liaison between senior Emergency Department physicians and the GP should occur as early as possible. Progress should be evaluated at regular intervals. Management of chronic pain generally requires a multi-modal approach which emphasises the role of non-drug techniques. It should not rely on pharmacological therapy alone.

Non-pharmacotherapy options include patient education, behaviour therapy, cognitive therapy, cognitive-behaviour therapy CBT , physical therapy, family therapy, complementary and alternative therapy e. Useful guidelines and tools are available on the Hunter Integrated Pain Service website. Before starting patients on medication, it is important to review their medication history, including:. If the patient does not respond, review and explore the reasons for non-response.

Existing evidence does not support the long term efficacy and safety of opioid therapy for chronic non-cancer pain. Depression and anxiety are almost synonymous with chronic pain, as is social isolation. Many studies show that a psychological evaluation and even ongoing psychological care can substantially improve pain management, as can other modalities, such as neurocognitive feedback.

If money is an issue, let him know. It is a good idea to bring a relative or friend who will talk to your physician about your suffering and the functional difference that pain medicine makes because prescribers are reassured when a patient using opioids has a visible support structure. It is also less likely that the physician will be rude or patronizing in front of a supportive friend or relative.

Some pain management physicians who are anesthesiologists by training have a firm bias toward invasive procedures over medical management, so they may suggest that you repeat sympathetic blocks or expensive tests even if a previous physician has already tried them.

You have no obligation to go along, particularly if your records reflect a history of procedures. The physician is obliged to seek your informed consent, which requires a discussion of risks and alternatives. Although you do not have to give it, the unfortunate upshot may be that he declines to treat you further.

Reality dictates that some physicians, even in the face of clear pain, will not be willing to prescribe opioids. More commonly, they are willing to prescribe low doses but have a personal comfort level limit that may or may not be adequate for you. Moreover, if you push him to titrate doses above that comfort level, he may decide that you are a drug seeker.

This serious ethical problem-the physician putting his perceived personal safety before his patient-is a deplorable situation that can lead to abandonment. Although state laws and medical ethical rules do not allow abrupt termination of a physician-patient relationship, a prescriber does not have to keep you in his practice.

If you are stable and able to find another physician, he can terminate you if he provides a brief written explanation of his reasons. An oral message is insufficient. The physician must also agree to continue your care for at least 30 days and he should also provide a referral. However, if you are at a critical or important point in your treatment, abandonment by notice and day care is not permissible under common law. This restriction should apply to a patient taking opioids for pain because the consequences of withdrawal for a person who has a chronic illness could be significant.

Additionally an un-medicated patient may face a return of the pain that had been mediated by the opioids; he will almost certainly experience anxiety and distress. In short, a period without continuity of care could constitute a medical emergency. It seems logical that refusal to treat a patient until the patient has obtained another physician or perhaps until it becomes clear that the patient is not making a serious effort to transfer care should constitute abandonment.

Try Informal resolution. In her research, Im has found strong ethnic differences in cancer pain intensity. Each ethnic group displayed a unique cancer pain experience. Asian participants, for example, had significantly lower cancer pain scores than those of Hispanic and white participants. African American participants had significantly lower pain scores than Hispanics and whites.

In addition, misconceptions about powerful pain relievers, including that they shorten life and cause addiction, have been reported to be common among Asians. This also makes them reluctant to manage their pain as does their sense of reported fatalism about cancer pain. The study showed that Hispanics had the highest functional status, meaning they are functioning in their daily lives better than other ethnic groups. The reason for high functional status among Hispanics is due in part to strong family support, Im said.

You can have both. Scott Strassels of the College of Pharmacy wants people to speak up about pain and says the first step is to begin a national conversation among patients, health care providers and related organizations. Because pain is highly subjective, it is important for doctors to trust what their patients tell them. School of Nursing researcher Dr. Eun-Ok Im says more than 80 percent of cancer patients experience pain during the course of their illness or treatment, but the pain is often undertreated.

She has developed a computer program to help oncology nurses better manage the pain of their patients. Other tips to maximize your appointment: Onset: When did the pain start? But when someone has chronic pain, the nerves that carry pain signals to the brain, or the brain itself, are behaving in an unusual way.

The nerves might be more sensitive than usual, or the brain might be misreading other signals as pain. Acute pain can develop into a chronic pain condition if left untreated or if the acute pain is poorly treated.

The longer pain remains untreated, the greater the risk of pain becoming chronic. Chronic pain can make it hard to work, take care of yourself and do the things you enjoy. It can also affect your sleep and mood. More than half of Australian adults with chronic pain become anxious or depressed because of their pain. It's important to treat this if it happens to you. Just as pain can affect your mood, improving your emotional health and wellbeing can also help you manage your pain.

Watch this video from NPS MedicineWise: Australians talk about their pain experience and the impact that pain has had on their lives. Medicines alone are not the solution to managing chronic pain. If you have chronic pain, you will also need other treatments such as self-management, physical activity and psychological approaches.

People with chronic pain who actively manage their pain on a daily basis do better than those who rely on passive therapies such as medication or surgery. Most people benefit from a range of different treatments and self-management, including:. Talk to your doctor about developing a plan for managing your chronic pain. You will probably see several health professionals as part of the plan. Long-term use of opioids is potentially harmful, including accidental fatal overdose , life-threatening breathing problems , dependence, tolerance and addiction.

But the aim of managing chronic pain is to stop pain from disrupting your life so that you can resume doing the things you enjoy, such as socialising, working and being active. You might also consider being referred to a pain management program at a pain clinic, available in most major public hospitals and also privately.