Why compassion and caution are vital in pain management
I remember my first personal experience with death and pain. While I was home on a much-needed vacation during my first year of medical school, my grandfather Hans died. He was 91 years old and a long-time smoker. He ran a little barber shop in Pelican Rapids, Minn., and cut hair almost to the end. Almost everyone in his circle smoked. He was stricken with lung cancer at age 90, and treatments didn't help. He was in Hospice care at home when I returned.
My mom and I spent the night with him and my grandmother Agnes in their little home in Rothsay, thankful for the couch and recliner. He was in a hospital bed in the kitchen, and the end was near. He was moaning and in severe pain. But he couldn't ask us for what he needed. There was morphine available, and the hospice nurse had left instructions about its use. But I was afraid. Morphine was a powerful, scary drug that could lead to addiction.
I had no experience with death, other than that of our family dog being hit by a car. By phone, my uncle admonished us "not to give him too much morphine. You might kill him." My uncle was so well-meaning, but he wasn't there to experience the pain. So my grandfather suffered. He suffered more than he should have, because I was scared and naïve and didn't know what to do. I listened to his last breaths from the next room because I couldn't bear to watch. And I will always be ashamed.
Over the years, I have witnessed death many more times. Some were trauma related, with a fight to the end. Some were cancer related, and the fight had given way to surrender and peace. I think about how we tried to ease suffering in both of these situations.
I think about our approach to pain, which in the early 2000s became a fifth vital sign to be asked of every patient. Doctors were accused of undertreating pain, and they were encouraged to make patients as comfortable as possible in all situations. Satisfaction scores depended on it.
But unwittingly, we've contributed to the opioid crisis by our focus on pain. Prescriptions for medications like hydrocodone and oxycodone have skyrocketed. Some of these pills are used appropriately, but some end up on the street for sale.
Doctors and patients need to have a better understanding of pain. There are people with severe pain from cancer or injury or chronic illness. They deserve compassion, treatment and perhaps a referral to a pain management specialist for multiple forms of treatment, not just medication.
I work with post-surgical patients on a regular basis. I tell them this is short-term discomfort and the light at the end of the tunnel is already visible. I give warnings now that I didn't give before. One in six people can become addicted to pain medication, even if used appropriately for surgical pain, and especially if used for longer than seven days. I encourage them to rest, keep hydrated and use Aleve or Motrin first, then Tylenol. I ask them to use narcotics for only breakthrough pain that's not relieved by the other meds. And I remind them that healing takes time and that they can expect some discomfort during the process.
Life itself is painful. We deal with stress, heartbreak, financial woes ... the list goes on and on. We all have really big ups and really low lows. How do we deal with the pain? Food, alcohol, drugs and sex can be used to "medicate the pain away", but often with serious consequences. Again, healing takes time as we navigate through the discomfort. Faith, family, friends, gratitude and resilience can help us heal.
I think it comes down to compassion and caution. None of us are the same, and our pain has different roots. Sometimes blanket policies, black and white thinking, and fear lead to more suffering.
With compassion and caution, we can treat, heal and recover.
Dr. Susan Mathison founded Catalyst Medical Center in Fargo and created PositivelyBeautiful.com. Email her at firstname.lastname@example.org.