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Pain management is what I try to do. Ideally, a correctable cause would be found and summarily dealt with. Wouldn't that be nice?
The reality is that pain management might ideally begin with the prevention of injury. It should certainly be involved in the early treatment of injury, including attempting to alleviate all related distress, including anxiety/ stress and, of course, pain. Once pain gets its metaphorical foot in the door, it can be hard to dislodge.
It is hard to tell if there is more chronic pain now than there used to be. There probably is - we have, for one example, hundreds of thousands of motor vehicle accidents in Canada each year. Many of these seem to result in long-term neck and back pain, with the accumulated numbers increasing with every year. The way we live in the present may well be the reason for the ever-growing numbers of those with fibromyalgia.
Living with frequent, perhaps even constant, pain changes everything. It can rob people of much of what defines their lives and it can make their future uncertain, even fearful. We may look to our doctors for help. It is hard for some to find a doctor, hard to see the doctor for enough time to explain the problem, hard to find answers. Each step in the process takes so much time. Meanwhile, pain may be throwing up roadblocks - interfering with work, sleep, life in general.
The problem of pain:
We know what pain is. Almost everyone has experienced pain somewhere - a headache, a broken wrist or a strained back. It would be understandable if we thought of pain as something that happens in a specific location in our bodies, capable perhaps of being "fixed" by some local intervention. For the briefest and most trivial of small injuries or tissue disruptions, that may well be almost completely accurate. Even the most trivial of these events will not , however, completely escape the attention of the ever-vigilant immune / inflammatory system(s), but, as the magnitude of the tissue disruption increases, so, to a degree, will increase the magnitude of the response and the peace and quiet of the rest of the person, which includes the totality of body and mind, will be correspondingly disturbed. Similarly, even for a smaller injury, the effects will become increasingly more widespread the longer the tissue disruption persists.
Those who have pain want it to "go away" and patients with pain may want their doctor to help make that happen. When the pain has become chronic, there will have been something like a ripple effect with the inflammatory response to the pain spreading locally and, via the circulatory system, throughout the body. The sensation of pain depends on the interaction of peripheral and central neural systems; these, too, can be affected by the far-reaching waves of the inflammatory response.
At this time in Canada, we have seen a rapid rise in reported opioid overdoses. Politicians, media and even some physicians have yielded to the temptation to classify a worrying trend as an epidemic. As usual, most of the agencies bearing some degree of responsibility are trying to do something, if only perhaps to make sure that they are seen to be doing something.
Patients who hear about the deadliness of fentanyl become terrified of a drug that is very safe when used properly. Fentanyl has been used for decades in ICUs and operating rooms and for almost as long as cutaneous patches for chronic pain management. Abuse of fentanyl may have existed for nearly as long - I will never forget being called in my teaching hospital in the early 1990s to try to resuscitate a member of the medical staff who had injected himself with sufentanil, a closely related drug.
In Ontario, a recent initiative to legislate the return of used patches before refilling the patient's prescription promises to rapidly reduce diversion of the prescription medication. However, we are now hearing of quantities of fentanyl entering the country from overseas. Unfortunately, those likely to use this fentanyl has no way of knowing how lethal even tiny amounts of fentanyl can be. The fairly standard initial dose of the fentanyl patch is 25 micrograms per hour - that is 1/40 th of a milligram; there are about 1.25 million micrograms in 1/4 teaspoon.
Addiction is a terrible illness. It is not, by any means, my area of expertise but it is impossible not to worry about its prevalence and what may be leading to so many being caught up in this nightmare. Proponents of supervised injection sites speak of the lives they save. Perhaps they do, that day. There must be a better alternative. There is a surreal quality about denying patients pain medications and providing opioids to those who are addicted to them.
MR
November 21, 2016
There are a lot of things that can be done to ease the burdens of living with pain, possibly including some basics - eating well, getting out into sun and fresh air, making sure we get enough sleep and trying to find ways to rest our minds. It could be that we might find better solutions for our afflictions of the present in the advice our grandmothers might have given us than in any of the investigations and medications of our time. It can be hard to see clearly when distractions are many.