Sunday, May 20, 2012
Singapore - Managing chronic pain
The brilliant J is hardworking, with plenty of potential in her job. She is also said to be charming, gentle and a darling to her friends and family.
But J is also a chronic pain sufferer. That separates her from many of us. Despite the fact that she is highly functional - she even outperforms me at times - she is in pain most of the time.
This is the main reason why J came forward. She wanted to be "normal".
I do not know what "normal" really means. So my definition of her request simply means that J wants to get better and feel better.
That is a worthy cause. It is also a difficult one.
Through my lens
J suffers from chronic migraine and chronic abdominal pain. She has had these for as long she can remember, she says.
Despite that, life goes on for her, like it does for many of us. She has settled down, brings up her family, goes to work, maintains social contact and takes part in an active lifestyle. She has endured the pain for so long that it has become a part of her life.
But J is also a very intelligent woman. She has sought help from many health professionals. She takes her medications and puts up with the side effects.
She listens to peer advice and occasionally calls me to ask for my professional opinion. She has also tried alternative medicine.
She meditates and has tried acupuncture, massage and aromatherapy. All this means she will never stop trying.
What pain does
Pain is real. The only reliable measure of pain and its intensity is the patient's report. As a health professional, I need to acknowledge that first.
There is a medical definition for chronic pain. There are advantages in classifying pain. It gives doctors invaluable information on the origin of the pain.
It guides us towards a proper treatment plan. However, it is equally important to understand that pain is also an experience. We tend to remember our own most excruciating pain experience, so much so that we hope that we won't have to go through the experience again. Pain can also become part of our emotional memory, hence J's wanting to "feel" better.
Her pain is debilitating. When she has her migraine attack or abdominal pain, she simply becomes "deficient".
Pain for her also means missing work hours, poor productivity level in general, reduced quality time with loved ones and the psychological burden that follows suit.
I have yet to meet a chronic pain sufferer who hasn't experienced anxiety and depression. What I have demonstrated here is that pain intrudes with many aspects of the patient's perceived quality of life and how effectively it can change it.
Pain management is a medical specialty. It does not exclusively belong to certain sections of health care practitioners or professionals because whatever level of medical profession you're at, one deals with patients who suffer pain on a regular basis.
However, the complexity of pain requires additional attention. For us in medical rehabilitation, it becomes a concern when the pathology affects the person's function and quality of life.
We already know J has chronic pain. She is a sufferer of pain. It means, in a more global concept, an overall negative feeling that impairs the sufferer's quality of life. We also know she has tried different kinds of treatments, all of which only gave her partial relief.
So the aim of treatment here is not only to identify the pathology so that we can medicate her with the hope of removing the pain altogether, but realistically, to explore her coping ability in dealing with pain as she goes through her daily functional life.
For her, the pain assessment is a multi-dimensional approach as her pain seems to affect almost every aspect of her life. This management plan would naturally involve a multi-disciplinary team and would be time consuming.
J never stops trying. Neither will we. J is coming to see us soon. She is also realistic. But it is important for us to meet with her so that we will have a common goal and mutual aim in managing the pain.
After having coffee with J earlier, I am now at my desk, reflecting on the issue and formulating a plan even as a sigh escapes my lips.
Having friends seated nearby in our small working space, one of them who knows the meaning of a frown on my face and my long sighs, turns to me and says: "My dear, pain is inevitable. Suffering is optional you know."
Wise words indeed.
New Straits Times