Sunday, November 3, 2013

How Is Pain Measured Accurately?

Have you ever had to go for a pain evaluation? What did they do? Do you know that the experience of pain is quite personal and related to your anxiety? The pain threshold, in fact, is directly related to anxiety. The more anxious you feel, and who doesn’t feel anxious if you havie a medical illness or a procedure, the less able you are to tolerate pain.

But how do they know how much pain they need to treat and how do they actually measure it? Comes right down to the fact that they don’t know at all how much pain to treat because the one pain “instrument” they have is to ask you, the pain sufferer, to evaluate your pain on a scale of 0-10. Medical staff believe that most patients either over exaggerate their pain while others understate it. Here’s what one scale looks like using numbers but without the appropriate emoticon faces.  The chart is placed in the patient’s room for all to see just how much the patient is or isn’t suffering:

Face 0 is very happy because he or she doesn't hurt at all.
Face 1 hurts just a little bit.
Face 2 hurts a little more.
Face 3 hurts even more.
Face 4 hurts a whole lot.
Face 5 hurts as much as you can imagine, although you don't have to be crying to feel this bad

But that’s only one problem with the scale because, remember, I said it goes from 0-10? The main problem is that you really have no idea, and neither does any medical professional, exactly how 2 is different from 4 or, on the larger scale, how 6 is less than 10 for example. It’s a dumb, meaningless scale that is much like one of my least favorite scales in clinical trials; the CGIC (Clinical Global Impression of Change) or what I’d rather call it the LMAD Scale (Let’s Make a Deal Scale).

The pain scale is left entirely up to the patient to measure and to make decisions regarding how much they can tolerate. The CGIC is left up to the memory of the clinician as to how much change you’ve exhibited in their OPINION regarding how you responded to the intervention. Both lousy measures that shouldn’t be used anywhere much less in a medical setting.

Oh, sure, you’ll find something on a Google search about a major breakthrough in pain measurement. It involves fMRI (functional magnetic resonance imaging) where they do brain scans to see how much of your brain is lighting up with pain responses. Now a simple question appears to be mandated here. Just how many hospitals and how many clinical settings utilize this fMRI-measuring device? Should I be somewhat fussy here and say I doubt more than a handful in the U.S. and probably no patient that you will ever meet will have had their pain measured in this manner? Sure, why not.

Ever hear any semi-professional or professional tell a patient that’d just have to hang in there until they are due for their next dose of pain medication? A good illustration is the scene in “Terms of Endearment” where Shirley MacLaine screams at the nurses that her daughter needs her medication NOW! Oh, such poor hospital manners!

I remember visiting a patient in a surgical ward and, in the next bed, a woman was telling her physician about the excruciating pain she was feeling. “Well,” the physician said blandly, “you’re going home today and I’ll give you some Tylenol to take with you.” Please, this lady had just two days prior had her abdomen opened, yanked wider open to reveal everything, poked, prodded and pulled and then stitched and now all she got was an OTC med from this empathic woman doc? The patient I was visiting had a morphine pump and she had the exact same surgery. Two docs, both women, two patients, same operation but not the same pain relief they both deserved.

Terminal cancer pain as well as surgical pain is something to be considered carefully, of course. But the first is one where the thought of “addiction” should be quickly tossed out the window where it belongs. When someone is dying don’t they deserve all the pain relief they can get? Would you send a terminal cancer patient to a drug rehab because of their oxy use? Don’t make me laugh. If anything is dark humor or muddled thinking this one surely is.

Pain measurement must come into the 21st century and it should happen quickly and not via sophisticated machinery that no one can afford or cares to get the personnel to use.