Pain... real pain

I will assume that you have suffered pain before. Not emotional pain but real pain. Physical pain that made you cry. Of course, you can remember what happened: no matter how long ago it was.

My pain

For me, I had a most horrible toothache in 1990. The tooth was rotten, infected and wobbly and oh, so painful. It hurt so much that the whole side of my face was red and inflamed. It was as if someone had a blow torch inside my mouth. I took overdoses of the readily available drugs and was even rubbing Paracetamol in my mouth, all to no avail. In the morning, I was the first in the dental clinic, with the singular ambition to get rid of the tooth, by any means necessary. They wanted to save the tooth by performing root canal therapy the next day, but I was not having it. I insisted on an immediate operation and removal of the offending tooth. Yes, I have a gap that meat slips through now, but, believe me, I have no regrets.

The professor’s pain

The professor came to my clinic one fine day. He was in serious pain. His back and both legs were so painful you had to pity him. He had severe arthritis in the spine with pressure on his nerves. He did agree, easily, to an operation on his back. He was in that much pain, he proceeded to have the operation without telling his wife, in case she attempted to persuade him otherwise! He would gladly have subjected himself to an amputation, if it would relieve the pain.

Different strokes

You may think that the professor and I are wimps, who cannot withstand a little pain. But, the pain we had was worse than that of labour. Of course, men also have a higher pain threshold than women. Especially black men, like me: except of course, for my mother in law. She is 80 and suffers from arthritis in the knee. She actually needs a new knee but will not have one, because her pastor says not to. Apparently, she cannot die with an artificial implant in her body. So she bears the pain, daily, every single minute of it. She is one tough cookie and I do not think they make them like that anymore. Sadly though, because of the pain, she does not wish to live long. When you wish her long life, she vehemently refuses to say Amen.

The fact is that everyone copes with pain differently. How are you coping with your pain? How are we managing pain in Nigeria? How should we be managing pain?

How are you coping with your pain?

Understanding your pain and being able to tell the doctor exactly how it is affecting you is important. That means knowing what is happening to your body and how, when, why and where. The way pain is influencing your mood, sleep and life in general is also important for the doctor to understand.

There may be things you can do to make your pain bearable. Talking to family and explaining things to them is important so they can give necessary support. Avoid unnecessary and dangerous drugs, concoctions, processes and procedures, that are unproven and may be harmful is important. Some people have allowed themselves to be scarified in different parts of the body without the pain being solved.

Do some physical activity, if possible, and consider others such as breathing exercises, body scan therapy, physiotherapy, massage, acupuncture, and physical exercises and aerobics therapy. These are known to have many benefits. Apart from improving physical health, other benefits include stress relief, improving sleep and additional benefits from socialising.

How are we managing pain?

Not very well it seems simply from anecdotal experiences. The commoner drugs such as Paracetamol and Ibuprofen, Diclofenac are sometimes misused and abused. There are other drugs such as Amitriptyline, Carbamazepine and Gabapentin which are also not often used to the maximum dose before being substituted. Drug combinations also do not take into consideration, the mode of action and duration of action of the drug. This means that the same types of drugs are used instead of drugs that work through different mechanisms, thus making pain relief more effective. We also have an irrational fear of the pretty strong pain killers due to ‘possible’ complications. The inability to use the drugs in safe mode cause many doctors to avoid them. A patient with terminal cancer was once refused opiates because of the fear of addiction! We do have some drugs but lack easy access to more serious pain killers.

How should we be managing pain in our patients?

It is important to listen to the patient and understand their pain. The history is vital to determine how the pain is affecting their lives and the importance of the pain to them. Pain can be acute or chronic and both can lead to psychological, physical, emotional reactions in the individual. The pain can also be the horrible ‘nociceptive’ pain (the type pain suffered by my mother in law) or the even more horrible ‘neuropathic’ pain (the type of pain suffered by the professor) due to problem with the nerves. Determining which kind of pain it is or whether it is mixed is important. There are different drugs for each type of pain. Before drugs of course, you need to make a firm and solid diagnosis of the underlying cause of the pain. Remove the cause and pain goes away, avoiding the need for drugs!

The way forward

Developing pain clinics and pain specialist services is important. A pain management team is an important group of people that should be in every hospital and are charged with managing serious acute/ chronic pain in patients. Cancer pain, post operative pain and pain without a firm diagnosis are all in the remit of the team. They have special ability and skills in diagnosing and treating pain with multiple arrays of effective therapies. The team is multidisciplinary and involves psychologists and psychotherapists as necessary. The team also has a wide variety of drugs at its disposal.

Their mission is to reduce acute and chronic pain to its least possible level, to restore physical functioning by increasing activity levels and to decrease the psychological impact of pain on the person.

Ask for the pain team in your local hospital.