Thursday, August 18, 2005
Pain treatment is now a routine part of medical care

By Dr. Anthony Policastro
Medical Director
Nanticoke Memorial Hospital

Pain accompanies many medical conditions. It is so common that many pain experts feel that patients should be asked whether they have pain or not for almost any visit to the doctor. If a patient indicates that he/she does have pain, other questions will follow. One of these has to do with how bad the pain is. This is called intensity of the pain. It is usually measured on a numerical scale. One common scale runs from 0 to 10. Zero is when someone has no pain. One refers to the presence of mild pain. Ten is the worst pain imaginable. Five and six are mid range. The other numbers are somewhere in between. Since each person has a different perception of pain, some people with exactly the same pain might give two different numbers. That really does not matter. The purpose of the number is to allow the physician to see if the number gets better after pain medication is provided. It offers a way of measuring how bad each individual thinks his /her pain is. There are certain expectations that patients should have for pain treatment. These are new expectations. We did not always pay attention to pain like we do today. The first expectation is that someone will ask you about pain. This should happen routinely. This should happen if you have a procedure that has pain associated with it. If you have pain and someone does not ask, you should let the medical personnel know. The second expectation is that if you have pain, it will be treated. There are a lot of different ways of treating pain. Sometimes mild pain can be treated with distraction. Watching a good movie might make you forget about a mild pain. Sometimes moving to a different position might help the pain. Sometimes putting on a dressing or bandage may make pain better. Sometimes, however, medication is needed. In the same way that two people might give a different number level to the same pain, people might respond differently to treatments for the same type of pain. We need to see what works best for each patient. The third expectation is that your pain will be treated to a level that is comfortable to you. Some people might say that their pain level is a 2 or a 3, but feel that it is so low that they do not want treatment. Others may not be comfortable unless their pain level is down to zero. You should expect that the individuals treating your pain ask these kinds of questions. They need to know what your pain level is now. They need to know what your pain level is after treatment.

They need to know what pain level is acceptable to you. They need to know if your pain level is down to where it is acceptable. They cannot know these things if you do not tell them. There are times when patients are not conscious. Very young children cannot easily communicate how much pain they are in. Because of this, special pain scales have been developed. The scales look at the kinds of reactions these patients have. Those reactions are put on a scale that also goes from 1 to 10. A good example of this is newborn circumcision. For years, no pain medication was given for circumcision. The thought was that newborns do not sense pain in the same way. That is not true. During circumcision, blood pressure and pulse rate go up because of pain. We found that we could use novocaine to eliminate those changes. So now we do circumcisions with a nerve block. This is similar to what the dentist does with novocaine. Patients should expect this as well. There are many procedures that we now do that cause pain and discomfort. In the past, they often were done in a painful fashion or required anesthesia. We now are able to do what is called conscious sedation. The patient is given medication that makes him/her awake and cooperative with the procedure. However, the medication creates amnesia for the procedure. So even if the patient is uncomfortable during the procedure, they do not remember it afterward. The medical profession has changed its approach to pain tremendously over the last few years. Patients need to change their expectations with that. They should expect to be asked about pain. They should expect to be treated for that pain. They should expect that treatment to be successful. If that does not happen, they need to make sure someone knows about it.