Pain Recovery for Families. Robert Hunter

are countless examples of how these factors can influence a person’s perception of pain. For instance, studies have identified a number of gender differences regarding pain perception. Women are likely to experience pain more often and with greater intensity, while men are less likely to seek help for and express their pain (suffering in silence with a “stiff upper lip”). Attitudes toward and expressions of pain also vary among different cultures. For example, Western cultures tend to have a much lower threshold for pain than some Asian cultures, where pain is viewed as having spiritual meaning.

      Prior painful experiences can also influence pain perception. Jim expected to have so much pain at a family picnic, because he had previously, that he just refused to get up and go with Mary and the kids—another serious disappointment for this damaged family. In fact, Jim would come to learn that believing that his pain would be worse based on the last time he was up and around for four hours actually created more pain for him and more suffering for his family.

      And just as the experience of pain is entirely subjective for Jim, the responses of Mary and the kids (and other family, friends, coworkers) to his pain vary widely.

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       Pain Is Subjective _____________________________________________

      Describe how the personal factors listed on the previous page may have affected _______________’s experience of pain. Include any factors not listed that you believe affected his or her pain.

      Describe your personal issues and assumptions about pain. How do these things affect your feelings about _______________’s pain?

       Manifestations of Chronic Pain

      Chronic pain can be a troublesome annoyance or a devastating curse that interrupts life functions, relationships, employment, and most things in life that bring people satisfaction. In Jim’s case, it took over his life and the lives of his family, it consumed them, and it threatened Jim’s well-being and the well-being of Mary, Mandi, and Ross. For Amy, traditional pain management (medication and physical interventions) did not help sufficiently. She developed a constellation of troubling symptoms.

       Pain Manifestations ___________________________________________

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      Here is a list of some of the manifestations of chronic pain. Please check off those you believe _______________ has experienced.

      ____ Pain that has lasted for more than six months.

      ____ Feelings of depression, anger, worry, discouragement, and irritability.

      ____ Sleep difficulties.

      ____ Financial problems.

      ____ Problems relating to others, causing significant disturbance in relationships.

      ____ Inability to tolerate physical activities.

      ____ Withdrawal from social activities.

      ____ Inability to concentrate.

      ____ Poor memory.

      ____ Isolation from support systems, including family, friends, and coworkers.

      ____ A decrease in sexual activity or performance.

      ____ A decrease in self-esteem.

      ____ Secondary physical problems.

      ____ Problematic use of pain medications and/or alcohol or addiction.

      ____ Avoiding work and leisure activities.

      ____ Negative attitudes concerning everyday life.

      ____ Other: __________________________________________________________

      _________________________________________________________________

      Write about the feelings that come up as you review this list.

       The Pitfalls of Pain Management

      Traditional pain management uses a multitude of interventions, including medications. Opioid medications are the primary drugs used to treat chronic pain and are often the cornerstone of pain management. Unfortunately, they carry with them a potential for side effects, decrease in function, and the development of dependence and addiction. The side effects of opioids may include cloudy thinking, drowsiness, depression, and sleep disturbance. In women, opioids and chronic pain can lower estrogen levels, even leading to early menopause and osteoporosis.

      In some cases, increasing the dose of opioids can actually cause more pain, a phenomenon known as opioid-induced hyperalgesia (OIH) that occurs in some people who are on long-term opioids. The proper treatment of OIH is to discontinue opioid medications under medical supervision so the brain can “reset” and eliminate the hyperalgesic effect of the drugs.

      It may amaze you to know that there are no scientifically reliable studies that justify the use of opioids for longer than three months, even though use of that length is standard operating procedure for treatment of chronic pain. There are a number of reasons for this disparity, but probably the best explanation is that opioids offer temporary relief to a permanent problem that is complex and difficult to treat. Doctors and drug companies have created an industry that promotes these powerful drugs for chronic pain, even though for many that is not the best course. Many people say they would never have started taking prescribed pain medication if they had known how much havoc it could wreak in their lives.

      Additionally, as in Amy’s case, painkillers are frequently prescribed in conjunction with other habit-forming medications, such as muscle relaxants (specifically Soma), stimulants used for sleepiness caused by the opioids, antianxiety drugs, and sleeping pills. The use of medications to treat the effects of other medications can be extremely frustrating for people with chronic pain and their families. Amy ended up on so many medications that her quality of life was severely compromised, and she still had significant pain. As a nurse, Mary certainly knew that Jim was no longer benefiting from his medications, but felt helpless to change anything. After all, “he’s in pain and can’t stop them,” or so Jim told her whenever she brought it up.

      Many medications are not habit-forming and may be prescribed as part of a pain management plan; these include muscle relaxants, antiseizure medicines, and antidepressants. Pain management also often includes invasive procedures such as injections (epidurals, facet blocks, and others) and surgeries, as well as nonmedication and nonsurgical techniques such as acupuncture, chiropractic, physical therapy, massage, and hydrotherapy.

       Prescription Pain Medications

      We’ve described potential problems with taking opioids for chronic pain. Here are the names of medications in this class and other classes of drugs with habit-forming potential:

      Table 1.1a

      There are a number of nonopioid medications that are used to decrease pain. Here’s a partial list:

      Table 1.1b

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