Pain: don't take it lying down
by Kristine Berey
Peter M. is weeks shy of his 80th birthday. Though he knows his children are planning an especially elaborate party for him this year, his joyful anticipation is marred by the dread of climbing the long set of stairs leading to his son's 2nd floor residence.
After minor knee surgery that was supposed to alleviate knee pain due to his osteo-arthritis, Peter still wakes in the early hours in agony. Lately, his “good” knee has started to ache. He has an upcoming appointment with his family doctor, but he's been told the next visit can be only in three months. Until then, having neglected to mention that he is in pain NOW, he waits in silence.
Although “Peter” is a fictitious name, the pain described is all too real. The importance of chronic pain should not be underestimated, says Dr. David Lussier, spokesperson for the International Association for the Study of Pain for Global Year in Older Persons and Director of the Geriatric Pain Clinic, McGill University Health Center.
“People are not aware that older people have chronic pain because they don't complain about it,” Lussier says. “Between 50% and 75% of older persons in the community are affected.”
But doctors care about what you feel and being silent and uncomplaining is exactly what not to do, says Dr. Aline Boulanger, who sits on a government advisory committee on the national development of pain clinics. Boulanger is a founding member of the Quebec Chronic Pain Association and president of the Quebec Pain Society, that recently held a conference dedicated to the problem of pain in older people. “We expected about 150 people,” Boulanger said. “The week before, 180 were registered and we had to stop at 225.” Many participants were general practitioners, Boulanger said.
Medical students now receive a mere four hours of training dedicated specifically to pain, out of their five years at medical school. But Boulanger and Lussier both say that is in the process of changing, as the need to address chronic pain becomes more evident to patients, family members and health professionals.
“The training we get in medical school is very limited because pain belongs to several specialties and is not a specialty in itself. “Everybody sees pain in their practice but nobody has special training in how to treat it,” Lussier said.
Until now, the rationale has been that, by treating the illness that causes it, you treat the pain. But as increasing numbers of people suffer from chronic pain from multiple causes, it should be seen not as a symptom but as an illness in itself, according to the Quebec Pain Society. “Acute pain has a protective function,” Lussier explains. “Chronic pain doesn't have a role and becomes an illness that can affect all your life.”
With the recent headlines about Vioxx and NSAIDs, both patients and doctors are less inclined to turn to medications for relief. All medicines can have secondary effects, even those sold over the counter, and it is always a good idea to discuss your situation with your pharmacist. “But pain has side effects too,” Boulanger says. “Pain provokes depression, interferes with work and your relationships and can seriously affect your quality of life. These things must be discussed; it's important to speak up and weigh the advantages and disadvantages in each individual case.” Dealing with chronic pain is a challenge not only for the patient but for the family and society, Boulanger says.
There is a body of knowledge that exists and is increasingly growing, on pain management, including pharmacological and alternative treatments. “Physiotherapy, exercise and massage can be very good,” says Lussier. “Swimming is excellent, because of the lack of gravity. Just being in the water is one of the best exercises.”
Acupuncture can be beneficial for some people, Lussier says, as can hypnosis and self-hypnosis, whose benefits in relieving the intensity of pain have been documented. “There is nothing esoteric about it,” Lussier says. There are also topical remedies, such as a gel dentists use called Lidocaine.
Cognitive psychological techniques have been successfully used in managing chronic pain as well. “If you always focus on pain, it gets worse. If you focus on something else, pain gets better. In studies we see that the way pain is felt in the brain changes brain circuitry.”
Boulanger says that as the population ages, the need for effective pain management rises. It is important that patients mobilize, as the problem is becoming not only medical but political. More research, better education and more access to treatment are needed.
Pain shouldn't be considered a “normal” part of aging if it means that it will be ignored. While there are no guarantees, pain can be prevented totally or partially, or diminished to the degree that people can still lead fulfilling lives. Your doctor can refer you to a pain clinic at several hospitals in Montreal. “Patients tell us that their pain is much better, that it is no longer constant, that they can go on with their regular activities,” Lussier says.
The Montreal General Hospital's Pain Clinic can be reached at: (514) 934-8286. For information about the Quebec Pain Society, visit: www.sqd.ca
