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Pain & Stress Management
PAIN MANAGEMENT
Betty Ferrell, PhD., R.N.,
F.A.A.N. is a nationally recognised educator in the field of pain management.
She has focused the last years of her research on quality of life issues for
people in pain. The following are some of the highlights from her presentation.
Patients and health care
providers share some of the same barriers to pain management. As patients, we
often fear becoming tolerant to and developing side effects from appropriate
medication. Health care providers often have insufficient knowledge about how to
assess and treat pain because they have little or no training in pain
management. As patients, we often fear becoming tolerant to and developing side
effects from appropriate medication. Health care providers often have
insufficient knowledge about how to assess and treat pain because they have
little or no training in pain management and they have concerns about the
regulation of controlled drugs. Health care providers’ time is often limited,
thus they often respond to objective information such as blood pressure, rather
than subjective quality of life issues, such as chronic pain.
Adequate pain management must be
the central focus of a pain patient’s treatment plan, rather than simply a
targeted concern. Often this is not an easy task, but it can be done if we
follow certain guidelines:
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We must report our pain to our health
care provider.
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We must be believed when we report our
pain.
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We must be cared for by a provider
knowledgeable about pain assessment and management.
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We need access to medication appropriate
for our condition.
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We need a provider who can manage any
side effects we develop.
People in pain are the most
vulnerable people in the world because our inclination is to give up control and
say "do anything to help me". We decrease our vulnerability and improve the
quality of our life by recognising that we have a right to adequate pain relief
– and making that the focus of our treatment plan.
Betty Ferrell discussed other
steps we can take to insure adequate treatment for pain. Listed below are some
of her suggestions: to our health care providers about the quality of our life
using objective information which describes what has happened to use because of
the pain. For example: loss of sleep, poor concentration, depressed feelings.
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Take control of our interaction with
health care providers by making a list of our concerns and focusing on
our top priority items.
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Help our providers obtain a clear pain
history. Describe the character and intensity of our pain, what makes
it better or worse, responses to prior treatment, and the impact the
pain has on our life.
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Write down the information and
instructions our providers give, or better still, take someone with us
and ask them to take notes.
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Keep a self-care log to record the
severity of the pain, the medication we used and its effect, and the
non-medication we used and its effect, and the non-medical
interventions we used and their effects.
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Use non-drug interventions such as heat,
massage, and biofeedback when appropriate.
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Seek help from a patients advocate when
that service is available and necessary.
STRESS MANAGEMENT
Many people with Dystonia have
told me that when they are under stress, their Dystonia symptoms become worse.
My son Michael, who has Dystonia, says that when he is feeling the pressure of a
work deadline as a newspaper editor, he notices that his Dystonia symptoms are
more extreme. My husband has Essential Tremor and when he is stressed, he will
experience much more shakiness. This is not surprising since research has known
for a long time that stress sets off a chain of chemical responses in the body,
and one of the prime targets of stress chemicals are the muscles.
Stress will make muscles contract
and become even more tense, which is not a good thing for Dystonia patients. In
addition, stress is linked to heart disease, immune deficiency, insomnia and
high blood pressure. Stress can also damage our mental well-being, leaving us
more tired, more anxious and depressed. The newest studies show that the effects
of stress are more profound than we have thought. The chemicals that are
released in the body when stress becomes routine can be destructive to our
bodies.
But stress is part of everyday
life and not all stress is bad. Stanford psychiatrist David Spiegel says,
"Living a stress-free life is not a reasonable goal. The goal is to deal with it
actively and effectively". Stress can be a positive force when it is linked to
motivation that makes us feel better or to the excitement and high we feel at an
amusement park or football game.
It is also true that some people
are more stress resistant than others. Researchers have found that "some people
weather devastating experiences like captivity, torture, illness or loss with
uncanny serenity". This was reported in a recent Newsweek cover story on stress.
The article goes on to say that people who are the most stress resistant tend to
"focus on immediate issues rather than global ones".
Identifying stress
It is essential to be able to
recognise your stress in order to do something about it. Hidden stress comes
with the pressure and worries of everyday life. In addition, living with a
chronic illness or living with someone who has a chronic illness produces its
own kind of stress. Sometimes we get so used to the stress and strains we don’t
realise how stressed we really are.
Awareness is always the first
step in changing behaviour. One technique I use to increase awareness when I am
leading a stress reduction workshop is to ask participants to imagine a measure
from 1 to 100. One is the calmest and most relaxed you could be (for me lying in
a hammock on Maui) and 100 is the highest (like a major catastrophe, for me our
last big earthquake). Tight now, yes this moment, ask yourself where you are on
this scale?
This stress scale is by no means
scientific, but it can give you a rough idea where you are in relation to the
continuum.
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