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Pain: how to communicate it, how to understand it

Author of summary: Claudia Zanini (Swiss Paraplegic Research)
Original article: Maino P, Zanini C. Il dolore tra medico e paziente, come comunicarlo, come comprenderlo. Rivista per le Medical Humanities. 2013;24(7):16-23.
 

When it comes to chronic pain, communication plays a crucial role, because to establish the diagnosis and propose a treatment, the doctor needs a patients' assessment, and because patients attribute importance to doctors' communication skills. It is therefore essential to improve communication and tools that help facilitate it to finally bring together doctors and patients with chronic pain.

What was the aim of this study?

Chronic pain is an increasing problem in today's society. In Europe alone, an estimated one in every five people suffers from it. There are existing guidelines for the treatment of pain and tools for its measurement, however, many studies show that patients with chronic pain are often treated improperly. Nevertheless, finding an appropriate therapy is important, because the consequences associated with chronic pain, such as decreased physical performance, depression, anxiety and insomnia, have an impact not only on the quality of life of the persons, but also on their productivity. In fact, physical disability can cause an economic loss, and an overuse of healthcare services.

In the article, the researchers present reflections on the reasons for inadequate management of patients with pain, and propose ideas to improve the situation.

How did the researchers proceed?

The researchers based their study on data from the scientific literature.

What did the researchers discover?

Main reasons for an inadequate management of patients with pain

Cultural reason: in our society there is an idea that pain is just another part of life. Patients do make an effort to be “good” patients, they try to be stoic and tough it out, until perhaps, the pain has become unbearable, causing them to finally visit a doctor. Furthermore, many religions have attributed pain to be a spiritual dimension that almost makes it desirable, as the means to get closer to the transcendent. In contrast, within the last decade, several international associations and organizations have stated that pain relief is a part of every person's rights and that doctors have to pursue this goal.

Institutional reason: health policies that aim to regulate the use of drugs often reflect societal prejudices and do not seem to distinguish addiction from therapeutic use. In addition, some studies suggest that the training of health professionals often does not reflect the latest scientific knowledge about pain therapy.

Practical reason: doctors and patients have difficulty in communicating and measuring pain. These difficulties are due to the unfeasibility of replacing the evaluation of the patient with the observation of physiological parameters (e.g., a thermometer to measure pain does not exist). Relying on patients' words can be challenging for physicians, who are used to assessing the severity of a health condition from the observation of objective parameters.

Tips for a better management of chronic pain patients

Systematic use of the instruments for the measurement of pain: there are several tools to quantify patients' pain. One of these is the verbal numeric scale of pain, in which patients indicate their pain level by choosing a number (from 0 = no pain to 10 = worst possible pain) that best corresponds to their feelings. Some studies have shown that in Europe only a few doctors actually use these tools. In most cases, the assessment of pain is done through a patient's self-assessment or through a physician's assessment based on the observation of physiological parameters.

Verbal numeric scale of pain (Source: www.vicburns.org.au, The Victorian Adult Burns Service, Alfred Health, Melbourne/AUS)

Ask patients to describe their pain: taking into account that pain assessment is done mostly based off the perception of the patient, it is important that health professionals encourage patients to express themselves freely, by explaining that their assessment is useful to select the most appropriate treatment for them.

Revise some health policies: current health policies hinder the implementation of the World Health Organization's recommendations, which advise the administration of opioids for the treatment of moderate to severe chronic pain. These policies could be revised to allow the medical use of opioids.

What do these findings mean?

When it comes to chronic pain, communication plays a crucial role for two main reasons. The first is related to the fact that communication is an essential instrument in measuring pain: to establish the diagnosis and propose a treatment, the doctor needs a patients' assessment. The second reason is linked to the importance that patients attribute to doctors' communication skills. It is essential that these are systematically developed during medical education programs in order to create a welcoming and comfortable atmosphere for patients and their pain. Communication and tools that help facilitate it could be what it takes to finally bring together doctors and patients with chronic pain.

Communication between doctor and patient (Source: ePharma Summit blog)

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