In the country of pain we are each alone.
May Sarton
My mother has been in pain with osteoarthritis for many years. She had her first joint replacement - a hip - more than ten years ago. Since then the other hip, both knees, and both shoulders have been replaced. She also has lower back pain that waxes and wanes. Sadly, most of what she has done to deal with this pain has been to take narcotic (opiod) pain relievers. Vicodin, Percocet, Morphine, she's taken them all. Of course, she didn't go out to find these medications, they were prescribed by a series of doctors: sometimes appropriately and sometimes inappropriately. The overdose rate is rising in chronic pain patients. In fact, a recent report from the Centers for Disease Control (CDC) shows that the risk of overdose is higher for people on prescription pain meds than it is for either heroin or cocaine. And, unfortunately for those who deal with chronic pain on a daily basis, like my mother, the likelihood of prescription drug addiction is high. Many of these people, not surprisingly, are seniors - as the percentage of the population over 65 is growing by leaps and bounds.
As doctors and scientists learn more about chronic pain, they are coming to realize that chronic pain is a disease in its own right. As a disease/condition it needs to be treated with more than just pain medications. Sadly, pain medication is the default for most patients when they're in a hospital or nursing home. Right now, my Mom is at about the maximum dosage of morphine that she can be on. Whether it's safe or not, remains to be seen. Even worse, it doesn't even seem to stop her pain. From what I can tell, as a non-professional, a large part of the reason that the pain meds aren't working has to do with the fact that, right now, Mom isn't moving much and her muscles are tense from stress and anxiety. Plus, she has cognitive decline related to the high dose of medications she's on and chronic pain. This leads to perseveration, a constant repetition of questions or requests that can be annoying, to say the least. What this all means is that it's difficult to tell how much pain Mom is actually in and, to what extent, more opiod pain meds will even help. Her pain is a perfect storm and drugs are the only thing she believes will end that storm. Sadly, in her overdrugged painful state her concerns begin to sound like a broken record. "I''m in pain, I'm suffering. I'm afraid. When do I get my next medicine?" she repeats over and over, sometimes saying the same thing every minute or two. She is particularly fixated on when she gets her next pain meds and, no matter how many times we explain that the meds are at their max, she keeps asking for more.
Two days ago, Mom was discharged from the hospital and returned to the Rehab Centre. I hope that once Mom is settled back in at the Rehab Center, the physical therapists will resume therapy with her and use other modalities, such as heat and ice and stretches to help with her pain. Acupuncture is another alternative pain relief technique that is becoming more popular in North America.
(Accupuncture, photo Wonderlane, flickr)
A good place to get started finding out more about other ways of dealing with chronic pain besides overmedication is Mindfulness and Chronic Pain by Jon Kabatt-Zin.
I'm going to try and get my hands on a copy and, hopefully, have more tips soon for the many caregivers out there dealing with chronic pain in either the people they care for or themselves, or in some cases, both. Pain is definitely one of the toughest parts of caregiving because nobody wants to see their loved ones or clients in pain. Short term solutions, however, can make long term pain worse or even endanger the life of the patient.
More later.
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