Understanding Pain: How Has The Pain Affected Function?

The success of pain management often depends on realistic expectations for the possible results and an appreciation for improvement throughout the course of treatment, rather than expecting complete resolution of pain as the only acceptable goal.

Depending on the severity of the condition that underlies the pain, the likelihood of curing the underlying condition and the time that the pain has been endured, varying levels of improvement may be expected.

For those who have endured many attempts at pain control with several health care providers and who have suffered for many years, the likelihood of complete elimination of pain is very rare indeed.

However, with patience and proper comprehensive treatment, the vast majority of the pain sufferers can realize significant improvement in their pain. The level of improvement is determined to a large degree by a combination of conditions.

• The first is how successfully an appropriate treatment regimen is identified.
• The second is the individual’s ability to tolerate and participate in treatment.
• The third is how effective the treatment is for the individual being treated.

Ultimately, however, success is determined by how the individual receiving treatment perceives the response. Much of what determines success depends on the degree to which pain initially controlled the patient’s life when compared to the amount of control regained by the patient.

To provide a framework on which to build, the pain sufferers should provide information about his level of functioning prior to the onset of his pain. If he was unable to play piano prior to developing pain, it is not likely that pain relief alone will make that skill possible. During recovery, it is important to identify the point from which one is starting and to set short-term goals that are likely to be attainable as benchmarks of progress during treatment.

Perhaps someone’s initial goal is to walk 50 feet, then 50 yards, then a mile; or perhaps it is to be comfortable enough to see a son or daughter graduate from college or get married. The goals should be realistic and especially important to the one trying to achieve them.

The psychological aspects of pain play a significant role in treatment failure and successes. Problems such as depression (which is frequently present in individuals who have suffered pain for longer than 6 months), anger, irritability and frustration that often lie unrecognized beneath the surface are conditions that perpetuate pain.

For many who suffer chronic pain, an underlying grief must be dealt with in order to move on to relief. The grief is most profound because it represents the loss of oneself, one’s identity, or an image of who one was meant to be. Along similar lines, consideration must be given to the fact that not only affects the person who feels it directly, but affects all individuals with whom the suffer has contact—spouse, family, friends and co-workers.

Thus, the psychological concerns for both the sufferer and his social relations are important to identify and to address if the best results are to be achieved.

Pages 19-20, Understanding Pain: What It Is, Why It Happens and How It’s Managed. Harry J. Gould III, MD, PhD.