Transcript Document

WELCOME ALL!
Previously on CWA seminar
FREE FROM PAIN
April 17, 2012
Part 1 – What is pain?
What is physical pain?
“Sensation of discomfort, distress,
or agony, resulting from the
stimulation of specialized nerve
endings. It serves as a protective
mechanism (induces the sufferer
to remove or withdraw).” –
http://www.doctorsforpain.com/
What should we tell our doctors?
L: Location of the pain and whether it travels to other body
parts.
O: Other associated symptoms such as nausea, numbness, or
weakness.
C: Character of the pain, whether it's throbbing, sharp, dull, or
burning.
A: Aggravating and alleviating factors. What makes the pain
better or worse?
T: Timing of the pain, how long it lasts, is it constant or
intermittent?
E: Environment where the pain occurs, for example, while
working or at home.
S: Severity of the pain. Use a 0-to-10 pain scale from no pain to
worst ever.
- American Pain Foundation
Location
Timing
• Duration
– Acute: less than 30 days
– Chronic: more than 6 months
– Recurrent acute pain: episodes
of pain over time
Further tests may include:
•
•
•
•
Physical exam, e.g., soreness
Neurologic exam, e.g., reflexes
Mental health exam
Other diagnostic tests, e.g., blood tests, X-rays
The doctor may then identify the
cause of the pain.
Nociceptive Pain
• Caused by real or potential
damage to tissues
• Usually acute, when tissue
damage heals, pain resolves
• Painkillers work
• Somatic: bone, joint,
muscle, skin, or connective
tissue – usually throbbing
• Visceral, i.e., internal organs
Neuropathic
• Malfunction in the central
or peripheral nervous
system
• Usually chronic, not fully
reversible
• Traditional painkillers do
not work
• E.g., phantom pains,
migraines, pinched nerves
WHEN SHOULD YOU GO TO THE
DOCTOR?
Part 2- Pain in the elderly
Is it normal to have pain as we age?
Some say pain is
natural with old
age.
Some say when
older people are
not clear in
explaining the
cause of their pain,
they are “just
complaining.”
These are partially WRONG
There is, almost always, a real problem behind
the aches and pains (Partners Against Pain).
Assessing the pain is the most
challenging part for older people
Older people don’t always express
their pain.
They might become grumpy or
aggressive due to pain. Try to
understand them.
How to find out if the senior is in
pain?
Caregivers and family members should
be alert at all times.
1. Know your senior well.
2. Ask about pain in several forms.
3. Remember that if something can be
expected to be painful, it probably
is.
4. Observe the older person’s
behaviors.
Symptoms to look for
Two scenarios
Able to communicate but
does not communicate
- Older person has
become
unusually
flushed, pale or
clammy
- Increased heart
rate
- Verbally abusive
Unable to
communicate
- Moaning
- Loss of appetite
- Change in sleep
patterns
- Difficulty moving
- Not wanting to
be touched in a
particular place
Source: Elder Care Team
Most common types of pain for older
people?
HIP (arthritis, bursitis, hip fracture, muscle strains)
KNEE (Osteoarthritis)
LOWER BACK (narrowing of the spinal canal,
disks become drier)
Part 2- How to cope with pain?
COPING WITH PAIN
An elderly couple doing a laughing
exercise: research has shown that laughter
can help relieve pain and even strengthen
immunity!
THE INDIVIDUAL
As we age, it is important that we use our powers of
observation and stay attuned to continual changes
within ourselves. Practice self-awareness.
a) Do I see physical changes? E.g., flushed or pale
skin and increased breathing rates.
b) Do I see changes in behavior? E.g., rigid
posture, loss of appetite, changes in sleeping
patterns and irritability.
THE CONSEQUENCES
Pain is more than just hurting. It can decrease your
physical, emotional , social and spiritual well-being in
different ways.
How has physical pain affected your life?
o You may be unable to concentrate on anything
except pain.
o You may experience social exclusion.
COMMUNICATION
o By having your perspective voiced, others can
empathize more effectively and understand your
reasons for not participating in certain daily
activities.
o However, pain does not mean confinement. You can
ask others to join you in activities that not only serve
to help your physical pain but create a mutual
bonding time. E.g., yoga at the park or therapeutic
massages at a wellness clinic.
COMMUNICATION CONTINUED
Often, we become complacent
with the attention and care we
receive from our doctors or
physical therapists. We should
always look at our reports and see
if there are any discrepancies or if
there are measures we can take to
avoid future complications.
Emphasize preventative medicine!
Do some
research!
Ask
questions!
Be
respectful!
“Are there any other symptoms I should be
aware of that could indicate a more serious
condition? “
CONVENTIONAL TREATMENT
o Milder forms of pain may be relieved by over-the-counter
medications such as nonsteroidal anti-inflammatory
drugs.
o Doctors may prescribe stronger medications such as
muscle relaxants or trigger point injections.
o However, it is important that you follow medication
protocols strictly; start off with low dosages if
permissible, and are aware of the potential side effects or
interactions.
HOLISTIC HEALING
A multidisciplinary approach with holistic treatments can
prove to be helpful and carries along with it fewer side
effects.
o Try swimming, rowing, walking, biking, rebounding,
yoga and even meditation. The release of endorphins
is the body’s natural painkiller!
o Massage can reduce stress and relieve tension by
increasing blood flow and decrease certain chemicals
that may generate pain in the body.
o Incorporating anti-inflammatory foods in your diet
can help pain by decreasing inflammation in the body.
E.g., wild salmon, cruciferous vegetables, berries and
turmeric.
Part 4– Palliative Care
What is Palliative Care?
• specialized medical care for
people with serious illnesses,
regardless of life expectancy
• provides patients with relief from
symptoms, pain and stress.
• improves quality of life for the
patient and the family
• palliative care and curative care
may be received at the same time
What Does a Palliative Care Team
Provide?
• time for close communication
• expert management of pain and other symptoms
• help navigating the healthcare system
• guidance with difficult and complex treatment choices
• emotional and spiritual support for you and your family
What is Hospice Care?
• specialized medical care for
people with a life expectancy
measured in months not years
• provides patients with relief from
symptoms, pain and stress
• a team of doctors, nurses, social
workers, home health aides, and
family provide end-of-life care
• all treatments and medicines
provided by hospice
Four Levels of Hospice Care
• Routine Home Care
often provided in home or long-term care facility; services provided on
an intermittent basis according to need
• Inpatient Care
designed for short-term, acute needs; inpatient units or hospital
• Respite Care
provides short-term relief to patient’s caregivers by transferring patient
to hospice for up to five days
• Continuous Care
Provided in residential setting when patient is in crisis and symptoms
not manageable with routine care
Statistics
• in 2009, both programs service an estimated 1.56 million
patients and families.
• more than 5,000 hospices participate in the Medicare
program in the U.S.
• Medicare Hospice Benefit, enacted by Congress in 1982, is
primary source of payment for hospice care
• in 2007 mean survival for hospice patients was 29 days longer
than nonhospice patients; in 2010 median survival patients
getting palliative care was 2.7 months longer
RESOURCES
Visiting Nurse Service of New York
Telephone Number: 1-800-675-0391
www.vnsny.org
Provides proactive symptom management to individuals in advanced stages
of illness
Hospice of New York
Telephone Number: 1-718-472-1999
www.hospiceny.com
Provides care; licensed by the State of New York and Certified by the Medicare
Program; accredited by the Community Health Accreditation Program
RESOURCES
National Hospice and Palliative Care Organization
Telephone Number: 1-800-658-8898; Multilingual HelpLine: 1-877-658-8896
www.nhpco.org
Provides free consumer information on hospice care and puts the public in
direct connect with hospice programs; service available in over 200 languages
Hospice and Palliative Care Association of New York State
Telephone Number: 1-518-446-1483
www.hpcanys.org
Provides the public and members with information about end-of-life-care;
promotes availability and accessibility of quality hospice and palliative care
for all persons in New York State
Part 5 – Other ways of ending the
pain – ending life?
Some vocabulary
• Physician aid-in-dying (PAD) = assisted suicide.
Requires the patient to self-administer a lethal dose of
medication and to determine whether and when to do this.
• Euthanasia
Entails the physician or another third party administering the
medication.
– Passive euthanasia
Withholding of common treatments necessary for the continuance of
life.
– Active euthanasia
Use of lethal substances or forces.
Legal aspect
Aid in dying is legal in the US states of
Washington, Oregon and Montana, and
in Switzerland where deadly drugs may
be prescribed to a Swiss person or to a
foreigner, where the recipient takes an
active role in the drug administration.
Active euthanasia is only legal in
the Netherlands, Belgium and
Luxembourg.
Passive euthanasia can occur in the US
since patients can refuse treatment
(example : Do Not Resuscitate)
Issues
Moral, ethical and religious issues surround the end of life and
management of pain.
The term “assisted suicide” was replaced by “aid in dying” because
of its negative connotation.
Pro
Con
Quality of life
Sanctity of life
Choice
Risk of abuse
Doctors should help
Doctors should save
Dignity (contrary to suicide)
We know how to ease pain
Choice made by sane person
Dying patients not always rational
Health care cost containment
Interesting studies and numbers
Ezekiel Emanuel, an American bioethicist conducted a study
among cancer patients in Boston. He found that unbearable
physical agony is almost never the reason patients give for seeking
end of life. Depression and other forms of mental distress were by
far the more common motivator.
According to the May 2007 Gallup poll, 49% of Americans say
doctor-assisted suicide is morally acceptable, while 44% say it is
morally wrong.
In France, passive euthanasia was legalized in 2005. According to a
March 2012 survey, 91% of French people want active euthanasia
to be legalized. However, 51% of them think it should be limited to
patients suffering from extreme pain that medicine can not ease.
Interesting studies and numbers
The Journal of Medical Ethics published a study
in 2008 showing that 34% of people who had
resorted to assisted suicide in Switzerland,
including youth under the age of 30, were not
suffering from a fatal illness.
“Death tourism” in Switzerland is an
increasing problem, with the majority of
prescriptions given to foreigners from
neighboring countries (mostly France,
Germany and the UK).
Thank you all for coming!!
MAY YOU BE FREE FROM PAIN