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ADVANCE Perspective: Nurses

No Sadder State: Living With Chronic Nonmalignant Pain

Published February 8, 2013 12:34 PM by Guest Blogger

By Diane Goodman, APRN, BC, MSN-C, CCRN, CNRN

Recent statistics demonstrate that approximately 15% of adults in the U.S. live with various types of chronic nonmalignant pain (median percentage point prevalence, Pain Physician, 2009). Whether this pain stems from diabetic neuropathy, fibromyalgia, disk disease, osteoarthritis, rheumatoid arthritis or a multitude of additional ailments, the patients would tell you that effective management of their discomfort is far from being reality.

Unfortunately, when a patient with chronic nonmalignant pain is seen in the emergency room, or admitted as an inpatient, an acute process that produces pain may be ignored completely or grossly undertreated. Providers erroneously assume the patient is already taking a prescribed analgesic, and that should "cover their needs." What a disappointing, unfortunate state of affairs this attitude perpetuates, for the patient with chronic pain may need more medication as opposed to less when an acute process occurs.

Dealing with pain on a daily basis is a delicate balancing act for the patient who wants to be both functional and comfortable. Not every patient in pain seeks drugs via every opportunity or every specialist. The multitude of patients with chronic nonmalignant pain manages their day-to-day needs by taking enough medication to be able to complete ADLs as well as live an independent life. The majorities of patients with chronic pain do not escalate drug dosages, or shop physicians seeking an arsenal of opioids to ingest at random. Physicians and caregivers apparently still need evidence that this is true.

Recently, I was seen in an emergency department for assessment of chest pain that felt ominously similar to what I had experienced in the past when diagnosed with bilateral pulmonary emboli. As soon as the chest CT was read as negative for thrombi, I was admitted to a telemetry bed for overnight observation. My analgesic orders did not "carry over," so I was neither offered pain medication, nor asked about discomfort for the remainder of my stay, even though I cried out at least once when trying to reposition myself in bed. As this cavalier approach to my physical discomfort grew tiresome, I asked for an analgesic. At that time, I was informed that "nothing had been ordered" and I would have to wait for the hospitalist to call in orders.

How did healthcare arrive at such a sad state of affairs? It would seem appropriate for a patient with a chief complaint of "chest pain" to be assessed and treated for pain once admitted to an acute care facility. Should the patient be allowed to be more uncomfortable than they would be at home? Even at discharge, when asking for a possible muscle relaxant, or alternate agent to ease distress, we were told to check with the primary care physician, who, by the way, was not available at that time.

For once, I felt thoroughly saddened by my peers in the healthcare profession. If I, as a midlevel provider, received such an appalling lack of care related to an acutely painful process, how would an elderly patient fare? What about an ischemic stroke patient, who might not be able to articulate pain? Or a patient who places all trust in their providers, assuming they will be given what is "best" for them, whether they verbalize the need for medication or not?

I cannot stress vehemently enough that not all patients experiencing pain are drug-seeking. Patients on chronic pain medication need to be asked about a pain history, which would include an overview of when and where they usually experience pain. They should be asked to "rate" their pain, as well as to describe how the acute pain differs from what they normally experience. They should be queried about a "pain goal," and what medications have proved to be effective for them in the past. They should not be ignored or assumed to be comfortable by providers who have become apathetic to the needs of patients.

I hope this narrative provides a wake-up call to at least one individual working in healthcare. To paraphrase a quote utilized by pain specialists: pain may be unavoidable, suffering is optional. We can and should do better. I'm angry, disappointed and shaken by my experience, for there is no sadder state than to be provided care by those who have forgotten what "care" should mean. As for my chest pain, the culprit turned out to be a re-injury of previously fractured ribs!


There are many things about the medical system that frustrate me. From the system itself, to funding to finally face to face interaction. I don't know that many health care professionals truly "understand pain". It is probably like me, I was an OP Mental Health therapist and I had no clue when I was treating clients with pain what they were really going through...until I was diagnosed myself. Now I know. It is sad that some of the treatment by physicians is so bad sometimes and also very discouraging. Thank you for sharing this story and sorry that you had to go through it.

Camper Jen February 26, 2013 6:49 PM

I have lived with chronic pain for over 30 years. In the last 10 years, I have deteriorated significantly in health to the point I am now on LTD, have been for 3 years and I won't be able to go back to the job I loved.

I have one doctor who manages my care, and one pharmacy who take care of my prescriptions. Between these two, it's impossible for me to get more than the prescribed amount of drugs. I've never doctor shopped, I've never pharmacy shopped and I've never done anything illegal to get drugs. I've never displayed any sign of agression or hostility or efforts to get "more" than I'm prescribed.

Why do I tell you all of this? So you'll understand that I represent MOST chronic pain patients, the ones who take their medications responsibly, but are still suffering with pain. Now...take that person, put them into a hospital for whatever reason, and ask them if their pain needs are being met. I can almost guarantee you the answer with be NO 9 times out of 10.

I am sick to death of being looked at like a criminal when I've ended up in ER in pain. In three of my last 4 hospitalizations, they were emergency situations that required surgery and all three of them took place within a 6 month period of time. I was completely wrecked, and I looked like an addict. Apparently, that gave the medical personnel the idea that I was an addict, and my pain was not managed appropriately at all. I suffered more in that week than I think I have in the last year or so all together.

I hate being looked at like that. I hate being treated like that. I live a respectful life, I worked in a busy, challenging job and I'm pretty sure I'd be considered a model citizen by anyone else in this town. But not here...not in the ER.

What a shame.

Pamela February 25, 2013 12:38 AM

So wonderfully written..This should be read by all nurses to remind us that not all 'pain patients' are 'drug seeking'

Mallory February 19, 2013 12:00 PM

As a spouse of a long time chronic pain sufferer who became an LPN after many years of dealing with the professionals who did not seem to understand the ramifications of what chronic pain can do to a patient and their families, I applaud the author for her words. Sadly even in the short time I have been an LPN it seems the majority of those I have worked with misunderstood so much about pain and the treatments for it, the life changing potential it has and the difficulty the patient faces as a result. Thank you for sharing this, I hope to share it with many others myself.

Tara, Long Term Care - LPN February 16, 2013 2:24 PM
Diamond Point NY

I am so glad to see this article. I have been in pain for over twenty years. It includes my back, feet and knees. I have never taken more pain medicine than what is prescribed, never Dr shopped and I write down when I take a medication. I am so angry the way patients in pain are sometimes treated. Now the FDA is trying to make it even more difficult for us to get our meds! Why is all of the concern about the abusers?

Janet, Retired February 10, 2013 9:28 PM
Brooksville FL

Thank you so much for this piece! Many people diagnosed with Crohn's disease are not treated for pain when they go to the ER even though the pain is very severe and many of us have multiple surgeries and suffer from bowel obstructions. I am fortunate in that my local ER asks about pain immediately and treats it. It breaks my heart to read about others who aren't as lucky.

Christina February 9, 2013 1:56 AM

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