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?

These are partially WRONG

There is, almost always, a real problem behind the aches and pains (Partners Against Pain).

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.”

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 forTwo scenarios

Able to communicate but does not communicate

Unable to communicate

- Older person has become unusually flushed, pale or clammy

- Increased heart rate

- Verbally abusive

- 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.

COMMUNICATIONo 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 CONTINUEDOften, 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 HEALINGA 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 Careoften provided in home or long-term care facility; services provided on an intermittent basis according to need

• Inpatient Caredesigned for short-term, acute needs; inpatient units or hospital

• Respite Careprovides short-term relief to patient’s caregivers by transferring patient to hospice for up to five days

• Continuous CareProvided 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 YorkTelephone Number: 1-800-675-0391

www.vnsny.orgProvides proactive symptom management to individuals in advanced stages

of illness

Hospice of New York

Telephone Number: 1-718-472-1999www.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 OrganizationTelephone Number: 1-800-658-8898; Multilingual HelpLine: 1-877-658-8896

www.nhpco.orgProvides 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 StateTelephone Number: 1-518-446-1483

www.hpcanys.orgProvides 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)

IssuesMoral, 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 ConQuality 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 numbersEzekiel 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).

MAY YOU BE FREE FROM PAIN

Thank you all for coming!!