Coping with Pain

Studies published in America's most respected medical journals over the last 30 years have recognized that pain is often under treated, even ignored.

One, two, three, four.

Forcing changes in every hospital, nursing home, and clinic in the United States. And that's just the beginning. On a scale of one to ten, how is your pain now? Ten is the absolute worst you can imagine and zero is none.

Medical facilities must use this zero to ten scale to assess pain regularly, just the way they record a patient's vital signs. Then they must control that pain to the best of their ability, or risk losing their accreditation. The new standards have been described as the Bill of Rights for pain sufferers.

And your pain level is where on a scale of one to ten?

Right about A three. About a three, OK.

What is pain? Pain is whatever the experiencing person says it is.

No pain? Good.

Sheila Gleason helps supervise the post operative unit at Moffitt-Long Hospital, which is part of the University of California, San Francisco. UCSF is one of the world's leading centers for pain.

So we haven't seen anybody screaming. Why is that?

Well, you know what? Our anesthesiologists are very aggressive about giving people pain medicine in surgery. So lots of times when they come out, they don't even have pain. It's a traumatic experience that people do not need to have anymore.

In fact, according to Gleason, the more pain you're in, the slower your recovery, as she had to tell a patient recently who was refusing pain medication.

I said, you know, you don't have to deal with it. I said, your goals today are that you have to be able to walk and take deep breaths. I want you take a deep breath for me right now. Can you do it? And he couldn't do it. And so he said, OK. I'll take my pain medicine.

But under treating pain can have much bigger consequences.

The more doctors have learned about the nervous system, the more they've come to realize that if they don't treat acute pain quickly and aggressively, the more likely it is they may actually cause that pain to become permanent.

Don't be a stoic. I think the person who says, well I can handle it. I'll put up with it. I can live with it. I think that's a mistake. Think of pain as a disease, not a symptom. Allan Basbaum heads the Department of Anatomy at the University of California San Francisco.

When pain persists or when injury persists, input continues into the spinal cord. And there are changes that take place in the sensitivity of the spinal cord. If you will, and the word I like to use is, there's a memory of the experience.

Doctors now know that the spinal cord literally rewires itself and tells the brain there is pain, even after there shouldn't be any. The goal is to eliminate pain messages to the spinal cord before the process has a chance to get started.

It's really—it's a shame. And I think that if more doctors suffered from a chronic pain condition themselves, it would probably not be such a bad thing. Because they would understand that—

Dr. Pamela Palmer is Director of UCSF's Pain Management Center. What a lot of patients come in and say is it's not so much the pain that's bothering them. It's that they can't live their life.

Now let's say—

Last night, I fell asleep. I was crying. I'm a big person. I don't cry easily.

Bob Simon was a physical education teacher for 30 years, a baseball coach, when his spine began to disintegrate. After the two back surgeries that were supposed to fix it, he was left in harrowing pain.

It changes every nuance of one's life. One's relations with one's wife, to just getting dressed in the morning.

Managing your drugs effectively, maximizing pain relief, minimizing side effects.

Before he found his way to Dr. Palmer at the Pain Management Center, his doctors had him on dozens of pills a day, heavy duty morphine based painkillers.

He couldn't even drive. And you say to me, they're helping a little bit. But I can't handle the side effects. I can't drive. I can't remember where I put my keys.

Dr. Palmer took him off most of those drugs and substituted a pain pump, surgically implanted under his skin. It delivers a preprogrammed level of morphine and other medications directly to wear his pain is. Simon remains clear headed and gets more relief on less morphine.

Thank God for the morphine pump and for all the other things they've discovered to help manage the pain.

As Susan [INAUDIBLE] learned, management of excruciating spinal pain involves a whole list of things. Spinal nerve blocks, physical therapy, psychotherapy, even acupuncture and biofeedback. But it was her reliance on morphine, she says, that caused her husband to walk out on what had appeared to be the perfect 26 year marriage.

I can remember him saying one day, I would never take morphine. And I looked back at him and said, you have no clue what you would do if your body was on fire 24 hours a day. He viewed using morphine and pain management as a moralistic judgment.

In other words, you were weak because you couldn't stand the pain?

I was weak.