Anyone who’s suffered through prolonged pain knows how much it impacts their ability to enjoy life, interferes with daily tasks and obligations, and even affects their personality. It is profoundly difficult to live life on your terms when you’re besieged by pain without relief.
But no matter the source, severity or longevity of pain, there are medical professionals whose practice focuses on effectively managing it to deliver the best possible quality of life, which is always the primary goal.
Persistent pain presents itself for all manner of reasons in countless different ways. Some is temporary, like an injury that will eventually heal if it’s handled properly. Some is prolonged or conditional, like the result of chemotherapy treatment or managing a diabetes diagnosis. And some has its roots in a terminal condition, which then demands palliative and end-of-life care.
The science of helping people of all ages and needs manage their chronic pain is an interdisciplinary branch of medicine that calls on a group of professionals’ expertise to deliver a treatment individualized to each patient’s wants, goals and circumstances.
It is an expansive topic that’s tough to drill down into generalities, says Dr. Andrew Kaufman, the current executive director of the New Jersey Society of Interventional Pain Physicians. But no matter the patient, helping them begins with an assessment or diagnosis to get to the source of the problem and begin their road to treatment with as much accuracy as possible.
“In the broadest strokes, we are diagnosticians as well as pain management physicians,” he explains.
Treating the Whole Patient
In a perfect world, if the source of pain isn’t immediately identifiable, a diagnosis identifies the offending issue so the team of physicians, psychologists, physical therapists and other professionals working with a patient can begin treating the root cause instead of just managing symptoms as they arise.
“We need to try to find the etiology of the problem,” Kaufman says. “That may include a referral to another doctor, very specific tests, or X-rays, MRIs or CT scans because we may need to gather more information. Or we may initiate modality work, such as physical therapy.”
He continues, “When specific tests are performed and we make more specific diagnoses, we may be able to offer you interventional procedures such as epidural injections or nerve blocks, which may be therapeutic and/or diagnostic. There are more advanced treatments for disease states, such as implantation of spinal cord stimulators, which modulates signals in the spinal canal, or even peripheral nerve stimulators, which are placed in over the nerves themselves and that also send electrical signals from modified signaling.”
That holistic approach to managing the entire patient is what Dr. Stephen Goldfine, chief medical officer at Samaritan, refers to as diminishing their “total pain.”
“Total pain is something we talk about a lot in hospice,” he says. “In my world, pain is not just physical: It’s emotional and spiritual and possibly financial, there’s so many reasons why people have pain syndromes. If we don’t address all of those spheres of care, then we don’t get to that comfort for the patient.”
And with the manifestation of pain being as much of a variable as anything else unique to an individual, there need to be different avenues of addressing all its causes made available to the patient so they can be aware of all their options.
“If a patient has cancer and they haven’t adapted to the reality of being in their terminal time—they’re not ready to die—then we use some therapeutic options like counseling with our social workers. There’s even things like music therapy and massage therapy and things that may help with some of the nonphysical, emotional component of that pain syndrome. If you don’t deal with that, then you’re not really taking care of the entire, total person.”
The Effects of the Opioid Crisis
A rising trend of patients demonstrating either a misuse of or addiction to opioids—ranging from prescription pain relievers, heroin and synthetic opioids like the increasingly headline-making fentanyl—correlates to an alarming increase of opioid-related overdose deaths that have come in three distinct waves since their increased prescription in the ’90s.
It is perhaps the natural result of medications being the first line of defense for so long when they should have been prescribed to a more secondary extent. The evolving approach to helping patients manage if not mitigate their pain levels is significantly influenced by the medical community’s attempts to counteract the opioid crisis with alternate methods.
“Twenty years ago, obviously opioids were the mainstay, but that’s not something we utilize at this time with the opioid crisis,” says Kaufman. “But I think even before it became a crisis, most really good pain doctors were moving away from that as we saw what the long-terms outcome was.”
At Cherry Hill’s pain management center Relievus, anesthesiologist Dr. Young Lee says that long-haul users of opioids like morphine, oxycodone and Vicodin build up a tolerance, demanding high doses of potentially dangerous substances over time. It’s why he tells patients, “We have options, not just opioids.”
Those options include controlled infusions of ketamine, stem cells or PRP (platelet-rich plasma) that boast regenerative properties, and ENR Therapy, a proven electromedical treatment that relieves the discomfort of not just pain but also the tingling, burning and numbness related to neuropathy and chronic nerve conditions.
In terms of treating someone at the end stages of their diagnosis, though, the long-term effects of dependency are eclipsed by making a terminal patient’s final months, weeks or even days as comfortable as possible, according to their wishes.
“We tend to think of morphine as being one of the most potent narcotic analgesics that we have when, in fact, it’s not,” Goldfine explains, adding that while plenty of medications can be used safely in a controlled medical environment or under close supervision, “we don’t worry about addiction as much in end-of-life care.”
Working With a Team
“The team-approach to patient care began in the hospice world,” Goldfine points out, noting that it has become an increasingly common practice across all medical providers. “We’ve been approaching patient care as a team for the last 40-plus years. That includes a nurse, a social worker, a chaplain or someone in a religious position managing these patients’ needs.”
He estimates that the past decade’s insights into pain being more than a physical issue have fostered an increase of professionals working together for the individual’s sake. “I think if we don’t approach these patients as a team then we’re doing them a disservice.”
Kaufman agrees. “We don’t want to work in silos. If you know someone is seeing a rheumatologist or a neurologist, I want to work as a team with those other physicians. You want to see how their problems overlap with what you’re doing, what they’re doing for treatment because then you can coordinate your treatments better. And I think it gives the patient much better care when all of their physicians take the time to work together instead of just focusing on their one little piece of it.”
That team doesn’t just include professionals: It means working with a person’s loved ones, too. While Kaufman says the feedback and personal observations of family and friends is invaluable guidance during treatment, Goldfine adds that interactions with a terminal patient’s nearest and dearest often inform how individuals seeking end-of-life pain management individualize their care.
An Improved Quality of Life
As pain management aims to give patients their life back in whatever way possible, regarding the patient as a human being whose life has been changed by pain is crucial in that endeavor. It’s a lesson that Kaufman, who’s also a professor of anesthesiology at Rutgers New Jersey Medical School, has also imparted to his students as future practitioners.
“One of the major things we emphasize is teaching those younger physicians to really listen to their patients and their stories,” he says. “We need to remember that we don’t treat MRIs, we treat people.”
The clarity of a diagnosis and having a prescribed course of treatment, if not a multitude of options to help zero in on what works best for a patient, can be a tremendous first step in addressing the core of the pain.
“There’s been a lot of data over the years that shows pain is underdiagnosed and undertreated,” Goldfine says. “That leads to a decrease in functional capacity for a segment of the population. We’re seeing that in people with delirium and dementia.”
No matter the pain, though, Goldfine says one thing is certain.
“You do not have to suffer,” he affirms. “I tell my patients and their families all the time that there’s no point in having a pain syndrome. Uncontrolled pain leads to worse outcomes and if a patient is suffering then their interactions with their loved ones aren’t as vibrant.”
SAS
Finding Relief for Chronic Pain
Specialists to help with a wide range of conditions
Relievus
Serving South Jersey
(888) 210-3054
relievus.com
Samaritan
Serving South Jersey
(800) 229-8183
Samaritannj.org
