On a scale from 1 to 10, how much better could your pain be managed?

“Everyone is different,” is a common response from healthcare professionals when the issue of improved pain management is raised.  That’s not really the case; rather, there is variability in how people respond to, say, post-surgical pain and to pain medicine.  Here are some simple suggestions about how to improve pain management:

1.  Keep a record of medicines taken and responses in a form that is accessible and digestible to the patient and the innumerable professionals who take their turns serving the patient (see table below).

2.  Have everyone refer to the same pain scale (e.g., Mankoski) so that the pain column can be consistently filled in and meaningfully interpreted, even granted that the experience of pain is subjective.

3.  Use the first rows to fill in previous experience with pain and medication.  That will allow the patient to specify, e.g., how sensitive their stomach is to ibuprofen, how constipating narcotics are, etc.

4.  Make decisions about what to continue and what to change based on reviewing the prior history and the current record.

Time Pain Oxycodone Dilaudia Toradol Tylenol Ibuprofen
 Post-surgery in 20xx  5-6 (on Mankoski scale) Administered thru I/V
 No pain after release from hospital on day 5  After release from hospital, in tablet form combined with ibuprofen  After release from hospital, in tablet form combined with toradol
 <insert amount>
 etc.

The fact that a non-professional is making these straightforward suggestions (based on recent experience for a family member and corroborated in various discussions) means not only that the family member’s pain was not managed well but also that there are some deeper issues about how healthcare professionals approach the improvement of their work, especially in hospital settings.  Why have they gone so long–from the surgeons, to the interns, to the nurses–without a systematic way of addressing the variability in ways patients experience pain and medications? Indeed, the imprecise response “Everyone is different” could be seen as a brush-off–just grin and bear it.

Admittedly, this blog post has been written without researching what experts in pain management say, but whatever it is they say either it has not filtered through to the healthcare professionals or it supports their unsystematic approach to patient variability.

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