Voss Hypnotics

Measuring Pain – Is Less More?

Patients in hospitals and nursing homes have been living in a new era of care since the dawn of the 21st century. In 2000, a new a set of standards was announced by the organization that accredits nearly 20,000 health-care institutions in the U.S.

What was this new idea that had hospitals in a tizzy? The notion that somebody should ask patients how they feel.

Pain, it had been discovered, actually makes a difference to patients. That may seem obvious to anyone who’s ever stubbed a toe, much less undergone surgery, but it wasn’t until the latter part of the 20th century that western medicine began to accept that pain matters in how patients heal as well as they feel.

There were good reasons for the lack of enthusiasm about treating pain. For one thing, surgeons, for example, have the empathy trained right out of them. Good thing, too. When you need someone to slice open your belly to grab that appendix before it bursts, you don’t really want someone who flinches when you do.

For another thing, perception of pain varies. It is difficult to measure. Its intensity can change from moment to moment, person to person and even culture to culture. Older people often don’t mention pain because they don’t want to complain. Worse, they may accept their discomfort as part of aging. Many people are afraid of becoming addicted to drugs.

Yet year after year, the more we learned about pain and stress, the more it became clear that increased comfort increases healing. By the late 1990s, medical literature was littered with studies like one published in 1998 in the journal Psychosomatic Medicine that found that stressed students took 40% longer to heal small wounds than more relaxed students.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) guidelines confirmed that "patients have the right to appropriate assessment and management of pain." That caused a big headache for clinicians, who found themselves expected to treat pain as the "fifth vital sign” after temperature, pulse, respiration and blood pressure.

Most facilities adopted a simple scale suggested by the joint commission: a scale of 1 to 10. Some use sad to happy faces. Others use a descriptive scale – available in dozens of languages – with a range from "no pain" to "worst possible pain.” Once that’s settled, providers can move on quiz you about pain intensity, quality, location and duration.

This has been great news for the average patient. In 2005, for example, the Journal Anesthesia & Analgesia published an article by Mayo Clinic doctors finding that since the new guidelines, 1082 patients who had surgery used more morphine afterward, with no major increase in serious side effects like nausea, longer hospital stays or death.

On the other hand, it’s not surprising that the pharmaceutical industry was a big fan of pain assessment standards. More pain treatment has been mostly interpreted as “more drugs.”

Many believe the best effect of the pain guidelines is the opening of many hospitals to “complementary” practitioners. As a hypnotherapist myself, trained in using relaxation and guided imagery to aid relaxation and healing, I welcome this recognition.

But there’s still a long way to go.

Just asking about pain counters much of what we know instinctively about the value of distraction: Giving a crying kid a lollipop really works. As does the less-recommended method of hitting one thumb to take your mind off the other one.

So how exactly does asking a patient, “How bad is your pain?” help them feel better?

The real change still lies ahead, when instead of using the pain scale, clinics begin using the “comfort scale.”

And even that may not be enough of a switch. A classic study related to this was published in 2002 by University of Heidelberg researchers. They found that back pain, as measured by EEG, was made worse by sympathetic spouses. Patients whose husbands or wives fetched medicine, offered massages or otherwise catered to them showed a higher pain response then those whose spouses distracted them, or merely left the room. Note that this measured brain activity – not just patients playing up their symptoms for some attention.

How comfortable do you feel now?