Prescribing Practices: Perception of Pain
Pain can be stifling and prevent people from fully engaging in their life. Pain can impact the quality of sleep, the ability to get around, employment options, family life, self-esteem, mental health, and life satisfaction.
The United States makes up 4.4% of the world’s population, and consumes over 80% of the world’s opioids. The US consumes approximately 99% percent of the world’s hydrocodone. Hydrocodone was moved from a Schedule III to a Schedule II drug in 2014 because of its high abuse potential.
Over the last 20 years, the narrative about pain has moved from something that we cope with or manage, to a condition that can be alleviated or even eliminated. The Pain Scale ratings were added to clinic flow procedures, and provider satisfaction ratings was determined, in part, by a patient’s decreased rating of pain. And yet, opioids are known to increase pain sensitivity over time.
Pain is more than tissue damage. Pain and the perception of pain is impacted by previous experiences of pain and trauma, the current state of the central nervous system, and the conditions of recovery. One study showed that patients recovering from surgery who could look out the window at green space needed statistically significant less pain medication than patients who were looking at a brick wall.
The most common mantras about pain are:
- No pain, no gain.
- If it hurts, don’t do it.
- When my pain gets better, I will get on with my life.
The first statement encourages people to push past or ignore pain. The second statement sets up expectations that a pain-free existence is possible. And the third statement supports putting our life on hold.
How would people approach their pain differently with the following statements?
- Sore, but safe.
- Hurt doesn’t always equal harm.
- I will get on with my life so my pain gets better.
Goals, rather than a reduction in pain, can be about an increase in functioning, self-reliance, and self-compassion. For example, goals can be related to returning to loved activities and hobbies, engaging in family life, independence in activities of daily living, increased capacity for employment, or dedication to self-care.
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