Pain can decrease one’s quality of life considerably, especially when prolonged. Appropriate and timely pain relief is a fundamental human right. However, this right is not always fulfilled.
Pain “As opposed to acute pain, the effects of chronic pain are typically not limited for instance to mobility alone. Instead, prolonged pain may cause both functional and mental impairments, affecting the patients’ overall ability to function as well as their mood,” says doctor Katri Hamunen who works at the Pain Clinic of the Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital. It is the leading Finnish clinic specialising in the management and research of chronic pain.
Acute or sudden pain occurs when the body reacts to an injury, infection or surgical operation, for example. It is important to treat acute pain properly, so as not to let it evolve into chronic pain. Pain is usually considered to be chronic, i.e. prolonged pain, when its duration exceeds 3 to 6 months. Regularly occurring pain, such as migraine, is also of chronic nature.
Strong painkillers are less used in Finland than in several other European countries.
“Timely and effective pain management is important after large surgical operations, too. Effective pain relief can reduce the risk of heart or lung complications after surgery,” says doctor Hamunen.
Medication is always
case-specific
The experience of pain is subjective, and the patient's own assessment is the primary starting point for the management of pain. A typical method of assessing the severity of the pain is a Visual Analogic Scale (VAS), in which the patient marks the level of the pain on the scale. Different numerical scales and pain glossaries are also used. Cancer patients’ need for pain relief is usually assessed with the help of a three-step ladder developed by WHO.
“Different pain assessments are not directly comparable. They are always specific to each patient and situation. Level 8 assessed for a chronic patient is not the same as that for a surgical patient,” doctor Hamunen points out.
Orally administered NSAIDs (non-steroidal anti-inflammatory drugs) are the primary treatment for pain caused by tissue damage, i.e., “normal” pain. More severe pain requires stronger medication in the form of an opioid, too. There are drugs specific for neuropathic pain.
“Morphine-related drugs can be used more freely to treat acute and temporary pain, when the need for strong medication is of short-term nature. Opioids are always used in good cancer care, too. However, when used to alleviate other types of chronic pain, such as neuropathic pain or prolonged back pain, use of strong medication must always be very carefully considered.”
In pain medication, it is important to select the right drug and get the timing and dosage right.
Sometimes the patient
must be adamant
According to research results, strong painkillers are less used in Finland than in several other European countries. Doctor Hamunen points out that there is great variation between hospitals, however.
“Unfortunately, at times we hear about patients whose pain has not been managed the best way possible. Chronic patients in particular need to be active and insist to get sufficient treatment.”
It is the duty of basic healthcare services to assess each patient’s situation and start the medication. According to doctor Hamunen, specialised care in particular is where there is a lot of expertise in the management of acute and chronic pain. However, it is not possible to refer all the patients to specialised care.
Side effects
must be considered
“It is important to remember that consumption of painkillers does not equal good pain management. Medication should of course be available to patients, but the risks and side effects of the drugs must also be assessed,” doctor Hamunen says.
Denmark tops the statistics in opioid use.
Of the Nordic countries, Denmark tops the statistics in opioid use. The main problem related to them is the addiction that patients develop over time. Other adverse effects of CNS (central nervous system) drugs include tiredness, nausea and constipation.
However, recovery can in many cases be accelerated by means other than medication.
“People often think that medication is the best and only treatment, but in the case of chronic pain in particular, active exercise or electrical stimulation administered by a physiotherapist, or relaxing and visualisation techniques learned from a psychologist can make a big difference, too.”
Continuous need
for training
According to doctor Hamunen, adequate pain relief is part of good patient care. Health professionals should measure the patients’ pain levels along with other vital signs, such as pulse rate, blood pressure, body temperature and level of consciousness. This is not always done, however.
“Even though we have actively focused on training in Finland for a few decades now, and on the management of cancer pain in particular, attitudes still need to be changed. For example, the concern over the addiction to strong painkillers among terminal cancer patients is unnecessary.”
Doctor Hamunen says that there is plenty of guidance and information available, and doctors can consult experts in pain clinics when necessary. It is also important to remember that the patient and the patient’s motivation are the key to successful pain management.
“Training and guidance of patients is very important for successful pain management. Numerous good guides are available for patients today.” Consult you local hospital for more information.
Text Timo Nykänen | Photos Jarkko Virtanen