“Are you experiencing any pain right now?” is a question that I ask all patients at every visit. For patients who are new, I first ask this question to ensure that he is comfortable while I am interviewing him. Patients who are in pain may lose hope right away and fail to disclose important information.
Filipinos have a high threshold for pain. Sometimes, they do not inform that they are in pain and just suffer through it (Matiisin). They think it is but normal to suffer in pain and sometimes, they think that God is punishing them with pain.
I once asked a patient whether he has pain or none. He replied “Meron po pero ok lang po ako, kaya ko naman po” (I’m in pain but I’m alright. I can handle it). So I asked the patient to give me a numerical value of his pain or “the pain score”. We ask patients to grade the severity of pain using a numerical scale from 0 to 10, 0 being absolutely no pain and 10 being the worst pain. The patient replied 6 (moderate severity of pain). I could just shake my head in disbelief at how he can say he is ok and handle such intensity of pain without any help.
Myth #1 If the patient does not mention it, he is not in pain
This is a very common mistake even among health care professionals. Not all patients with cancer experience pain but Not because the patient does not mention it means that it does not exist. Patients experience a whirlwind of emotions such as fear, helplessness, depression that can affect their judgment, confidence, worthiness and ability to communicate.
Patients often have this notion that pain goes hand in hand with cancer and there is nothing to be done but endure the pain. Some are afraid to tell their pain because they fear that it is a signal of worsening condition while others think that showing pain is a sign of weakness.
We need to make it imperative to ask about pain and recognize pain all the time. There may be a lot of instances that we cannot get rid of the tumor but there is no excuse NOT TO COMFORT.
Myth #2 Having pain means you are hopeless, dying or the disease is getting worse
Patients are often reluctant to communicate their pain because they fear that they will be viewed as hopeless and dying soon. Some fear that if people know that they are dying or diagnosed with cancer, people will feel sorry for them or that they may not get the help they need or that nothing can be done.
These beliefs are absolutely false. Being diagnosed with cancer is not a death sentence. Many treatment options are available. Even if the patient may already be dying, there is still so much that can be done to minimize suffering. There is now a specialty in medicine called Palliative Care which focuses on alleviating suffering among terminally ill patients. (Palliative Care does not cater only to cancer patients but all patients who need relief from their suffering)
Myth #3 The medicines used to treat pain are addictive
This is one of the most difficult beliefs to eradicate from the minds of patients and families, especially with the advent of drug abuse by celebrities. Patients sometimes adjust the medicines by themselves for fear of being addicted. Patients who are in pain need not worry about addiction. Drug addicts are those who use the drug for a different purpose other than pain control. Patients who use medicines for pain relief will never fall in this category as long as there is reason to use the medicine. Nature has installed safeguards to prevent drug overdose among patients who are experiencing REAL pain.
I also hear statements like “I don’t want to become dependent on the medicines”. There is nothing wrong with being dependent on these medicines as long as there is pain. Problems arise only when patients continue using the medicine when no longer needed and when not supervised by a physician.
Myth #4 The patient is just inventing the pain
Cancer pain is what and how the patient describes it. WE NEED TO BELIEVE THEM. Sometimes we are quick to judge that patients are feigning the symptom. This attitude is bound to dismiss the patient’s suffering and inflict not only physical but psychological pain as well. There are really times when pain is intensified by psychological or social situations because pain is formed by an interplay of physical, social and psychological components. The best way to address these problems is to pay attention and heed but never to dismiss.
Myth #5 The doctor did not give any pain medicine. I probably don’t need it
Unfortunately, not all healthcare professionals are always mindful of the patient’s pain or well-equipped to provide adequate pain control. Bring up the subject even when the healthcare providers don’t ask. Be insistent on good pain control. Demand it from your healthcare provider. If you are not satisfied with your level of pain control, ask to be referred to the right specialists – oncologists, anaesthesiologist, neurologist, palliative care specialist. Many hospitals also have pain clinics.
Myth #6 Leave it to the healthcare professionals to manage the pain
This is a very common misconception for all types of health problems, not only pain. The cornerstone of good healthcare is patient responsibility and adherence to the treatment regimen. After leaving our clinics, it is the responsibility of the patient to carry out what needs to be done. Even if patients are under the care of a superb team, if he does not follow the plan, there is nothing else that the team can do for him.
Many patients keep on coming back to their doctors with the same complaints. Upon evaluation, we find out that the main reason why the problem still exists is because of poor compliance. I have also encountered countless patients who adjust their medicines without letting us know and without asking about the consequences of thsose actions. In my experience, those patients who are diligent are the ones who are most comfortable and are likely to get well.
Myth #7 Pain medicines should be taken on an as needed basis only
A lot of patients, especially if they are in severe pain, will follow the doctor’s order diligently. However, once they start becoming comfortable, they adjust their medicines only to return to the emergency department with severe pain again. They think that because the pain is gone, they don’t need to continue taking the medicines or that it is ok to decrease the dose. Pain goes away with the right dose of medications. Once we remove these medicines or give them at inadequate doses, the pain will come back. Most of the time cancer patients will need to rely on these pain medicines for life. There is nothing wrong with that.
There are times when medicines can be adjusted by the patient but you need to ask your doctor when this is appropriate. Pain medicines are usually given round the clock to maintain an adequate level of medicine in the body especially when the pain is moderate to severe in intensity.
We may not always get rid of the physical illness but we can always provide comfort. Pain eats up the patient’s energy. It robs them of life and the ability to make the most of everyday. There is no point in enduring unnecessary pain.