Summer 2001 ~ Newsletter
Pain Management
Newsletter Navigation:
Quick Navigation:
Pain and Cystic Fibrosis
by Marion Broome, PhD, RN, FAAN and Ramprasad Subramaniam, MD
Pain has always been one of the most feared outcomes of any illness, especially for the chronically ill. Cystic Fibrosis is a chronic illness that has recently been recognized as one in which patients suffer pain, both short and long term. As a result of new medical advances, improved nutrition, and better management of pulmonary infections, the average age of survival is 30 years, with pain becoming one of the major medical problems as the patients age. Although there has been a great deal of research done on pain in other patient populations, there are currently no nationally accepted guidelines for the treatment of pain in CF.
Pain is a common reason for patients with CF to consult a physician, yet it is frequently inadequately treated, leading to enormous loss of production, needless suffering, and excessive healthcare expenditures. Scarring is caused by recurrent lung and sinus infections, surgery, and pneumothorax can lead to significant pain. Thick and viscid intestinal secretions lead to obstruction and pain. Bone and joint pain is associated with osteomalacia and osteoporosis which result from malabsorption of essential minerals and vitamins.
Pain management in CF patients is falling far short of the goals. Indeed it would not be an exaggeration to say that pain is perceived to be out of control by many CF patients. Patients experience chronic pain in various sites in the body, with the majority of first episodes of pain reported when the patients are still active. Optimal pain management should be instituted early to preserve functional status. Yet, there is widespread misunderstanding by patients and confusion about appropriate treatment for pain, especially in relation to the effective use of opiates. Concern stems from issues about the "legality" of the use of opiates and potential abuse of opiates by patients with chronic pain. The subject of drug-seeking behavior among chronically ill patients is a sensitive one and often contributes to an overestimation of the degree of drug-seeking behavior in this population. Poorly controlled pain symptoms cause hospitalizations, sick days, and activity limitations that may cause CF sufferers to accept a much lower quality of life than need be. Treatment modalities for pain can basically be divided into Pharmacological and Non-pharmacological.
Medical Strategies for Pain:
Ibuprofen and Acetaminophen (non-opioids) codeine, and/or morphine (opioids) and their relatives are very useful for management of pain. Non-opioids include over-the-counter medications such as Advil and Aleve and are very effective for mild to moderate pain. Even these, when used on a continual basis, must be monitored because they can have side effects such as gastritis. Newer drugs such as Celebrex have fewer side effects and will go a long way in providing better pain relief. For moderate to sever pain stronger drugs such as opioids can be very effective. Problems associated with these include concerns about addiction, respiratory depression and other side effects, tolerance, diversion, and fear of legal action. Yet, there has been research conducted with chronic pain patients for the past twenty years and it has documented that these concerns are based on misconceptions about pain and its treatments and outcomes.
Other Strategies for Pain:
Psychological Techniques: Relaxation, Imagery, Hypnosis and Behavioral Therapy - These techniques are often used by patients in both chronic and acute pain and many researchers have found them to be effective. Use of these strategies can help patients distract themselves from the pain and to use biofeedback and relaxation techniques to reduce muscle spasms and tension resulting from pain. These techniques are viewed as coping skills to help deal with the pain and anxiety. Music is another very useful strategy for relaxation.
Acupuncture and TENS - Acupuncture is also used in some clinics. Transcutaneous Electrical Nerve Stimulation (TENS) may be helpful in relieving chronic pain. The device is worn by the patient and turned on and off as needed. TENS and acupuncture are not effective in every patient and only a trial will tell which patients will benefit.
Heat, Positioning, Massage, and Physical Therapy - These methods of pain relief work by identifying and reducing factors which contribute to pain. Patients who use them also learn more about correct posture and body positions to reduce pain. These strategies are thought to be associated with the release of endorphins, which are hormones that naturally reduce pain.
In summary, pain is a problem in CF patients. With advancements in medical care available for CF patients, pain will become more of an issue. Effective use of medicines and methods will help patients cope better with pain associated with CF.
UAB is currently conducting a nationwide survey of pain experienced by children, adolescents, and young adults with cystic fibrosis, and the effectiveness of treatments they use for their pain. We are interested in learning more about your pain experiences. If you would like to receive a questionnaire, please call Dr. Marion Broome at (205) 975-0343 or e-mail to broomem@son.uab.edu.