Summer 2001 ~ Newsletter
Pain Management
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Q and A on Pain Management
by Sandra L Durham, MD
I am a physician practicing pain management. Writing this to the CF community definitely interests me because I had a son who had CF. I am interested in pain, regardless of where the pain is, what type of person has it, or what type of condition is involved. Because there is pain with Cystic Fibrosis, I would like to be able to give back to the CF community to be helpful to other parents.
Q: How do you deal with pain management?
CF patients are living longer so we are seeing many more problems and pain is one of them. The first thing we should do is make ourselves aware of it. The second thing is to believe the patient. When they tell you they are having pain you have to believe them. It might be something you have never heard of before or something unexplainable of why it's hurting.
Q: When somebody comes to you and they have pain, what do you do for them?
I totally evaluate the person to know what is it that's hurting, how it hurts, when does it hurt, what is it associated with, and what are the factors. If a CF patient says, "my stomach hurts", then I want to know if it hurts before you eat, after you eat, or when you need to have a bowel movement. Is it relieved after you have bowel movement, does it hurt worse if you take your enzymes or don't take your enzymes? You have to find out what is associated with it, where it is happening, and what type of pain it is. Is it a dull, aching pain, is it a stabbing pain, or is it a throbbing pain? Many times we must even teach the patient to describe the pain, as they are not accustomed to describing it.
Many CF patients state their backs hurt, because they are used to leaning forward to breathe, and tend to have back problems. This could possibly constitute a person taking pain medicine. However, I would look for other methods to try first. Being taught proper body mechanics may correct the pain, but you must look at each person individually, and how they function. If it is constant straining putting the muscles in positions that actually cause muscle spasms, look at the various ways you might be able to relieve the spasm. If it is bone pain, that is completely different. But we work with each individual patient until we determine exactly what the cause is and then treat it. It has to be done by a person trained in exactly what's going on with the cystic fibrosis to start with. You can also use other methods such as pool therapy which helps them.
Q. What are some cautions for pain management you might tell a parent with CF or somebody taking pain medicine?
The most dangerous side effect of any of the pain medicines is respiratory depression. We certainly don't want to depress the respirations of a CF patient, at least not significantly. On the other hand, if that person can be relieved of pain to the point of relaxing, it could help the respiratory system, if they could be totally relaxed.
The other thing we are always concerned about, especially with younger people on medication, is to make certain that we are treating physical pain and not emotional pain. We know there can be a tremendous emotional pain when dealing with a chronic illness. We don't want them to be treating those issues with analgesics that are intended for physical pain. So you have to always remember that fine line between the two. The thing I do more than anything is tell patients up front to be very open, and have honest communication. If I feel you are getting to a point that you are abusing medicine in any way, I am going to call you on it. We are going to be very open and not keep any secrets. We are going to discuss thing between the two of us.
If you have any questions, you can reach my office, the Lighthouse Pain Clinic, located on Valleydale Road, by calling (205) 444-1167.