Do you remember when Pain became the "6th vital sign" according to JCAHO? Chances are if you don't, then you have not been practicing medicine long enough. Conversely, if you have been around the block then you know that poorly controlled op & non-op chronic pain can be ascribed or attributed to too many reasons; among them, listed herein are some of the most commonly seen or encountered underlying causes seen in clinical practice:
1. Provider's pain assessments are incorrectly based when only normal VS are presented to them by the nursing staff.
2. During rounds or office encounter patient is non-distressed & is calm-appearing on presentations or exams.
3. Assuming a sleeping or a patient taking a nap is not ever in pain.
4. Assuming the patient is drug-seeking given their PMHx of "doctor/provider shopping"
5. Assuming the patient is a closet drug user or pusher.
6. Assuming/believing ( “knowing”) procedure or treatment is relatively painless.
7. Assuming the patient is being "manic" given their charted PMHx of Bipolar disorder.
Due to the inherent subjectivity of pain being experienced by the patient @ any given time, many providers (including residents) may undertreat the condition due to personal unconscious or implicit biases. It is best to provide an immediate empathetic response such as: "I sympathize with your experienced discomfort and am sorry to hear that you're experiencing pain. Please allow me to look into your pain regimen more closely and make some readjustments, allow me a day or two to see if these changes were helpful. Don't hesitate to let the nurse or me know if there's anything else I/we can do to assist you in finding relief and making you feel more comfortable.
This frank verbal acknowledgment will ease the patient's fear of being dismissed and underrated as they may have experienced in previous medical encounters. Also assured them, everybody's pain-handling issues are different as you will come to see due to expectations, cultural identity, or even socioeconomic status. Better yet, explain and educate the patient that for his/her benefit you may consider implementing a multimodal pain management approach, or if your interventions are not easing or/ helping mitigate the pain you then may consider ordering or referring the patient to a Pain Management Specialist in order to achieve pain control. Do not forget to add other adjunctive agents such as muscle relaxants, NSAIDs, SSIs, etc. So when we, healthcare professionals (HCPs) use bedside shared-decision making with our patients, then patient satisfaction increases, thus ultimately improving patient trust as a final byproduct.
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