This month on Pain Doctor, we covered a number of important topics that dealt with chronic pain. When we look past the medical condition itself, we were able to explore what living with chronic pain really means. Who suffers from chronic pain? How can we begin to understand those with chronic pain better? Where are people not receiving the help they need?
Diversity in chronic pain
1.5 billion people suffer from chronic pain. Chronic pain affects the elderly and the young. It affects men and women. It affects people in every area of the world, regardless of race or socioeconomic status.
Chronic pain, unfortunately, is the great equalizer.
Even more unfortunate, however, is that access to chronic pain care and management varies according to those socioeconomic boundaries. Even though the chronic pain that one person feels is just as excruciating for one person as it is for the next.
This month on Pain Doctor, we discussed racial biases in pain management.
Just as we are culturally dealing with the issues raised by the racially charged actions in Ferguson, so too must we address disparities present in our healthcare system. In our post, we noted that:
- Racial biases can diminish empathy–a critical component of the patient doctor relationship
- People of color are prescribed opioid analgesics at lower rates than white people, even when reporting higher pain scores
- Black patients are less likely to be recommended to a pain specialist but more likely to be referred for substance abuse assessment
These discrepancies are clearly unacceptable. We can and must work every day to overcome these discrepancies to make sure all patients have access to the same level of care for their chronic pain.
Rural healthcare challenges
Just as there are discrepancies based on race, we also covered the many challenges facing those who relied on rural healthcare. In a recent paper published by the Center for Rural Affairs, they noted that healthcare in rural areas suffered in both quantity and quality of care. Locating a doctor to attend to basic needs in rural areas can be nearly impossible, while specialists are even scarcer.
The paper listed the following ten unique challenges facing rural healthcare:
- An economy based on self-employment and small business that leads to less stable incomes and limited healthcare coverage
- Large populations that are dependent on public health insurance, with a 122% increase in need since 1987
- Not enough physical space and supplies in rural hospitals and clinics
- A shortage of doctors, nurses, and other healthcare providers
- An aging rural population
- Greater rates of diabetes, arthritis, hypertension, asthma, and other chronic conditions
- A lack of preventative care due to few facilities and healthcare professionals
- Few, if any, mental health services
- Medicine’s reliance on technology that is often neglected in rural areas due to more pressing concerns
- A need for more effective emergency medicine
In our post, we did discuss some of the creative solutions that rural areas are using to meet these challenges. These ranged from using telemedicine to focusing instead on smaller outpatient clinics.
Caring for chronic pain in children
Children suffering from chronic pain face their own set of challenges. We noted, in particular, the difficulty of assessing the level of pain in children.
“A major reason this link between mental health and chronic pain is so complex is that young people may have difficulty communicating the level of their pain. Pediatric pain patients are often seen in a heightened state of distress and anxiety. If there is a history of mental health issues, including anxiety, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), or even attention deficit hyperactivity disorder (ADHD), it may be difficult to gauge the level of pain being experienced. Because of this, pain in youth is generally unidentified and under-treated.”
There are, however, age-specific pain diagnostic tests that can help healthcare professionals better diagnose chronic pain in children. For infants, these generally rely on facial indications of pain, breathing patterns, or tension. Likewise, many doctors use facial expressions, crying, and grasping to diagnose pain in toddlers.
Once children reach preschool age or older, there are more options for diagnosing pain. Preschoolers may be able to self-report pain using the poker chip tool. School-age children can directly self-report pain levels. For adolescents–when self-reporting may be hindered by social pressures–healthcare professionals can rely on systems of trust in order to diagnose the correct level of pain.
Faces of Pain
Nowhere is the diversity of chronic pain more noticeable than on Faces of Pain, our online support forum, or our Facebook support group. By collecting the voices of many, we have begun to see an overall face of pain–a face that is not defined by age, race, gender, socioeconomic status, or belief structures.
Our contributors find solace through their religion, music, gardening, pets, or their grandkids. They may suffer from fibromyalgia, arthritis, cancer, or injuries. Their goals range from getting out of bed every morning to finishing a university program to spending time with their children.
We’ve found that some days are just bad days. The next day might be the day that person cheers on another person for getting out of bed. The next may be the day they find advice that helps them relieve some of their pain.
Chronic pain knows no boundaries, so it’s time that we do the same. Provide support to others in online support groups or just take the time to help out a loved one who suffers from chronic pain. Together, we can find strength and comfort in each other.
How has chronic pain affected you?
Image by Andrew Moore via Flickr