Ron Rosenbaum

Pain Management: Don't Let Them Deny You

Well you could think of all of life as “Pain Management” if you were so inclined (and I often find myself so inclined). But I’m referring here to the medical subdiscipline that has become such an important part of your experience in and out of hospitals.

As someone recently recovering from surgery, I probably had a similar experience to many–the first night after the operation in particular. Too much pain, not enough attention to actually relieving suffering, reliance on that idiot chart of ten smiley and frowny faces to indicate levels of pain (extremely objective!), and hospital personnel utterly unsympathetic to, or suspicious of genuine, readily available means to ease suffering.

Most of the latter attitude, I find comes from the old guard nursing establishment within hospitals and the inattentive residents who spend five seconds with each postoperative patient, each visit without stopping to listen to questions or complaints. Too overburdened, too much of a hassle.

I could go on about the misplaced puritanism that seems to consider post-operative pain to be a necessary part of the surgical procedure in some repressed sadistic way. Or the government’s vicious and cruel persecution of doctors and pain management specialists, a crusade that manages to criminalize or at least demonize prescribing effective pain relief because there are those who abuse pain killers.

But instead I’ll stick to the practical. Most hospitals now have a Patients’ Bill of Rights, most of it devoted of course to circumscribing your rights, but some parts of it an advance. One in particular is the requirement in most of these that if you don’t think your pain is being attended to adequately you have the right to call upon a “Pain Management Team” to evaluate your situation.

I’ve found hospital personnel resist compliance with this, don’t want to have the red tape or black mark that repeated Pain Management consults result in, and so they will say “we’ll adjust your pain medication and if that doesn’t work we’ll call in Pain Management”. This generally means you’ll get what you need–or better than what you had–but it violates your “Patient’s Rights” and you shouldn’t be intimidated from insisting on the consult regardless of whether they temporarily improve things. Because if they think they can escape notice by giving you a little bit more they will. And then they’ll take it away on whim of some arrogant resident. If the add-on doesn’t improve things enough, insist on having a written record made of your request to see Pain Management put in your chart and tell every intern, resident, and doctor involved in your case that you want the consult. The results may not always be entirely satisfactory, but it makes them take your needs seriously. It’s no guarantee that they’re going to do better but you won’t know if you don’t try.

Patients who don’t speak up and choose to live silently with their pain so as “not to make a fuss”, not only hurt themselves, they hurt others in pain whose suffering is thereby marginalized.

No one should suffer needlessly because of a medical procedure or condition in or out of the hospital. No one should suffer needlessly because of the insufferable arrogance of doctors. I was fortunate in having one of the new breed sensitive to the pain question, and I thought at one time, the arrogance factor was diminishing in the rest of the profession. But in fact there are still too many who treat patients as inferior human beings and take advantage of the patient’s vulnerable position to indulge in shameful narcissistic power displays. They react with barely suppressed rage and impatience at being questioned, still consider themselves inerrant deities, although statistics on idiot medical mistakes by doctors keep going up).

But allowing pain to go unmanaged out of some “principle” is frankly, as bad as deliberate torture and it’s time we called it that.

I’d be interested in hearing the experiences of others with “pain management” practices.