Pain is what the patient says hurts

Eric is in so much pain that the folds on his face have become permanent. His eyes are sunken and all he can do is to hold onto his stomach.

His wife, Tina, can only stroke his hair and squeeze his hand to make the pain bearable.

Brian was involved in a road accident three month ago and the road to recovery has been slow. The physical wounds are well healed but his back radiates pain confining him to his home.

It breaks Tina to see her husband this way. He can no longer play with their son. Watching his favourite team play remains a mirage. Eric spends most of his time in bed listening to his body.

Pain has taken over his body.

Every few minutes, he screams. Tina runs to be at his side, to squeeze his hand.

Strong pain killers should be prescribed.

Their three-year-old son, Taji, looks at daddy then he retreats to his play corner; he doesn’t understand why daddy no longer plays with him. He is always in bed or on his 4-wheeled chair.

“I am a mess!” Eric describes his current situation especially with the unmanageable pain.

Dr Zipporah Ali,  a palliative care specialist and the Executive Director of Kenya Hospices and Palliative Care Association (KEHPCA) acknowledges that pain hurts and wears the patient.

“It is an unpleasant sensation that distresses the body or mind.  It is also the main reason we seek medical help,” said Dr Ali.

Dr Zipporah Ali, Palliative Care specialist

Pain serves both as a protective mechanism or a warning sign that all is not well in the body. The chemicals that reduce or inhibit the transmission or perception of pain include endorphins.

Some of the indicators that point out that a person is in pain include an increased heart and breathing rate, larger pupils of the eye and increased blood glucose levels.

Whereas Dr Ali agrees that these pointers are more clinical based, she points out that pain should not be ignored because it could lead towards diagnosing an underlying condition.

Dr Ali defines the following spheres of pain;

  • Physical pain
  • Emotional pain
  • Psychological pain
  • Spiritual pain
  • Financial pain

“We pay more attention to the physical pain, yet the rest are also equally important because they influence the patient’s welfare,” Dr Ali says.

Photo by Sam Burriss on Unsplash

Pain is further described according to the intensity and its location.

  • Acute pain- recent onset or for specific injury. It lasts seconds to 6 months
  • Chronic pain- constant or intermittent pain six months or longer
  • Cancer pain
  • Pain classified by location

Whereas the threshold of pain is determined by the following factors, Dr Ali advices that pain complaints should be taken seriously.

  • Past experience
  • Anxiety and Depression
  • Culture
  • Gender
  • Genetics
  • Placebo effect

Dr Ali says that in some cases when a patient complains of pain, loved ones or colleagues tend to underestimate it and in other cases, it is simply dismissed and passed as a sign of weakness.

“Pain is an important marker of what is happening in the body. The patient should see a specialist who encourages him or her to describe the pain and rate it against a prescribed scale,” said Dr Ali.

The pain specialist will also be a better position to take history and to assess the emotional distress of the patient and their ability to cope with the pain, Dr Ali added. The most effective drugs for moderate and severe pain are known as opioid drugs.

Are pain killers addictive?

Dr Ali further clarifies that addiction to pain killers is rarely a problem due to the strictness of the health specialists who prescribed these medicines.

In June last year, the WHO expressed concern that there is very low access to medication for moderate and severe ain, particularly in low and middle-income countries.

Is there a standard way of rating pain?

Dr Ali pointed out the Wong Baker pain measurement scale, below, that shows a series of faces ranging from a happy face at 0, or “no hurt”, to a crying face at 10, which represents “hurts like the worst pain imaginable”.

The client is asked to place a mark indicating where the current pain lies on the line.

Wong Baker pain rating scale

How to manage pain?

  • Cryotherapy-use of ice packs
  • Exercise
  • Use of superficial heat
  • Acupuncture
  • Placebo therapy
  • Distraction technique like listening to music, use of pets, read a book
  • Use of medicines
  • Massage
  • Bedrest

For Eric, seeing a palliative care specialist in the last fortnight has changed his life drastically.

This has offered him a more hopeful horizon.

A hope that one day he will be free of pain.

One day there will be a chance;

To play with his son.

To hug his wife.

To watch his favourite team play an entire game

To take a walk.

To return to his business.

To watch his family grow.

Today he chooses to HANG ON.

TO HANG ON for a painless tomorrow.





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