Tuesday, 12 January 2016

Pain: What About Patient Centered Care?

This week I had a hand operation that involved the rearrangement of bones and tendons. In case you have not read much about orthopedic surgery it often involves power tools, and may cause you to feel pain after the procedure is over and the nerve block wears off.

In the past I have accepted the usual prescriptions for percocet and Tylenol 3, but this time I refused them since they make me sick to my stomach. Nothing like surgery and throwing up to make you feel really bad.

The plan for another type of pain relief did not work very well at all. I was given a prescription for a different type of pain pill and told to take 1 or 2 every 3 hours. How patient friendly is that? How could you manage to sleep?

perfect pain killer?

If these pills were so ineffective that they would only help with the pain for three hours that just doesn't seem good enough. What kind of patient friendly dosage schedule means you take pills every 3 hours? I phoned the surgeon about this and he did not even understand the point I was trying to make.

Let's just imagine we were talking to a Doctor like Victor Montori, who has sympathy for what is now known as the burden of disease. I wonder if he might think of a better way?

Burden of disease is crushing

I was about to delete this blog post until I ran it by a few friends. 

This is what Lucy thought: 

"I don't know what it is with pain medication but I think they think we are all addicts. When I had my knee replaced I had to fight for more pain medication in the hospital and then when I went home they gave me barely enough to last two weeks. Thank goodness my doctor agreed to give me more. Another patient at Physio had hardly been given anything by his hospital and couldn't do his therapy. It was really awful - he didn't have a GP to go to for help. 

I always meant to talk to my surgeon about this and I will in future as I think it is something they need to look at."

And Joanne agreed to an extent:

"I agree with you on the pain pills and with Lucy's comments. The drugs they give us going out of the hospital are completely inadequate both in dosage and in # of pills. I got too little after my hip surgery. Only enough for 3-5 days. I don't know the equivalence but after the hip experience, I asked my GP for a prescription in advance of hand surgery and had plenty of pills. Even that didn't get rid of the pain entirely. 

The fact that my pills had acetaminophen in them was also an issue because it would have taken me above my daily limit. If I have any more surgeries, I will request drugs in advance from my GP. From 3 surgeries, it doesn't seem to me that the hospitals will bend on this issue. I hope your pain begins to subside soon."

Whatever happened to patient centered care? Is it any wonder that patients don't always follow instructions?!

When you obviously have pain, beyond a shadow of a doubt, you can't even get adequate pain relief. That adds even more weight to the previous post about the difficulty of getting pain relief with chronic pain.


  1. Having never had a surgery (other than an lump removal from my finger under local), I find it totally wrong that the hospitals are allowed to put your body through the trauma of surgery without providing adequate and strong enough pain relief. Do they just figure that we're used to pain so we'll muddle through somehow? Or is it more to do with not wanting to be held accountable if someone has addiction issues with pain meds? I'd love to see how these people that make the decisions would cope if they were operated on and sent home with less than helpful pain relief.
    Being a chronic pain patient I always make sure I have a few extra pain pills in case of ever ending up in this kind of situation. For the vast majority of people we only take pain meds so that we can function on a daily basis and most of us would happily go without both the pills and the pain if it were possible. I hope the hand isn't too painful today Annette xx

    1. I really wanted to say that having to take the medication every three hours intrudes on your life in an unacceptable way. It seems that the focus is all on potential addiction, not easing pain and lessening the work of being a patient. I read a shocking article in the orthopedic journal about patients and pain but there was no way for a member of the public to respond. It was insensitive to say the least.
      Thanks for asking about my hand. It's been a week since the operation and feels OK most of the time

  2. It's absolutely shocking. I think it's not an exaggeration to call this medical torture. And the thing is, you recover better when you have adequate pain control because it allows you to move and do the physiotherapy you need to do to attain maximum function. It's completely counterproductive.
    PS hope the hand gets better real soon

  3. I agree with you Lene. You have a real way with words. As for recovery, rest is a large part of getting better, and if you are prescribed mild pills that the doctors know will only deal with you pain for 3 hours how can you get any decent rest.

    I've read often that staying on top of the pain is the best strategy - you don't wait until it is as bad as possible before you take your next dose of painkiller, you take it regularly to keep the pain at a manageable level or to enable you to engage in therapy or treatments that will cause pain.

  4. Thanks for this, full of insights. We do need new thinking about pain. We either run the risk of a nasty opioid addiction, or we endure pain. Nor am I certain opioids should be the answer - after a bad luck surgery (severing of nerve bundles), they gave me the max dose of IV Fentanyl - so high a dose I needed an oxygen line to stay awake (respiratory problems are a known side effect). The pain was still shocking until I got an ice pack and froze the incision. We need new, less intense ways to deal with pain.

    1. You had to be inventive to get pain relief that time. Sorry to hear about your surgery misfortune. It's something I am sure we all think about before we go ahead with another surgery. I wonder if there is much research on new ways to treat pain.

  5. After laparoscopic knee surgery I was given two days worth of pain killers and at my post-surgical check-up I mentioned that I needed more and was treated as if I just wanted pills. I agree that patient care has gone downhill, it is almost as if they forget they are dealing with humans and pain is extremely debilitating.

    Natasha Shelton @ CCOE

    1. Sometimes I get the feeling that the only time to get painkillers is from your regular doctor when you are not in pain. Once I was looking for an answer (with undiagnosed shingles) and the doctor did not figure it out. He just gave me painkillers, but that wasn't the answer.
      Certainly sounds as though you needed more in your case. That sounds like very little help.