Skilled pain control is both an art and a science, yet the sad fact is that many doctors are less than sophisticated in this realm. The end result is that many patients suffer needlessly, trusting the assumed expertise of their doctor and unaware of the option of referral to a pain control specialist.
Let me give you several examples from my own experience:
The last months of my father’s life were spent under the care of a hospice which provided very unsophisticated pain control. He had a hairline fracture of one of his vertebrae which was causing excruciating unrelenting pain. I shuttled back and forth to the nurses’ station, begging for relief for him. The horrifying response was that they’d given him the maximum dose of codeine, and that was it, as far as they were concerned. If his pain wasn’t controlled, it was because my father was dramatizing his agony. (!!!)
In desperation, I called my dear friend, a nurse pain control specialist at our hospice in Hawaii. Her first question was : “What is the most likely cause of his pain?” It seemed obvious that this was bone pain from the fractured vertebra. Her response was quick and incisive: “Codeine will not even touch bone pain. He needs ibuprofen. Can you get his doctor to order that? Make sure that the order is written so that it is given around the clock and not just when your dad asks for it.” I called his doctor, got the order written, and made sure that the nurse gave him his first dose immediately. Within a few hours, my father was more comfortable and peaceful than I’d seen him in the last week.
The take-away? The wrong pain control drug, even when given in large doses, does not alleviate pain. Sometimes the solution is as simple as common over-the-counter medication. The key question a pain relief specialist addresses first is the likely cause of the pain. From there, there is a ladder of narrowing choices that should lead to the most effective drug fairly quickly. In my dad’s case, the solution was obvious to my friend, but a complete mystery to the staff at his hospice.
What patients and their families need to know is that there are pain control specialists at almost every medical center or clinic. They may be doctors, but there are many highly skilled pain control nurses as well. My experience is that they are mostly invisible, but readily available if requested. Doctors do not necessarily always consider a referral to these specialists, so it may fall to the patient to ask.
Another example from my more recent experience with my husband:
During his last hospitalization, he suffered unrelenting pain which was sporadically controlled for short periods of time. The pain regimen seemed bizarre to me: two different hospitalists with differing approaches to pain control and a reluctance to administer “high” doses of pain control had created a set-up which required us to summon a floor nurse to inject a bolus into his IV each time his pain level reached unbearability. The result was a wild see-sawing between being zonked and crying from pain.
When the palliative care doctor took control of his case, she took one look at his pain control regimen and pronounced it “ridiculous!” She re-arranged his entire drug protocol, put him on a relatively high continuous background dose, with the option of bolussing himself if needed for breakthrough pain. Within a few hours, that frantic look had faded from his face, his comfort level was enormously improved and he was able to relax and sleep peacefully.
The lesson from this experience is that even if the patient is given the appropriate pain control drug, if it is poorly administered or at sub-optimal dosage, the patient suffers. A skilled pain control expert is able to recognize these common errors immediately.
One of the common obstacles to good pain control is, ironically, the patient’s own preconceptions. There is a common misconception that high doses of pain control drugs cause the patient to be out-of-it, or “loopy”, or “zonked”. I watched helplessly as my mom declined morphine for her pain because she didn’t want to be “a drug addict”. The truth is that when good pain control is administered carefully, there is no danger of physical addiction. Habituation, yes– but addiction, no. In my husband’s case, on the few occasions when his dosage was too high, the telltale sign was that “drugged” demeanor. As soon as the dosage was lowered to an appropriate level, his alertness returned and his mind cleared. I have personally witnessed patients on massive levels of pain control drugs that made “regular” doctors gasp who were able to function quite normally, and even run their businesses while on a pain pump dispensing very high dosages of opioids. Clarity and good pain control are not antithetical.
There did come a point in my husband’s trajectory when even skilled pain control seemed to have reached its limits. The cause of his pain was becoming increasingly less apparent, and diagnostic tests had a high probability of causing his immediate death.
When I offered to do Reiki , he begrudgingly accepted. He had had reservations about this ancient healing modality in the past, having categorized it as “too woo-woo” in his own mind. But now there were few other choices. As he lay back and allowed my hands to rest gently on his stomach (or shoulders, or neck– wherever his pain seemed greatest), I could see his face and body softening, relaxing. Often he fell into a deep sleep after only a few minutes.
After only a few sessions, he announced that
“Reiki really works. It actually works better than Oxycodone. I know that it takes the Oxycodone 15 minutes before I start to feel relief, but when you put your hands on me, I feel my pain go down at least 3 notches in only five minutes.”
Although this was an astonishing discovery for my husband, it was no surprise to me. I have been using Reiki on my hospice patients for 10 years, and this pain-relieving, peace-inducing effect has been universal for all. The majority of my patients had never even heard of Reiki, so there was no mental bias or preconception. Regardless of their belief system, all were eager to try a non-invasive healing modality that offered peace; Reiki fulfilled that hope without fail.
What I have concluded in my experiences with Reiki, on myself and on others, is that in addition to relief from pain, it facilitates an interior spaciousness that allows each person to find their own unique version of spirituality. Within that spaciousness, each is able to experience “the peace that passeth all understanding.”