Taking the Hurt Out of Pain
Pain is a universal experience shared by all humans. The word is derived from the Latin word “poena” which literally means punishment. It has been referred to as mankind’s lowest common denominator. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” What this definition doesn’t say is that pain is a very complex subjective experience that is difficult to define and difficult to measure. Optimal treatment requires knowledge of its etiology and natural history. Treatment must be individualized, multi-modal, and multidisciplinary. The effective management of pain, especially chronic malignant and nonmalignant pain, requires the collaborative efforts of many providers including physicians, nurses, psychologists, social workers, the clergy and even non-traditional practitioners. As a member of the health care provider team, the pharmacist has an important role to play in managing patients with pain.
From its earliest beginnings, the pharmacist has been a respected trustee of the public’s health. The role of the pharmacist has changed from the compounding of healing medicaments to the provision of sophisticated pharmaceutical care. For over a decade, the pharmacy profession has come to embrace the paradigm shift called pharmaceutical care.
This new philosophy charges the pharmacist with having a shared responsibility with physicians and other health care providers for the outcomes of drug therapy, including both improved clinical and quality of life indicators. Given the bio-psychosocial and economic ramifications of pain, the pharmaceutical care model is equipped to impact the lives of those afflicted with this important problem.
Recently, a report on the development and impact of a pharmacist-based pain management service in a major teaching hospital was published in a leading pharmacy journal.1 The service was well received and resulted in improved clinical and economic parameters. It is anticipated that the published findings from future clinical, pharmacoeconomic, and outcomes research efforts in pain patients will further articulate the value of pharmaceutical care to health care providers, third-party payors, patients, and the public.
Along with the health provider partnership mentioned above, the patient must also be empowered to assume an active role in his or her care so the full benefits of pharmaceutical care can be realized. The importance of including the patient with pain in the assessment process was recently espoused by noted pharmacy educator and pain expert Robert Supernaw.2 In his editorial, Dr. Supernaw argues that the patient (including spouse or immediate caregiver) should preferentially judge the “true cost” of pain and its management via the administration of patient-centered quality-of-life assessment tools. He also challenges pharmacists to develop and use such tools in keeping with one of the important tenets of pharmaceutical care — namely patient satisfaction.
It is well known that the pharmacist is the most accessible health care provider. Whereas many smaller communities lack readily available physician or mid-level provider care, invariably one will find a community pharmacy with access to one or more pharmacists. Given their training and expertise, pharmacists can be assets for patients (and their families and/or caretakers) with various pain-associated conditions. The pharmacist can serve as an educational resource (beyond the traditional patient counseling role) for both the patient and care providers regarding various medications and products used in the management of pain. Monitoring the treatment plan (including patient assessment) and serving as a triage to other individuals or resources are other important pharmaceutical care services that can be offered. The community pharmacy can also serve as a clearinghouse for available community resources and other information available to persons with pain-associated conditions or other interested individuals. One might even envision a community pharmacy serving as an “internet café” for pain-related information where computer stations are available for individuals to search the world wide web.
Given their training and expertise, pharmacists can be assets for patients... with various pain- associated conditions.
Despite the obvious benefits of pharmaceutical care, the provision of pain management services requires competence in this clinical area. It is well known that health care providers, including the pharmacy profession, receive little formal training in pain management. This fact, coupled with misconceptions about drug dependency and the fear of regulatory agency scrutiny and investigation, has lead to mismanagement and needless patient suffering. In recent surveys assessing knowledge and attitudes about pain, pharmacists scored lower than physicians and nurses and were the least knowledgeable compared to these same groups regarding pain assessment of cancer patients.3,4 There also continues to be apprehension concerning the dispensing of controlled substances, a fear of robbery, and a lack of knowledge regarding state and federal controlled substance policies by some pharmacists.5,6
Although these results are troubling, they should serve as a wake up call to the profession. I believe pharmacy school curricula should reflect an increased awareness and sensitivity to pain and its management. It is incumbent upon individual practitioners to upgrade their skills in this area via self-study, attendance at symposia, and participation in other appropriate venues. The profession (collectively and individually) should also be encouraged to enter the public policy debate and strengthen its legislative lobbying efforts on behalf of pain management issues. Targeting pharmaceutical care efforts against pain can be a rewarding activity for the pharmacist. Taking the hurt out of pain is a noble cause, which deserves our attention.