RENEE MONTAGNE, host:
This is MORNING EDITION from NPR News. I'm Renee Montagne.
STEVE INSKEEP, host:
And I'm Steve Inskeep. In Your Health today, we'll look at how patients can take greater control of their treatments. In a minute, we'll hear the story of patients who form online networks to share details of their health problems. First, we have a report on pain. A decade after standards were set for pain treatment, many hospitals still are not getting it right. NPR's Patti Neighmond looks at why that's the case and what patients can do about it.
Unidentified Woman: Check in at patient registration in anytime before 7:00 in the morning.
PATTI NEIGHMOND: Once settled in their room, patients here at St. Agnes Medical Center in Fresno, California, see what most patients across the country see: a display of a series of circles starting with a smiley face that begins to droop circle by circle until it becomes a full-blown tearful frown. Anesthesiologist Linda Hertzberg.
Dr. LINDA HERTZBERG (Anesthesiologist): Zero is no pain; one to four is mild pain; five to seven is moderate pain; and eight to 10 is severe pain.
NEIGHMOND: Measuring pain has been coined the fifth vital sign, along with blood pressure, heart rate, temperature and respiration. Hertzberg says when patients define their level of pain it helps doctors target their treatment. And treating pain has advanced dramatically over the past decade, starting with the discovery that medication delivered directly into the spinal cord could stop pain signals to the brain.
Dr. HERTZBERG: There's also peripheral nerve blocks, where you can, say, numb up someone's arm or shoulder, or numb up their leg for a period of up to 24 hours by doing nerve blocks for, say, orthopedic procedures.
NEIGHMOND: Hertzberg says most hospitals are now paying more attention to pain, but not all. Erica Thiel's 26 now. At 21 she was diagnosed with a rare genetic disorder involving an enzyme deficiency. As a result, she's had dozens of surgeries and procedures for joint, heart, brain and spinal cord problems. And she says she's endured lots of pain in different hospitals, most recently from abdominal surgery.
Ms. ERICA THIEL: I just kept, you know, I kept asking them if there was something different that we could do for pain control, because I felt awful. I couldn't sleep. I couldn't roll from side to side. There was nothing I could do. And they just kept telling me, oh, you just need to go to sleep or try to relax. I spent hours that night in tears, really upset. You're almost near hysterical because nobody believes you. They basically tell you that the pain is in your head.
NEIGHMOND: Thiel says it seemed like the young doctors just didn't believe her. She now goes to a pain specialist who helps coordinate her care.
Dr. Lynn Webster is also a pain specialist. He runs a clinic in Salt Lake City. Webster says most doctors still aren't adequately trained in pain management in medical school. As a result, he says, many don't realize that post-surgical pain if not adequately treated can feed on itself and become a chronic problem. And pain can actually undermine recovery.
Dr. LYNN WEBSTER (Director, Lifetree Clinical Research and Pain Clinic): Patients who have good post-op pain control are able to breathe better. They can take in deep breaths, which can prevent the development of pneumonia. And if they're able to get up and walk quickly it can decrease the risk of having a blood clot in their legs that could even be lethal.
NEIGHMOND: And because it's so subjective, doctors have a difficult time measuring pain. There's no lab test or X-ray that tells exactly how much pain and where. On top of that, Webster says, patients respond to pain relievers very differently.
Dr. WEBSTER: There may be a tenfold difference in our response from one individual to another with the same drug given for the same amount of pain stimulus. This is not something that has been appreciated for long within the medical field, and probably is still not appreciated by most physicians who are not in our field.
NEIGHMOND: Health professionals like Webster want to see the treatment and management of pain standardized in a medical specialty that's as rigorous as cardiology or pulmonology.
In the meantime, Webster says patients should be proactive and sit down with their physician, surgeon or nurse before any surgery that's not an emergency and talk about expected pain and how it can be controlled.
Patti Neighmond, NPR News.
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