How may clinicians have responded to the information they see at every patient encounter regarding the presence of pain? Having the knowledge that their patients are in pain, would often prompt clinicians to react with a response to treat the pain. This has led to an increase in opioid medication prescribing when acetaminophen and NSAIDS fail. Dispensing opioids has almost doubled according to National Health and Nutrition Examination Survey data showing that from 1988–1994, 3.2 percent of Americans reported using opioids for pain while from 2005–2008, 5.7 percent reported use. 3 This significant increase has been associated with serious consequences including an estimated 40 deaths per day due to prescription opioids. 4– 5

Some of these changes include increasing drug excretion and reducing the number of receptors to bind the drug. Many advanced cancer patients find that they need increasing doses of opioids to control their pain. His dreams, potential, and future were all being devoured by a relentless addiction too powerful to fight. Despair filled him as he realized he wasn’t going to survive.The Fifth Vital is an amazing memoir by Mike Majlak. He recounts his troubled past with a detailed first person account. I read a lot of books on addiction and recovery and I mean I read A LOT of them and thoroughly zipped through this one. Character and quality of pain. What words does the patient use to describe the pain and its character, quality, or intensity?

Since pain is now routinely measured due to efforts of the VHA and JCAHO, the NRS is also asked of patients who are seeing physicians that have little to do with pain management on a day to day basis. So what is the role of pain assessment in these settings? There is not a simple answer, but it should be considered that assessing pain at every patient encounter may not be reasonable. Careful thought needs to go into the purpose of the pain assessment and what will be done with the pain assessment once the clinician receives it. This brings us full circle to the importance of provider education and management of pain. Not many people have the guts to do such a thing but if you take the leap you may just surprise yourself.

an iatrogenic syndrome created by the undertreatment of pain. It is characterized by patient behaviors such as anger and escalating demands for more or different medications, and results in suspicion and avoidance by staff. (p. 1) Nurses should be aware of the beliefs of older patients regarding pain management. Nurses and other caregivers often undermedicate these patients and are sometimes reluctant to administer the prescribed analgesics. The nurse’s primary role in pain management is to advocate for the patient by believing reports of pain and acting promptly to relieve it, while respecting the patient’s preferences and values (Quality and Safety Education for Nurses [QSEN], 2011). Even though some nurses with many years of experience think that they can identify patients in pain, it is sometimes not easy to do. Consider the older adult at risk for the undertreatment of cancer pain because of inappropriate beliefs about pain sensitivity, tolerance, and ability to take opioids.

Lorenz KA, Sherbourne CD, Shugarman LR, Rubenstein LV, Wen L, Cohen A, Goebel JR, Hagenmeier E, Simon B, Lanto A, Asch SM. Lorenz KA, et al. J Am Board Fam Med. 2009 May-Jun;22(3):291-8. doi: 10.3122/jabfm.2009.03.080162. J Am Board Fam Med. 2009. PMID: 19429735 Clinical Trial. As mentioned earlier, Both Kane Hodder and Robert Englund’s books inspired me to jump into this pool of self-employment, quit my job and fly to LA from the UK a week after quitting to work on a movie. High power objective (usually 100×): A closer look at the oil-immersed field can help in identifying morphologic abnormalities in WBCs (e.g., toxic granulations or Döhle bodies) and RBCs (e.g., Howell-Jolly bodies). Moreover, quantification methods to assess the manual blood counts can be done by examining multiple fields. Pain is generally related to some type of tissue damage and serves as a warning signal. Although pain is familiar to most people, it is so complex that there is no single, universal treatment.Although it seems obvious, nonverbal, intubated, and cognitively impaired patients do feel pain! It is important to be proactive and assume pain is present, or “APP.” Any book that gives me the confidence or reassurance needed to keep chasing a dream is a book I’m proud to have in my collection. Overall

Pseudoaddiction can be distinguished from true addiction in that the behaviors resolve when pain is effectively treated.Certain motor or body movements may be associated with either acute or chronic pain. Some may be more exaggerated or obvious than others. Patients in pain may support or shield (“splint”), holding painful body parts while moving, or they may lie listlessly because they are afraid to move. Assess the functional status and degree of impairment in the patient with pain. Morone NE, Weiner DK. Pain as the fifth vital sign: exposing the vital need for pain education. Clin Ther. 2013; 35( 11):1728–32. doi: 10.1016/j.clinthera.2013.10.001 In addition to receiving less analgesia, older adults tend to report pain less often than do younger adults. These findings may be related to beliefs and concerns about pain and the reporting of pain. Many older people hold these beliefs and concerns about pain: Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, et al. American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med. 2005; 165( 14):1574–80. 165/14/1574 [pii] doi: 10.1001/archinte.165.14.1574 Azevedo LF, Costa-Pereira A, Mendonca L, Dias CC, Castro-Lopes JM. A population-based study on chronic pain and the use of opioids in Portugal. Pain. 2013; 154( 12):2844–52. doi: 10.1016/j.pain.2013.08.022