Pain is what the patient says it is … but not all pain is mu-opioid responsive … Bio-Psycho-Social-Spiritual assume most acute pain is predominantly “bio” assume most chronic pain has elements of “psycho-social-spiritual” + neuropathy pain mgmt case #1 78 female severe lower extremity ulcerations – circumferential on right diabetes, morbid obesity, s/p multiple …
When we listen to stories of terrible pain and we know we can’t do anything about it, we touch our own vulnerability. We have heard the scream of pain, but we don’t know what to do with it. None of us knows what to do with the deep brokenness of our world. Maybe that realization …
… as we have noted before, there is mounting evidence that we need to move away from just “throwing more opioids” at patients with chronic non-malignant pain syndromes … as well as those with multidimensional pain. Some resources … Alberta Hospice Palliative Care Manual (see esp. pp. 12 ff. multidimensional pain) … McBeth’s recent article …
… Grady et. al. provide an excellent summary of the case for not using opiates for chronic non-malignant pain … “A partial explanation of why we got to this point is that the lessons learned from the undertreatment of pain in patients with cancer were generalized to patients with chronic pain and no clear end …
… Kross et. al. in “Social rejection shares somatosensory representations with physical pain” use functional MRI to show that “rejection [recent break-up of a relationship] and physical pain are similar not only in that they are both distressing—they share a common somatosensory representation as well.” Pain is what the patient says it is … but …
