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The Pain Which Does Not Complain

The patient who cries wolf. Not.

I have discussed in this space articles in the scientific literature which have raised concerns that prescription pain medications are at times being misused, if not abused.

An article in the January 15, 2008 "Annals of Internal Medicine" reminds us that there are a lot of folks out there who are quietly suffering their pain-and who perhaps are not being treated adequately for that pain.

The article dealt with the pain of sickle cell disease, a genetic red blood cell disorder which affects individuals of African, Mediterranean, or Asian background. The pain of sickle cell disease can be extreme, to the point of disabling. It affects the bones, joints, back, abdomen, and chest.

A sickle cell patient generally presents to the doctor with so-called vaso-occlusive pain, which is episodic and commonly referred to as a "crisis". The more crises a sickle cell patient has, the greater the risk of death. But there has up until now been little information regarding the daily pain some sickle cell patients experience. This issue was studied by considering over 230 sickle cell patients, who were required to complete a daily diary for 6 months.

Interestingly, the patients studied reported pain on 56% of the days; a crisis was reported on 13% of the days. 29% of patients had pain nearly every day. Only 15% rarely suffered pain. But the patients only sought treatment on 4% of the days during the study period.

Patients who required more opiates also had more pain, more sickle cell crises, and sought health care more frequently.

The authors of this study conclude that patients with sickle cell disease experience pain more frequently than previously reported.

This tells me that we in the health care community should trust reports of pain in those patients suffering from sickle cell disease. Opiates should not be withheld for no reason. The sickle cell patient needs to make sure that his or her doctor assists in maintaining a home pain management program.

Of course, all this ongoing pain in sickle cell disease also means that researchers need to continue to find medicines which will stop the vaso-occlusive process which leads to the pain in sickle cell disease.

It is important that health care professionals understand the nature of a patient's pain, whether it be due to sickle cell disease, or some other illness that creates chronic pain. Such health care professionals might use the old label "crisis" when referring to the pain a sickle cell patient experiences; but the patient knows that pain is just not during such a crisis.

The sickle cell patient feels the pain more frequently than those urgent visits for pain medications. It is the exception to not experience chronic pain. And once all involved understand this, then a more comprehensive approach to the chronic pain can be initiated.

Otherwise the real crisis will be the lack of understanding the effect this devastating illness has on its victims.



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