(March 18, 1999, Gazette)
We all experience pain. For some it is intense, but temporary - for others it is a constant aggravation.
Three researchers in the health sciences at Memorial have studied pain from different perspectives. They are also working closely together on plans for the 1999 annual meeting of the Canadian Pain Society which takes place in St. John's May 14-16.
Dr. Sandra LeFort, Nursing, has developed a local program based on existing expertise in the self-management of chronic pain. Dr. Michael Murray, Community Medicine, is a health psychologist who looks at how people understand and think about pain. Dr. Christopher Loomis, Pharmacy, has expertise in neural pain injury.
Managing chronic pain
Two years ago, Dr. LeFort ran a controlled trial at the Grace Hospital in St. John's to see if people with chronic pain (other than arthritis) could learn to manage it better. "We worked with 110 people, half of them assigned to take the program right away and the rest serving as a control group for three months. Overall, the results were positive. People in the program had less pain and im proved quality of life."
The nurse-delivered community-based group program is called the Chronic Pain Self-Management Program. Dr. LeFort would like to see it used throughout the province to help people with chronic pain, such as back problems and tension headaches, to live a less painful life.
"In the trial program, we offered a smorgasbord of approaches, and the people in the group learned which ones worked for them. Although we did discuss medication, we were more interested people other approaches to pain management, such as exercise, relaxation techniques, problem-solving skills, and communication."
Dr. LeFort knows from personal experience just how difficult it can be for a professional health care worker to understand a patient's pain if the patient doesn't have the right words to describe it. "When I was working up North I'd have people say to me, ‘My dear, I have some wonderful, terrible pain.' As a nurse, that's not really helpful to me - I have to figure out what it means."
In the CPSMP, the trained leader helps people with ongoing pain deal rationally with their situation. For example, when they go to see a busy physician, often a specialist, they will only have a short time to explain the problem. "That's the reality and there's no point getting mad," said Dr. LeFort. "The specialist might only have five minutes, and the patient has to be smart about that five minutes. We help people to think through what issues they want addressed, what questions are likely to be asked, and then be prepared to answer them."
One useful tool to quantify pain is to rate it on a scale of 1 to 10. For example, a person with chronic pain might say: "When I wake up in the morning, my pain is a 7, I'm so stiff," Dr. LeFort explained. The sufferer can then go on to elaborate: "When I have a shower and warm up and it's a 4. But lately I've been having days where it's a 10 all the time."
"There's no easy way to describe a subjective symptom," said Dr. LeFort. "But clear communication by the patient can really help."
As a health psychologist, Dr. Murray adds another dimension to research about pain. "It's not simply physical, but psycho-social. It's not sufficient to medically understand the physiology of pain, we also have to understand what individuals think, how their family reacts, and what cultural values are involved."
Dr. Murray has looked specifically at the pain experience of elderly people. "It holds true that even though people tend to have more pain as they get older, there are also varying reactions to the pain depending on their individual psycho-social history."
From a basic science and pharmaceutical approach, Dr. Loomis has studied a rather unusual variant of pain known as allodynia, in which the slightest touch can trigger acute pain. Although there is a definite physiological basis for this type of pain, it is hard for family and friends to sympathize, and it is poorly controlled by current treatments.
Memorial's pain experts will have lots of opportunity in May to talk with their colleagues from other parts of the country. The scientific program for the Canadian Pain Society 1999 annual meeting is now available. For further information contact Angela Drake at 722-0283, email:firstname.lastname@example.org. Dr. Sandra LeFort is at 737-7059, email: email@example.com. The CPS web site is http://www.medicine.dal.ca/cps/stjohns