eHope: What is pain?
|Jay Thomas. (Photo by p. cunningham)|
Jay Thomas, M.D., Ph.D.: In terms of physical pain, there are different types. Nociceptive pain is the “normal” pain we feel when, for instance, we stub our toe. A pain nerve in our toe picks up the signal and sends it to the spinal cord then the brain, and we feel and experience that hurt.
Neuropathic pain, on the other hand, usually results from physical nerve damage. For example, a cancer surgeon might cut through a nerve while removing a tumor, and if the nerve grows back abnormally, this can result in pain signals being sent to the brain long after any physical damage.
In some cases, a chronic nociceptive pain can become neuropathic in nature. For example, if I slap my hand once, it hurts quickly then fades. But if I keep slapping my hand continually for some time, biochemical and physical changes occur in the spinal cord that short-circuit the process. The pain then becomes neuropathic.
But pain and its associated suffering is more than just the physical pain. This leads us to the concept of “total pain.”
eH: Can you explain?
JT: Total pain takes into account the fact that the suffering we experience from physical pain can be profoundly affected by our psychological, interpersonal and spiritual concerns.
Experiments show us that people perceive not just physical pain, but suffering also. This suffering is heavily influenced by our emotional state. So our relationships with other people, our psychological health and our spiritual concerns are very important to how we perceive pain.
As health-care providers, we must address pain at each level. Even with the right medicines, we can’t optimally control pain without addressing total pain.
eH: How does this relate to cancer pain?
JT: Tumors can damage nerves as they grow. Also, different treatments, such as chemotherapy and radiation, can cause nerve damage. But cancer is an assault on the whole person and that person’s family. The disease and its treatment comes with considerable stress and distress, as you can imagine. All of these things must be accounted for.
eH: What can patients or their loved ones do to alleviate pain?
JT: The best thing is to report pain accurately. It can be difficult to communicate pain to your doctor; it’s very subjective. I recommend keeping a log and answering some basic questions: Where is the pain? How would you describe the pain (sharp, dull, burning, radiating)? When did it start? How long does it last (continuous or comes and goes)? What makes it better or worse?
If patients can come to us armed with these answers, it really helps us understand and intervene appropriately.
eH: How do doctors manage cancer-related pain?
JT: Each person is unique, so their experience with pain will be unique. To effectively address a patient’s pain, you must treat total pain. City of Hope is doing something unprecedented with its supportive care program. By bringing together a comprehensive, interdisciplinary group of psychologists, psychiatrists, social workers and spiritual care providers to team with each other and the patient, family and caregivers, we can effectively address the total pain experience together for the best outcomes.
This team approach is vital. No matter how enlightened or skilled a physician, you need a team like this to address the patient’s needs. City of Hope is exemplary in that aspect.
For more information about supportive care services, visit the Sheri & Les Biller Patient and Family Resource Center online or call 626-256-4673, ext. 3CARE (32273).