Patients with persistent pain – The revolving door patient
Pain is essentially defined as a natural response of the body that acts a warning to indicate harm or potential danger to tissues in the body.
The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
Meanwhile, the pain is termed as ‘persistent’ when it fails to respond to all forms of conventional and alternative medication and has lasted for more than a period of one year. Physicians define persistent pain as a chronic pain that lasts for more than 3-6 months.
Persistent pain has recently been gaining epidemic proportions.
Research has indicated that half of the adult population will develop a chronic problem at some point of time in their later lives.
Persistent pain is also soon emerging as one of the most challenging problems, especially in the elderly age group. According to the figures available, one in every five older Americans takes pain-killing drugs regularly. Besides, four out of five nursing home residents have persistent pain that is basically under-treated.
In addition, almost two-thirds of psychiatric patients ultimately become a part of the category of revolving door patients.
Persistent Pain – Key Aspects
Clinically, persistent pain is defined as a pain that lasts beyond the period of tissue healing or is present in the absence of identifiable tissue damage.
An important factor in the development and existence of persistent pain is that this kind of pain never occurs in a physiologic vacuum. It is mostly associated with an emotional component and psychiatric comorbidity.
In fact, experts indicate that at some time, the distinction between the physical and psychological causes of persistent pain becomes meaningless. Hence, the management of persistent pain remains incomplete without addressing the psychological state of the revolving door patient.
The Revolving-Door Patient
A revolving door patient is an individual who is suffering from chronic diseases that necessitate that he/she receives continuous treatment and also observe self-care.
The revolving door concept is a new concept of the modern medicine. Researchers and physicians generally use the term to segregate such patients from the class of patients suffering from pain related to other diseases.
For the revolving door patient, brief hospital stays should be seen as a part of the treatment. In some cases, regular admissions might not be required, but short duration stays are important.
In addition to the pain and its persistent nature, the revolving-door patient also has to face a series of allied complications, including:
Guilt, of constantly complaining about the pain Frustration, stemming out of failures of treatment Social alienation and reduction in social attendance Loss of productivity and efficiency Damage to the quality of family life Additional costs and expenses of medication and hospitalization
For an accurate assessment of the condition of the revolving door patient, the following steps are generally followed.
Validation of the existence of the pain and the patient’s discomfort Identification of the current nature of pain Assessment of the patient’s current functional status Review of the previous records of the patient Documentation of average and peak pain intensity Informing the patient about the outcome and discussion of the treatment modalities
Revolving Door Patient – Treatment Methods
Successful management of persistent pain basically involves the following:
Comprehensive assessment Use of routine medication Careful monitoring of medical functional status
The treatment modalities adopted for the revolving door patient can be basically divided into two categories, including the nonpharmacologic and pharmacologic management of pain.
In this section, we give a brief explanation of each one of these.
A) Nonpharmacologic Treatment
Nonpharmacologic treatments are those that are basically not supported by the use of medicine.
The most common forms of nonpharmacologic treatment for the treatment of persistent pain for revolving door patients include:
Exercise Physical therapy Massage Acupuncture Yoga, and many more
B) Pharmacologic treatment
There are basically five classes of medication involved in the treatment of persistent pain.
Anti-inflammatory medications NSAIDs, COX2 inhibitors Antidepressants Anticonvulsants Topical Agents Opioids
The drugs prescribed for the relief from persistent pain can carry the risk of side effects and should be taken in proper medical consultation.