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Definition: Pain vs. Suffering Pain is what the patient perceives. Assessing pain is an individual process. There is a difference, too, between pain and suffering. Pain is immediate. Suffering often relates to the past or future, and goes beyond; pain can incorporate thoughts, feelings, and emotions. Those who suffer can benefit from an end-of-life review. 
There are other types of pain, depending upon its causes:
Susceptive Pain vs. Neuropathic Pain Susceptive pain is pain in the muscles: from a sports injury, a toothache, tissue damage. Neuropathic pain feels like pins and needles, after chemotherapy, shingles, or diabetic neuropathy. Treating pain requires that the doctor prescribing understands the type of pain. In some cases, creative pain management is a must. And there are up-to-date findings which your physician must be aware. For example, Haldol, an antipsychotic with side effects, is useful in some pain management. In terms of pain definitions, the World Health Organization (WHO) not identifies Total Pain, in an impeccable assessment. Treatment Treatment needs to be addressed rapidly with a comprehensive management approach.All of this pain must be considered. We know that the more we manage Total Pain, the less pain a patient feels. The NOPQRSTUV of pain I attended an education seminar, given by one of our local Pain Management nurses. She explained this concept to us. N: the numerical value patient assigns to the pain, between 1 and 10 O: onset or origins of pain P: palliativate or provoke: what provokes the pain? Q: qualify the pain: is it neuropathic, or susceptive? R: regions or pain. Does it radiate, my physiotherapist also uses the word 'referring' pain, as it spreads down the body. S: severity of the pain according to times of the day, or situational, or anticipatory pain U: understanding, does the care recipient and family understand everything going on? Do they need more information, e.g., the use of Halidol, rather than another medication. V: value, what is the importance value of pain for you? If you have pain currently at a level 9, for example, are you able to live with it if it can be reduced to a level 4? Can you live a better quality of life at a level 4, go outside, relate to family and friends? There are many barriers to pain management. WHO, according to Dr. Sirianni, says that 70% of cancer patients have pain, and the 80% of those die with uncontrolled pain. Pain is often poorly managed due to many factors: myths, misunderstandings, and barriers to access to quality palliative care . In the final days of life, pain may be difficult to assess due to unconscious, or comatose patients. Family members must be aware of what they might expect, e.g., Cheynes-Stokes breathing. Physical/behavioural signs: agitation, confusion, delirium, twitching. Cardiovascular signs: decreasing blood pressure, rapid, weak heart rate, edema. In addition, family members must understand that the body is shutting down, and that mouth care is crucial, as the mouth becomes dry. Skin: pale, blue, mottled, cool, with possible skin breakdown. Food and liquid intake may be counterproductive in those whose organs are shutting down, eventually it will decrease to zero. It is amazing how long we can go without food (2 weeks - one nurse told me), water (2 days) and oxygen (2 minutes). This is when a specialist is crucial. Genitourinary: (urinary tract, genitals) incontinence, reduced urine output, dark colored urine.  Resources Pain Management at the End of Life Dr. Giovanna Sirianni Staff File Format: Microsoft Powerpoint - Quick View ... by means of early identification and impeccable assessment and treatment of other ...Take home point: When assessing and managing pain, especially in the ... of pain related to more than somatic factors; Components of “Total Pain” La Belle Mort en Milieu Rural: a report of an ethnographic study of the good death for Quebec rural francophones . Veillette AM , Fillion L , Wilson DM , Thomas R , Dumont S ., Centre de recherche de l'Hôtel-Dieu de Québec, 9 McMahon Street, Quebec City, Quebec, Canada G1R 2J6. Bruera, E., et al. 1991. The E dmonton symptom assessment system (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care. 7 (2): 6–9. Retrieved March 13, 2011, from www.palliative.org/PC/ClinicalInfo/AssessmentTools/AssessmentToolsIDX.html. Using a quality framework to assess rural palliative care. by D Goodridge - 2010 WHO Definition of Palliative Care : Palliative care, in part:provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death; |
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In Ontario, we are organized into 14 regional Local Health Integration Networks (LHIN). It is an important part of our healthcare system, as there are many differences between care in urban Toronto or Ottawa, versus rural areas, such as the one where I live, S. E. Ontario (LHIN 10).
That said, while local Boards of Directors shape the policies and spending priorities of each LHIN. There are provincial initiatives that serve to shape the LHIN delivery of services.
CCAC
For example, each LHIN now has a Pain and Symptom Management specialist whose job it is to educate and consult with caregivers in their homes, to educate physicians, social workers, as well as these exclusive consultations. They are also going into long-term care (LTC) to do these client assessments. To access these nurse specialists, you either phone your local Community Care Access Centre (CCAC) office, if you are a caregiver, or the charge nurse of the institution where your loved one resides is responsible for inviting them in.