It’s been less than a month since Christmas? Unbelievable. All the decorations at our home have been safely stored away until next year, except for the artificial-snow laden tree on the screened porch. I will get to that soon. It just seems as if all those wonderful celebrations of Jesus’ birth occurred months ago. Maybe it was because I became a semi-invalid on Christmas Eve – a condition that lasted almost a week. At least it was after I had completed all the necessary preparations; in fact, it was probably because I had concluded them. About five minutes after I leaned back in my lounge chair on Christmas Eve, exulting in the knowledge that everything on my list had been checked-off, I felt as if a screwdriver was being poked into my upper right shoulder. Repositioning to work out the kink, the pain only increased – and I screamed out loud! Now, I don’t often do that, except of course when a grandkid sneaks up behind me and yells “boo!” I like to think I have a high pain tolerance. But this pain was severe. I will not go into all the details, but suffice it to say the muscle spasm (probably due to repetitive motion and overwork) ruled my life off and on for the next week. Through a combination of Tylenol, alternating heat and cold, non-smelly topical pain cream and massage, I made it through Christmas Day without screaming out loud but twice. In the following days, mostly spent at home with nothing to do but get better, I let the pain run its course. And it did; by New’s Year Eve I was ready to party…well, play games with the grandkids kind of partying…but by then most of them had a respiratory virus, so we just stayed home and relaxed. That’s really not a bad way to celebrate a new year. This experience brought the subject of “pain” to the forefront of my mind and the pages of this blog.

When I was in nursing school we were taught that pain was the fifth vital sign (the first four being temperature; pulse; respiratory rate; and blood pressure). This view was developed in the VA hospital system in the late 1990s. The Joint Commission standardized the concept in 2001 – alleging that pain was being under treated – and hospitals began assessing a patient’s pain level on every shift.

Some doctors disagreed with this monitoring, noting that it was based on the mistaken idea that pain should always be closely monitored and treated. Patients assumed that pain medication could always render them pain free – a false notion. Unlike the four vital signs, there is no conclusive way to measure pain, and by definition a “sign” is something that can be measured and therefore objective. In contrast, pain is a subjective symptom. Only the person experiencing the pain can feel and describe it.

Since these guidelines went into effect, America has experienced a surge in opioid prescriptions such as oxycodone and hydrocodone, which has lead to an increase in overdoses and deaths related to these painkillers. Presently, according to the Centers for Disease Control and Prevention, more than 140 Americans die from drug overdoses, each day. Almost three-fourths of these are due to opioids.

Clearly, the use of prescription opioid mediations is out of control and many steps are now being taken to correct the false assumption that all pain could be ended. In reality, this is not a feasible goal.

Yet, as caregivers, we want and need to respond to the pain of our loved one. The most reliable indicator of pain is to ask the recipient if he is in pain. If the answer is yes, seek additional information. Consider that some people may use a variety of words to indicate pain, including “ache,” “throbbing,” “sore,” “tightness,” or “tender.”

Although rating pain on a scale from 0 to 10 is widely used, an elderly person may have difficulty understanding the meaning of this measure. (You have probably been asked this yourself; didn’t you find it rather ambiguous to have to choose one of those numbers?)

To get a better assessment, be patient and allow the degree and type of pain to be expressed in the recipient’s own words. If more details are needed, ask open-ended questions – ones that require more than a yes or no answer such as, “What time of the day does the pain bother you the most?”

Other clues that may indicate the one you care for is experiencing pain include being unwilling to perform simple tasks that were previously enjoyed; relying on more assistance for activities of daily living; and losing interest in usual activities. If these occur, show support and concern without being critical.

Changes in demeanor and behavior can also be caused by pain. Think about a time you experienced severe pain; you probably did not respond to those around you with grace and sweetness.

Even more difficult is determining pain if your loved has dementia or is unable to communicate. In these situations, you should be attentive and observe for pain “clues.” These may include keeping eyes tightly closed; blinking rapidly; distorted facial expressions; groans; calling out during sleep; a change in appetite; increased confusion or even crying. The key is to look for new or unusual actions that may indicate the presence of pain.

It is common for elderly persons to suffer from chronic pain and many times the symptoms can be alleviated. Keeping a diary of type and degree of pain and when it occurs (such as during movement or lying still) is information that will help the receiver’s health care provider determine what treatment, including medications, is best. As caregiver, your responsibility is to recognize and report pain as well as monitor responses and degree of relief and keep the doctor informed.

Two final thoughts: Sometimes when people express pain and feel they are not believed, they may feel upset and stop reporting. Be sensitive. And of course, new pain that is severe should be reported to the doctor immediately.

Next week – non-pharmaceutical remedies to help alleviate pain