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The suffering patient: Nature and management of pain


The Institute for Family Studies and Ethics held a highly informative webinar on the 18th of March 2021 on how to accentuate and navigate pain.

Dr. Gladwell G. Kiarie, a medical oncologist and senior lecturer in the department of clinical medicine at the University of Nairobi, and Dr. Patrick Olang’, consultant anesthesiologist and senior lecturer, department of anesthesia and critical care, University of Nairobi, were the key speakers for the Thursday evening session. The webinar was moderated by Dr. Njoki Fernandes, an obstetrician and gynecologist.

What is pain?

According to Dr. Olang’, pain can only be described from an individual’s perspective. If a person says they feel pain, it is only prudent for the recipient of this information to take it as it is said, instead of trying to justify or downplay the intensity of pain felt by the other person.

IASP (International Association for the Study of Pain) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Pain can be classified based on its duration and sensation felt. When it comes to duration, first, it can be acute, meaning it is short-term. In most cases, it has lasted for less than 3 – 6 months and sets in suddenly due to a specific cause. Secondly, chronic pain means it has lasted well over 3 – 6 months and is persistent even after the healing of the original injury.

Chronic pain management assessment (grading on a 10 point scale) is usually followed by goal setting, for instance, decreasing pain intensity, return to work or improving day-to-day functions like moving from place to place.

Is grief pain?

The webinar also touched on grief which is an expression of loss: loss of a job, ability to function, self-esteem, or of a loved one. It is undergone in the well known stages though sometimes it grief may encounter them in random order: denial, anger, bargaining, depression and, finally, acceptance.

The management of grief, regardless of its cause, should always result in acceptance. This is when the person admits that they are at a certain point in life where a few changes are paramount and yet, they are at peace with it.

Pain management and its challenges

Since pain is a manifestation of potential or actual tissue damage, it must be treated or managed. Management methods may include radio-frequency, surgical implants, physical therapy and exercise, psychological therapy, or alternative therapy like massage or chiropractic methods. They, however, vary as a result of the cause of the pain.

At times, it can be taxing to pinpoint the cause of pain. Treatment or management may also not give the expected results soon enough, resulting in an overdose or an increase in opioid intake. This leads us to the ethical dilemma of, ‘is it ethical to treat intractable pain with opioids and sedatives even if this will hasten death?’.

This article was written by Anna Jessica Munya.


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