Pain management… Tramadol

The European approach to pain management depends on a formalized team approach. It’s never assumed one person knows enough to guarantee the right answer for every patient every time. This more open-minded approach makes the patient the focus of interest. If the patient has been complaining of pain and there’s no clear explanation for its cause or the most obvious treatments have already been tried without success, pain specialists will be called in.

The new team then reviews the diagnosis and treatment to date. This is not to find fault or blame anyone for past failures. Everyone wants to learn and avoid repeating mistakes. So the fresh pairs of eyes start again, question the initial assumptions, and look for alternate explanations for the current problems. If further tests will help this differential diagnosis, they are done. This may include further surgical procedures to collect biopsies or a wider range of scans to look for possible causes. Only when the team is satisfied all treatment options for the underlying causes have been exhausted, do they move on to a formal pain management strategy. In other words, they first try for a full cure and, only if that proves impossible, do they accept the pain as a permanent feature of the patient’s life and begin the process of managing that pain.

The team now excludes the physical specialists and brings in specialists in psychiatry, physical therapy, counseling, and Cognitive Behavioral Therapy (CBT). This recognizes the real nature of the problem. The patient must accept the reality of long-term pain. Without the guidance of a psychiatrist and the allied counselors and therapists, the prospect of persistent pain would be a source of depression.

If you are the patient, you must be shown how to have a more positive view of life. This is not just theoretical. It starts with the physical limitations affecting life and plans how to cope more effectively. In the home, there may be a need to redesign the use of space to make it easier to move around and get things done. In the workplace, it’s often helpful to look at how the work is done and suggest new ways in which the tasks can be performed. Most employers are sympathetic so long as the smooth flow of work is not disturbed for one person. Now come the physical therapists. If you have lost muscle tone or should develop more strength in some movements, they will design a specific exercise program for you to follow. It’s often challenging to maintain commitment to these exercise routines but, if you are to make the best of your life with the new physical limits, you should stay positive and keep working. In most cases, patients report a real improvement in the quality of life.

This marks the difference with our experience with doctors, clinics and hospitals. No one has any time to sit down and talk with us about our problems. Everyone is on the clock to see a given number of patients in the hour. So we go in, we pick up out prescription for Tramadol and go home. It’s a tragedy. Although Tramadol is an excellent painkiller, there’s so much more that can be done, but we are denied access to any of it.