Pain treatment as a symptom of multiple illnesses has been increasingly important over recent decades. Pain Units are no longer uncommon in most large hospitals (and those that are no so large). Similarly, Palliative Care in patients with very advanced or irreversible illnesses has also become common.
Also, epidural analgesia is now common practice in delivery rooms, leaving behind the times when giving birth meant a great deal of pain for mothers.
Why this growing concern for reducing or eliminating pain? Not so long ago, pain was seen as a “necessary evil” that the patient had to endure during their stay in hospital, as the pain relief available was reserved for especially serious cases. Among other things, this was due to its side effects and how easy it was get addicted to, in the case of morphine and its derivatives.
The appearance of new pain relief drugs that remove a large part of the unwanted effects was a key factor. But just as important was the effort made in hospitals to humanise health care, wanting to not only treat and cure illnesses but to also do so in the most comfortable way possible for the patient. It changed from “inevitable suffering” to “the patient doesn’t have to suffer if we can avoid it”.
Technology in treatment and pain control
Pain is probably the most widespread of clinical manifestations of any pathology. Very few illnesses or chemical procedures have no kind of pain. However, medical science does not have a diagnostic test that can objectively evaluate the level of pain that a patient feels. In this respect, pain is a subjective perception. The patient can refer the doctor to where it hurts, what the pain is like and what level it is, but the doctor cannot “measure it” themselves.
The type, spread, duration or intensity of the pain are necessary criteria to classify the pain and make a diagnosis. In many cases, the mere presence of a specific pain may trigger suspicions for a specific pathology, being “typical” pains of specific illnesses. However, once a diagnosis is made, relieving the pain becomes one of the priorities in the treatment.
Pain creates stress and anxiety in the sufferer. This not only has consequences in their level of comfort or psychological well-being as it is proven that stress created by pain has physical consequences on the patient’s organism, slowing down or even making their recovery difficult.
Because pain is subjective and the pain threshold of each patient is different, how can the right dose of pain relief be set? In many cases empirical methods are used where medication is administered until the patient is not in pain, within the dosage limits of each drug, or generic doses are used which may be more or less than those needed for the specific patient.
The technological advance in infusion pumps has allowed to develop techniques in which the patient themselves can request the dosage for pain medication at the pump, within the limits set by the doctor for each drug. This technique, known as Patient-Controlled Analgesia (PCA) is highly beneficial both for the patient and for the professionals in charge of their care. Firstly, because the patient knows how much it hurts and can, better than anyone, decide if it is time for a new dosage of pain medication or not. Also, they have an active role in controlling their illness, which benefits their psychological state as they are no longer a passive subject.
Allowing the patient to control the pain medication dosage generally results in improved respiratory function, reduces the side effects of pain relief administered (especially in the case of opioids) and decreases the workload of the nursing staff.
Similarly, patient controlled epidural analgesia (PCEA) has similar effects on patients when giving birth.
The arcomed Chroma series pumps are ready to work in PCA or PCEA mode with a push of a button. For immobilised patients or those who cannot use their upper extremities, we will launch a device to the market (ArcoAir PCA Switch) that will allow the patient to request pain medication by putting air into a mouthpiece placed on an articulated support at mouth height. In all cases there are drug libraries available in which maximum and minimum limits of dosage, bolus speed and/or continuous, blocking time and continuous infusion time can be set, and many other configuration options.
At arcomed, as global leaders in infusion technology, we are committed to the safety and well-being of hospital patients.