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Best Practices for Managing Pain

Henry Mayo recognizes that all patients have their own unique pain management needs. Whether it is controlling pain after surgery or managing chronic pain, our Santa Clarita hospital’s expert staff is dedicated to providing the highest quality of patient-centered care when it comes to pain management.

Pam Geyer, RN, discusses best practices for managing pain and some non surgical treatment options available at Henry Mayo Newhall Hospital.
Best Practices for Managing Pain
Featured Speaker:
Pam Geyer, JD, RN
Pam Geyer is manager of the joint replacement, spine surgery and pain management programs at Henry Mayo Newhall Hospital.  She is registered nurse and an attorney.

Melanie Cole (Host): If you suffer from chronic pain you know that it can be debilitating and it can keep you from taking part in the activities that you enjoy, but when that pain begins to interfere with your daily life, it might be time to see a physician to assess your pain. My guest today is Pam Geyer. She’s the manager of the joint replacement, spine surgery, and pain management programs at Henry Mayo Newhall Hospital. Pam, welcome to the show. Let’s start by discussing the basic types of pain. There’s chronic and acute. Since they’re somewhat subjective, how do you even measure pain with someone?

Pam Geyer (Guest): Well that really has become the focal point of the current opioid use epidemic. Everyone pretty much is familiar with a pain scale, one to ten, and I want to talk about that a little bit more in depth but first of all, let’s touch back on the acute and the chronic so people can kind of understand what that difference is. Acute pain is if I walked up to you right now and I socked you in the nose, you probably would say that hurts, along with a few other things, but that’s the acute pain, that’s the here and now, that’s something has happened so your body is telling you that you need to take some type of action. Someone that maybe has an appendix that’s rupturing, they have that pain. That’s your body telling you, you need to go see a doctor. Something is going on that we’re alerting you. So that type of pain really is an alert system for the body. Chronic pain is pain that’s been around a while such as arthritis can be a type of chronic pain. There are chronic pain conditions, fibromyalgia, lupus where actually that pain nerve has been kind of attacked for quite a long time and it’s actually changed in how it responds to pain and its sensitivity on that. So we have to manage chronic pain conditions differently than what we manage acute because acute are short term. They’re going to get better and they’re going to go away, you’re going to heal, you’re going to whatever, and you say goodbye to it. Chronic pain kind of tends to be your friend for quite a while. Now, anytime that you have a condition that say would be a chronic long term illness, you have to wrap your head around that and that’s really I think where this current use state has – has come to its – its meeting point on it and we’ve all heard the statistics out there that are absolutely shocking and should shock us. Us as part of the healthcare profession, you know when you look at Department of Health and Human Services, they’ve got a great facts sheet. CDC has a great facts sheet and you look at it and you say in 2016 over 42,000 people died as a result of accidental overdose due to prescription opioids. That should make us frightened beyond what we can even – even fathom as to what we’re going to do with that, and that’s really where we’re at now in this crisis. So this pain rating scale where we came up with this numerical number, and it doesn’t take really a lot to figure out that the bigger the number, the more the medication. Now I don’t fault people for that because they didn’t know any better; healthcare didn’t know any better. There’s no blame here on practitioners, providers because at the time, everybody believed in how we were medicating pain was the right thing to do. We were trying to alleviate suffering for the patient. The thing we didn’t think about that we now know is all of that medication management with all of those opioids didn’t improve functionality for people. People weren’t getting better, so if people aren’t getting better we can’t continue to do the same thing. Now not only are they not getting better because, as you know, pain is a leading contributor to disability, so people aren’t able to work, they’re not able to participate and function within their family unit, their communities, their churches, whatever activities they do, that is a significant impact on – on all of us within a community and within a society. Not just financially, but we want people to have satisfactory lives. We want them to be able to contribute. They want to be able to contribute. You know, I kind of can’t imagine not feeling that I can give to my family, that I can support my community, so it’s a very horrible state to be in, but what we’ve learned is these medications have not made people better. Not only have they not made them better, but they’re actually resulting in the loss of life so healthcare has to change. We have to look at this differently and that’s really kind of the whole point of all of the research that is going on out there and all of the work groups from the President all the way down to local communities and looking at how do we address this so that we’re not just running to medication of a number. So patients are going to start seeing things a little bit different. Someone’s not just going to say what’s your pain number. They’re going to ask you that but then we’re going to have a conversation because that number has to be related to what is your functionality. What are you able to do, and I don’t know if you’re familiar, or not, but kind of opioids came out of the need to medicate soldiers on the battlefield. So if you think of battlefield injuries, that’s pretty severe. That’s a 10, okay. We have to put 10 into perspective. If I’m able to have this conversation with you, I can talk on my phone, I can get up and go to the bathroom, I can get dressed, that’s not functionality with a pain level of 10, so we need to educate people and bring them back to looking at this. Fortunately for the majority of everyone that lives on this planet, we will never experience at 9 or 10 in our lifetime.

Melanie: No kidding.

Ms. Geyer: Many blessings for that, yes. So even childbirth, and some women may argue with this, but childbirth really is looked at, probably 7 on the scale and you might say well why is that, that’s terrible pain, women will describe this as the worst pain in their life, and it very well may be the worst pain in their life; however, when the doctor tells you to push or tells you not to push, you’re able to follow those directions. If your pain was sitting at 10, cognitively, which means like your communication, your ability to – to listen and follow commands, you couldn’t do that. That really is the person that has a horrific crushing injury from a trauma. They can’t even speak to you. Their pain has so overtaken every possible bodily function that – that they have. Even breathing for them becomes difficult as a result of that pain. So when we – we look at that and we try to put those things into perspective, then most patients will say, well okay yeah I’m not on the battlefield and I am having a conversation with you about my pain level, so that kind of takes me out of that 10 category. Now, no doubt it may be the worst that they’ve ever experienced but we have to bring it back to functionality. So the pain management community is emphasizing functionality. The Joint Commission, which is a large accrediting body for hospitals and other organizations has brought pain back to functionality. So we need to look at that. Now there’s also many things that can be done that are extremely effective for pain that are not opioids. You know we sort of have lost track of also that acetaminophen is a very good drug, which is Tylenol by brand name, but that’s an excellent drug. Ibuprofen, Motrin, excellent drugs to treat pain and realistically, sometimes people say well my pain goal is to have zero pain. I can tell you for sure at my age and where I’m at in my life, I don’t get up in the morning without my knees hurting a little bit. So really pain is a part of life, so to say my expectation is I have zero – I had a pain specialist one time tell me well you can expect zero when you’re no longer on this earth.

Melanie: Yeah.

Ms. Geyer: That really stuck with me for many, many years and I thought you know what? That’s true.

Melanie: And we do have to be realistic, so let’s – let’s discuss some of those nonsurgical, nonopioid types of pain management that you do and really your collaborative approach at Henry Mayo. So tell us a little bit about some of those maybe nerve blocks, acupuncture, injection procedures. You’ve already talked about some of the medications, ibuprofen, acetaminophen. Tell us a little bit how physical therapy, exercise or mediation, biofeedback, psychotherapy, there are so many other times, and we don’t have a lot of time in these segments, but you know just kind of go a broad overview of how you would work with somebody to go through some of these and pick which one would work best for them.

Ms. Geyer: Absolutely. There’s a principal in pain management that’s call multimodal. Now that’s just really a word that’s saying we’re going to put a lot of things together because we know different medications respond differently to pain nerves. Pain nerves are sensitive to certain medications. Also, the body itself, we are creatures of movement and mobility. So the best thing to help you when you are feeling incapacitated, is you’ve got to get up and move, so that movement capacity, and all of those types of interventions that relate to movement. You had talked about therapy. Therapy is phenomenal. Now there are some conditions, people that have severe back pain or nerves may be compromised and you might not be in that category. So as with anything you’re going to do, if you’re in a health state that you’re under treatment with a physician, ask them first before you just go and – and jump into these things, but anything that is going to improve your mobility, aquatic therapy is extremely good because it’s low impact on the body, the joints and it gets you moving. When you build the core of your body, and we’ve all kind of heard this because everybody knows a trainer or knows somebody who knows a trainer, when you make your center strong, it makes the rest of your body strong and you’re now able to kind of carry yourself better to where you might know you hurt but the other muscles are saying we’re going to offload that and you’re going to continue to be able to do the things that you choose to be able to do. So along with the therapies, occupational and physical therapy that you have there, aquatic therapy, also several other types of interventions are good that you mentioned. Acupuncture, acupressure, massage therapy are extremely, extremely beneficial to folks, even things such as the biofeedback where we’re kind of telling – we – we retrain the brain and you have to make a decision. When you have a chronic condition, you have to decide, is that going to run my life or am I going to take control of my life, and that’s really the difference of putting something in the front of your brain and kicking it to the rear to where you’re no longer going to allow that to guide a direct what you do every single day.

Melanie: Thank you Pam so much for being with us today. We can certainly hear your passion for your profession. It comes through in your sharing, your expertise, explaining this all so well for us about the collaborative approach and these other ways to deal with chronic pain. Thank you again for joining us. You’re listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, please visit, that’s This is Melanie Cole, thanks so much for tuning in.