WELCOME ALL!

1. WELCOME ALL!

2. Previously on CWA seminar

3. FREE FROM PAIN April 17, 2012

4. Part 1 – What is pain?

5. What is physical pain? “Sensation of discomfort, distress, or agony, resulting from the stimulation of specialized nerve endings. It serves as a protective mechanism (induces the sufferer to remove or withdraw).” – http://www.doctorsforpain.com/

6. What should we tell our doctors? L: Location of the pain and whether it travels to other body parts.O: Other associated symptoms such as nausea, numbness, or weakness.C: Character of the pain, whether it's throbbing, sharp, dull, or burning.A: Aggravating and alleviating factors. What makes the pain better or worse?T: Timing of the pain, how long it lasts, is it constant or intermittent?E: Environment where the pain occurs, for example, while working or at home.S: Severity of the pain. Use a 0-to-10 pain scale from no pain to worst ever. - American Pain Foundation

7. Location

8. Timing • Duration • Acute: less than 30 days • Chronic: more than 6 months • Recurrent acute pain: episodes of pain over time

9. Further tests may include: • Physical exam, e.g., soreness • Neurologic exam, e.g., reflexes • Mental health exam • Other diagnostic tests, e.g., blood tests, X-rays

10. The doctor may then identify the cause of the pain. Nociceptive Pain Neuropathic Malfunction in the central or peripheral nervous system Usually chronic, not fully reversible Traditional painkillers do not work E.g., phantom pains, migraines, pinched nerves • Caused by real or potential damage to tissues • Usually acute, when tissue damage heals, pain resolves • Painkillers work • Somatic: bone, joint, muscle, skin, or connective tissue – usually throbbing • Visceral, i.e., internal organs

11. When should you go to the doctor?

12. Part 2- Pain in the elderly

13. Is it normal to have pain as we age? Some say when older people are not clear in explaining the cause of their pain, they are “just complaining.” Some say pain is natural with old age. These are partially WRONG There is, almost always, a real problem behind the aches and pains (Partners Against Pain).

14. Assessing the pain is the most challenging part for older people Older people don’t always express their pain. They might become grumpy or aggressive due to pain. Try to understand them.

15. How to find out if the senior is in pain? Caregivers and family members should be alert at all times. • Know your senior well. • Ask about pain in several forms. • Remember that if something can be expected to be painful, it probably is. • Observe the older person’s behaviors.

16. Symptoms to look for Two scenarios Able to communicate but does not communicate Unable to communicate • Moaning • Loss of appetite • Change in sleep patterns • Difficulty moving • Not wanting to be touched in a particular place • Older person has become unusually flushed, pale or clammy • Increased heart rate • Verbally abusive Source: Elder Care Team

17. Most common types of pain for older people? HIP (arthritis, bursitis, hip fracture, muscle strains) KNEE (Osteoarthritis) LOWER BACK (narrowing of the spinal canal, disks become drier)

18. Part 2- How to cope with pain?

19. COPING WITH PAIN An elderly couple doing a laughing exercise: research has shown that laughter can help relieve pain and even strengthen immunity!

20. THE INDIVIDUAL As we age, it is important that we use our powers of observation and stay attuned to continual changes within ourselves. Practice self-awareness. • Do I see physical changes? E.g., flushed or pale skin and increased breathing rates. • Do I see changes in behavior? E.g., rigid posture, loss of appetite, changes in sleeping patterns and irritability.

21. THE CONSEQUENCES Pain is more than just hurting. It can decrease your physical, emotional , social and spiritual well-being in different ways. How has physical pain affected your life? • You may be unable to concentrate on anything except pain. • You may experience social exclusion.

22. COMMUNICATION • By having your perspective voiced, others can empathize more effectively and understand your reasons for not participating in certain daily activities. • However, pain does not mean confinement. You can ask others to join you in activities that not only serve to help your physical pain but create a mutual bonding time. E.g., yoga at the park or therapeutic massages at a wellness clinic.

23. COMMUNICATION CONTINUED Often, we become complacent with the attention and care we receive from our doctors or physical therapists. We should always look at our reports and see if there are any discrepancies or if there are measures we can take to avoid future complications. Emphasize preventative medicine! Do some research! Ask questions! Be respectful! “Are there any other symptoms I should be aware of that could indicate a more serious condition? “

24. CONVENTIONAL TREATMENT • Milder forms of pain may be relieved by over-the-counter medications such as nonsteroidal anti-inflammatory drugs. • Doctors may prescribe stronger medications such as muscle relaxants or trigger point injections. • However, it is important that you follow medication protocols strictly; start off with low dosages if permissible, and are aware of the potential side effects or interactions.

25. HOLISTIC HEALING • A multidisciplinary approach with holistic treatments can prove to be helpful and carries along with it fewer side effects. • Try swimming, rowing, walking, biking, rebounding, yoga and even meditation. The release of endorphins is the body’s natural painkiller! • Massage can reduce stress and relieve tension by increasing blood flow and decrease certain chemicals that may generate pain in the body. • Incorporating anti-inflammatory foods in your diet can help pain by decreasing inflammation in the body. E.g., wild salmon, cruciferous vegetables, berries and turmeric.

26. Part 4– Palliative Care

27. What is Palliative Care? • specialized medical care for people with serious illnesses, regardless of life expectancy • provides patients with relief from symptoms, pain and stress. • improves quality of life for the patient and the family • palliative care and curative care may be received at the same time

28. What Does a Palliative Care Team Provide? • time for close communication • expert management of pain and other symptoms • help navigating the healthcare system • guidance with difficult and complex treatment choices • emotional and spiritual support for you and your family

29. What is Hospice Care? • specialized medical care for people with a life expectancy measured in months not years • provides patients with relief from symptoms, pain and stress • a team of doctors, nurses, social workers, home health aides, and family provide end-of-life care • all treatments and medicines provided by hospice

30. Four Levels of Hospice Care • Routine Home Care often provided in home or long-term care facility; services provided on an intermittent basis according to need • Inpatient Care designed for short-term, acute needs; inpatient units or hospital • Respite Care provides short-term relief to patient’s caregivers by transferring patient to hospice for up to five days • Continuous Care Provided in residential setting when patient is in crisis and symptoms not manageable with routine care

31. Statistics • in 2009, both programs service an estimated 1.56 million patients and families. • more than 5,000 hospices participate in the Medicare program in the U.S. • Medicare Hospice Benefit, enacted by Congress in 1982, is primary source of payment for hospice care • in 2007 mean survival for hospice patients was 29 days longer than nonhospice patients; in 2010 median survival patients getting palliative care was 2.7 months longer

32. RESOURCES Visiting Nurse Service of New York Telephone Number: 1-800-675-0391 www.vnsny.org Provides proactive symptom management to individuals in advanced stages of illness Hospice of New York Telephone Number: 1-718-472-1999 www.hospiceny.com Provides care; licensed by the State of New York and Certified by the Medicare Program; accredited by the Community Health Accreditation Program

33. RESOURCES National Hospice and Palliative Care Organization Telephone Number: 1-800-658-8898; Multilingual HelpLine: 1-877-658-8896 www.nhpco.org Provides free consumer information on hospice care and puts the public in direct connect with hospice programs; service available in over 200 languages Hospice and Palliative Care Association of New York State Telephone Number: 1-518-446-1483 www.hpcanys.org Provides the public and members with information about end-of-life-care; promotes availability and accessibility of quality hospice and palliative care for all persons in New York State

34. Part 5– Other ways of ending the pain – ending life?

35. Some vocabulary • Physician aid-in-dying (PAD) = assisted suicide. Requires the patient to self-administer a lethal dose of medication and to determine whether and when to do this. • Euthanasia Entails the physician or another third party administering the medication. • Passive euthanasia Withholding of common treatments necessary for the continuance of life. • Active euthanasia Use of lethal substances or forces.

36. Legal aspect Aid in dying is legal in the US states of Washington, Oregon and Montana, and in Switzerland where deadly drugs may be prescribed to a Swiss person or to a foreigner, where the recipient takes an active role in the drug administration. Active euthanasia is only legal in the Netherlands, Belgium and  Luxembourg. Passive euthanasia can occur in the US since patients can refuse treatment (example : Do Not Resuscitate)

37. Issues Moral, ethical and religious issues surround the end of lifeand management of pain. The term “assisted suicide” was replaced by “aid in dying” because of its negative connotation.

38. Interesting studies and numbers Ezekiel Emanuel, an American bioethicist conducted a study among cancer patients in Boston. He found that unbearable physical agony is almost never the reason patients give for seeking end of life. Depression and other forms of mental distress were by far the more common motivator. According to the May 2007 Gallup poll, 49% of Americans say doctor-assisted suicide is morally acceptable, while 44% say it is morally wrong. In France, passive euthanasia waslegalized in 2005. According to a March 2012 survey, 91% of French people want active euthanasia to belegalized. However, 51% of themthinkitshouldbelimited to patients sufferingfromextreme pain thatmedicinecan not ease.

39. Interesting studies and numbers The Journal of Medical Ethics published a study in 2008 showing that 34% of people who had resorted to assisted suicide in Switzerland, including youth under the age of 30,were not suffering from a fatal illness. “Death tourism” in Switzerland is an increasing problem, with the majority of prescriptions given to foreigners from neighboring countries (mostly France, Germany and the UK).

40. Thank you all for coming!! MAY YOU BE FREE FROM PAIN