Michelle Barlow: No Easy Answer for Pain BACK

Published by AFAR

A few weeks into my summer project, and I officially have a better understanding of the true nature of this process that we call “research.” Unfortunately, my initiation into this world comes with an agonizing wait for that elusive entity known as “IRB approval” to allow my project to proceed beyond background research into the prospective collection of data. However, I cannot complain as this time has afforded me the opportunity to prepare more fully to undertake the data collection as well as increase my knowledge of the topic, geriatric pain management in the ED. As a result, I am in the process of coming into a fuller understanding of what exactly pain means to an elderly patient, what we ought to be doing to treat it, and ways in which the reality of this treatment can be improved. It turns out that just like everything else in geriatrics, and most things in medicine as a whole, pain is anything but simple.

Pain comes in many forms and levels of severity; it is truly as diverse as its population. It has many causes, both chronic and acute, but it also may be the cause of additional problems, such as delirium and depression. In geriatric patients, the true source of pain is often disguised behind dementia or accepted as a natural cause of aging, and its treatment can be just as complex as the diagnosis. Truly, care of the geriatric patient in pain is not for the faint of heart. It requires time and dedication, and often leads to both practical and existential questions. When do the benefits outweigh the risks? When is enough, enough – when is it better to let them rest in peace rather than continuing to do invasive surgeries and procedures? How can I do my best as a physician and still learn how to let go without feeling like a failure? This, of course, is part of the challenge and the charm of geriatrics. There is no easy answer. Many patients require numerous specialist consultations and high levels of teamwork; they take time and effort above and beyond the average UTI or common cold; they must be treated with compassion and gentleness that you didn’t necessarily know you had, but they have so much to offer in return. They can help make you the best that you can be, a doctor with a wide range of knowledge and a big heart.

Unfortunately, many doctors only see their geriatric patients when they’re sick. They’re short of breath and in pain; they’re delirious or demented or depressed; they are tired but alive. But just wait until they’re well again – see their faces light up as they talk about their kids and grandkids, watch them go for walks and play games with their friends, see the sparkle in their eyes and that big sincere smile that makes it seem as if they have discovered the secret to what life is really all about.

Of course, I don’t expect to see this entire transformation take place during my time in the ED. After all, the Emergency Room is a place of practicality, not existentialism. There are simply too many patients and not enough time to really be able to address the multifactorial concerns of a geriatric patient. Perhaps this is why EM physicians struggle to adequately care for their older patients. It can be a harsh environment for everyone involved, but it doesn’t have to be. One step at a time, we can improve the system. And if my one meager research project can promote change just enough so that future physicians get to see one more wizened face light up with sparkling eyes and a knowing smile as they walk out the door, I will be pleased to have been a part of the progress.

Michelle Barlow
Mount Sinai School of Medicine

 

"Diary of an MSTAR Student" follows scholars in the 2011 Medical Student Training in Aging Research (MSTAR) Program, highlighting their summer experiences. As they continue their path of research, training and clinical practice, read their daily thoughts at www.afar.org/mstarblog. New diary entries are posted every day, so check back soon.