Karel Schram, P.A.-C. is the grand prize winner of the PainEDU PAINWeek2011® Scholarship.

"Pain is a Pain!" When a health care provider utters these words in the course of their day, they are summing up the difficulties and frustrations they experience while trying to treat chronic pain. Despite the frequency of pain as the chief complaint, the management of this condition continues to be controversial and challenging for the primary care provider.

My interest in treating pain began in the early 80s when, as a nurse, I cared for and watched a skeletal breast cancer patient spend her last days in indescribable uncontrolled pain. The response to my plea to the doctor to do something more for her was an admonishment, “You have the order, Demerol 50-75mg IM q6 hrs PRN pain, so why are you calling me?” As I watched her suffering I couldn’t help but be moved by my thoughts that this under treatment of pain was just plain wrong.

Fast forward 8 years, this time it was my Dad with cancer. Hospice was great about addressing the pain and managing home oral morphine, but then came the day the tumor progressed and acute pain set in. A 3 hour wait in ER for a pain shot was unacceptable! This once handsome, strong, hard working stoic man was reduced to a sobbing, moaning, writhing vulnerable emaciated “patient” who had to wait for x-rays, labs and a call to oncology before anything could be done. We were asking for a shot; I suppose they needed to be sure he wasn’t a “drug seeker”. I couldn’t help but be moved by my thoughts, again, that this under treatment of pain was just plain wrong.

Fast forward 10 years, I am accepted to the University of North Dakota School of Medicine to become a physician assistant. I am fortunate enough to do a rotation in a multi-disciplinary pain center and I have found my calling.

Now I’m 12 years into this, and I consider myself a pain patient advocate. I have worked in a pain clinic for 6 years, and then transferred to serve in a Federally Qualified Health Center (FQHC) clinic where most patients have essentially little to no access to a multi-disciplinary pain center. Using all the resources we could muster, we have developed a program that closely resembles those multi service programs that are available to the more “privileged” patients in pain.

This is not to say that this role doesn’t come with its trials and tribulations. While some providers may agree that treating pain is a pain, and I might think being a pain patient advocate is a pain, our struggles as providers pale in comparison to the pain our patients experience living daily with this condition. I don’t need to recap the impact on patients, families and the community that chronic pain bestows; I believe there is no argument about that. Where the controversy comes in is, what do we, as providers, do about it?

There is tons of press about the under treatment of pain and an equal amount of press about drug abuse and unintentional death from prescription drugs - both a national health crisis. No wonder we providers feel so much angst! Yes, we want to help the patients, their families and the community, but we cannot help but feel a discomfort level as we balance trying to do no harm, too.

Pain treatment awareness has come a long way. We have excellent resources and guidelines developed and endorsed by the major pain organizations. So what’s the problem? Why don’t we have more resolution of our angst and discomfort? It’s because we need the knowledge and experience to be more comfortable treating pain. Knowledge comes with education and with the practice of treating pain. With practice comes experience; with experience comes an improved comfort level!

So…the key to start with is education. We need to educate ourselves, our colleagues, our patients, their families and the community. This education comes from sources such as Pain Week. My wish is that I, along with many other pain treatment advocates, will be able to attend Pain Week to learn and then spread the knowledge needed to treat pain while adequately managing the risk. We must achieve the comfort level so we cannot help but think that, when we treat pain, it is just plain right!

Karel Schram is a physician assistant with Hackley Community Care Center, an FQHC in Muskegon, Michigan. She is credentialed by the American Academy of Pain Management, and takes a special interest in the art of educating about, and treating, chronic pain.