Chapter 11: Special Issues in Pain Management

V.S. Periyakoiladdresses another major issue mentioned earlier, that of pain management. In many ways, Periyakoil weaves together earlier themes. She notes the role that co-morbidity of conditions such as PTSD, psychological and spiritual distress, anxiety, or depression can play in complicating the management of pain. Periyakoil also describes how the culture of stoicism may create difficulties for assessing pain. It may be more effective to ask open-ended questions such as, “Are you comfortable?” rather than, “Are you in pain?” to moderate a stoical response. She is also aware that abuse of substances such as marijuana or prescription drugs may also inhibit effective pain management. Periyakoil’s chapter provides sage guidance for navigating through these difficulties to manage pain.

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