36 hours ago · The Present State of Pain Theory and Thought. Pain is described in a myriad of ways: in temporal terms: chronic pain, subacute pain and acute pain. in characterizations: intermittent pain, intractable pain, lancinating pain, referred pain, burning pain and dull pain. in acceptable diagnoses (which are all basically syndromes): phantom pain ... >> Go To The Portal
This concept analysis on pain management will provide healthcare providers with defined meanings of pain and its management.
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To revisit the defining attributes, they include: Pain as an emotional subjective perception related to neurological functions and cognitive thinking, pain management as the successful alleviation of suffering, and patient compliance is a large factor in successful pain management.
In summary, a “patient-centered” view of pain is more accurate more efficient, safer, more equitable, and better aligned with the core principles and philosophy of medicine. To diminish inequity and the neglect and marginalization of pain care, health care systems and medicine need to be redefined.
The pain may be of a stabbing, cutting, stinging, burning, boring, splitting, colicky, crushing, gnawing, nagging, gripping, scalding, shooting, or throbbing character. It may be dull or sharp, localized or general, persistent, recurrent or chronic. Often it is radiating.
Patients should be asked to describe their pain in terms of the following characteristics: location, radiation, mode of onset, character, temporal pattern, exacerbating and relieving factors, and intensity. The Joint Commission updated the assessment of pain to include focusing on how it affects patients' function.
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Generally, all the necessary information regarding pain can be acquired if pain-related history is obtained using the "OPQRST" mnemonic, that is, onset, provocation/palliative factor, quality, region/radiation/related symptoms, severity, and time characteristics.
Nonverbal Indicators of PainTense body language.Restlessness.Strained facial expressions.Sad facial expressions.Tearfulness.Increased resistance/agitation with movement.Increased breathing.Shortness of breath.
THE FOUR MAJOR TYPES OF PAIN:Nociceptive Pain: Typically the result of tissue injury. ... Inflammatory Pain: An abnormal inflammation caused by an inappropriate response by the body's immune system. ... Neuropathic Pain: Pain caused by nerve irritation. ... Functional Pain: Pain without obvious origin, but can cause pain.
The updated 2020 IASP definition of pain provides an opportunity for nurses to focus on the importance of their roles in assessing pain and advocating for their patients and for optimal pain management strategies to be implemented.
Pain assessment is a broad concept involving clinical judgment based on observation of the type, significance and context of the individual's pain experience. There are challenges in assessing paediatric pain, none more so than in the pre-verbal and developmentally disabled child.
There are 3 widely accepted pain types relevant for musculoskeletal pain:Nociceptive pain (including nociceptive inflammatory pain)Neuropathic pain.Nociplastic pain.
Six Tips to Documenting Patient PainTip 1: Document the SEVERITY level of pain. ... Tip 2: Document what causes VARIABILITY of pain. ... Tip 3: Document the MOVEMENTS of the patient at pain onset. ... Tip 4: Document the LOCATION of pain. ... Tip 5: Document the TIME of pain onset. ... Tip 6: Document your EVALUATION of the pain site.More items...•
At a minimum it should include the following, but be prepared to take down any information the patient gives you that might be relevant:Allergies and drug reactions.Current medications, including over-the-counter drugs.Current and past medical or psychiatric illnesses or conditions.Past hospitalizations.More items...
Summarising. After taking the history, it's useful to give the patient a run-down of what they've told you as you understand it. For example: 'So, Michael, from what I understand you've been losing weight, feeling sick, had trouble swallowing - particularly meat - and the whole thing's been getting you down.
Further, we propose that all pain can be understood by considering problems of stimulation of sensors, conduction along nerves and/or perception in the spinal cord and brain. The perception then may involve feedback, either positive or negative (i.e. release — or not — of native painkillers, e.g. endorphins). If negative, the result is, by and large, a dysfunction that conceptually could stand alone.
Caudill 2 analyzed pain from different angles to emphasize its complexity, where pain:
Chronic pain merely means that pain is perceived over a long period of time, which has been arbitrarily set at 6 months.
The primary focus in Pain Medicine are the small sensory nerves, which carry unpleasant signals to the brain and may or may not be perceived by the brain. Descartes 4 depicted exactly that: a noxious stimulus causes information to be conveyed to the brain which is then perceived as pain (see Figure 1).
To add complexity, many factors, such as culture, personality, psychosocial stressors and nutritional status, can be involved to influence the degree of pain and to confound the causal factors of the pain.
There are three types of fibers that carry pain signals to the brain — A-beta, A-delta and C-fibers. The first two are evolutionarily modern fibers that are myelinated (insulated) and carry nerve impulses rapidly to the cortical regions of the brain (refer to a basic neurophysiology textbook).
While the Joint Commission 1 now recognizes and mandates pain as the “fifth vital sign,” the present focus of Pain Medicine is “cover-up” rather than “cure.” Even with an abundance of detailed Pain Medicine literature, there appears to be a limited understanding of the basic mechanisms of pain, even within the research world. Obviously, without a reasonably detailed diagnosis reflecting the underlying pathophysiology of a given pain, treatment is no more than “hit and miss.”
Trauma-focused therapies (eg, trauma-focused cognitive-behavioral therapy, narrative exposure, and mindfulness) may be optimal for youth experiencing chronic pain to address the potential for an ongoing stress response.
Presented at the 16th World Congress on Pain in Yokohama, Japan, in September 2016, these papers represent the thinking of the world's top pain scientists and clinicians.
How obesity affects pain sensitivity in pain-free individuals remains to be fully characterized. Quantitative sensory testing revealed that obese individuals had responses to heat and cold pain that were indistinguishable from nonobese individuals. Thus, obesity alone does not appear to be associated with amplification of nociceptive processing.
The results from a large sample suggest there is no clinically significant increase in odds of constipation in lumbosacral radiculopathy compared with nonradicular low back pain.
Opioid doctor shopping was a rare phenomenon among people living with chronic noncancer pain but was associated with the occurrence of opioid overdoses.
First, health care professionals have an ethical obligation to relieve pain.12Second, this obligation has been largely neglected.4All types of pain (eg, traumatic, postoperative, chronic, non-cancer, cancer, and end of life) remain largely untreated and undertreated. Several studies have illuminated this problem: 80% of patients who undergo surgical procedures experience acute postoperative pain, and ~75% of those with postoperative pain report the severity as moderate, severe, or extreme.13An inordinately large proportion of nursing home residents are estimated to experience pain daily in nursing homes ranging from 40% to 85%, with as many as 25% of these older adults receiving no intervention for pain relief.14Pain is highly prevalent among nursing home residents with moderate-to-severe dementia (61.5%), and only 30.7% of patients were treated with analgesic drugs.15Even at the end of life, the data regarding adequate pain management remain discouraging; nearly one of two patients with cancer pain is undertreated;16–19there is significant disparity in pain treatment adequacy with the odds of undertreatment twice as high for minority patients,13and more than 65% of nursing home residents with cancer had pain.20So widespread are the stories of unrelieved pain at the end of life that some believe that public support for euthanasia or physician-assisted suicide is driven by the fear of dying in pain.4
Unrelieved pain may leave patients extremely vulnerable, speechless, changed , and even destroyed. In common medical ethics parlance, unrelieved pain can compromise a person’s autonomy and increase vulnerability,69whereas providing pain relief can potentially protect a person’s integrity and promote dignity. The consent process, for example, demonstrates respect for patients’ values and decision-making capacities. However, autonomy can be compromised in a suffering person when provider goals are directed by the immediate needs of the sick body or by the compulsion to address what is perceived to be the source of suffering. This issue should be taken into account when caring for a patient in pain.2Regrettably, the term “vulnerable” too often is used without any concrete meaning. Given the absence of commonly accepted standards for the identification and solution to the issue of vulnerability, a list of six types of vulnerability has been proposed: cognitive, juridical, deferential, medical, allocational, and infrastructural.63These six types of vulnerability might also represent an ethically relevant feature that bespeaks vulnerability in the context of pain care.70,71
Narrative medicine64stands out as a logical pathway for integration in pain management, as it aims to address each individual patient’s experience as a source of data and a resource through which to better attend and understand the pain condition. It requires the collection of patients’, caregivers’ and health care professionals’ stories both to provide patients with more effective care and foster shared decision making. The stories told by all stakeholders and the practice of reflective writing and closed reading set up a common ground of shared expectations, fears, and doubts. These can provide privileged access to the inner world of those who suffer and those who care.65By emphasizing this first-person narrative, the entirety of the person in pain can be considered, rather than simply focusing on signs and symptoms.
Patient–physician relationships can be categorized into three main models: 1) paternalistic, deliberative, interpretive, informative;462) paternalistic, shared, informed ;47and 3) patient-active, collaborative, passive.48As physician and patient endeavor to exchange information, emotions can dominate the clinical encounter, and the traditional models may not address this emotional exchange. In fact, in a humanistic approach, this dialogical task is strongly about ethics; this ethics encounter fosters the capacity of physicians to see themselves as a character in others’ stories.49Thus, physicians relying on the traditional models of care may fail in treating those patients who have emotionally distressing symptoms.50Regardless of the model of patient–physician dyad, this relationship is ideally characterized by a therapeutic alliance between the one suffering (vulnerable) and the one caring (responsible). The development of such a relationship requires cognitive skills, emotional preparation, and reflective capacity. However, since the “curative model” in modern medical education and practice remains prominent, the development of these types of skills remains challenging and uncharacteristic. Therefore, an approach on care-based49,51,52as well as virtue-based ethics53–55may be envisaged as potential guides for answers to this type of problem. In our opinion and as stated by Benner,56the major point of contrast between virtue- and care-based ethics lies in the manner in which virtues are manifested. In virtue-based ethics, the point of scrutiny lies in the inner character of the actor, whereas in care-based ethics, the focus is relational, ie, how virtues are lived out in specific relationships, particularly unequal relationships in which certain members are vulnerable. Accordingly, pain and its optimal management challenge the defiant straddling of the mind–body dualism characteristic of this curative model that persists in much of Western culture.
Various barriers to effective pain management (relief of pain and suffering as well as improvement in function and quality of life ) have been described in the literature: 1) failure of physicians to identify pain as a priority in patient care, which relates to the prevalence of the curative model over a person-centered care paradigm as well as the dominance of the scientific approach over the humanistic approach;212) failure of physicians to develop adequate relationships with their patients, which threatens the possibility of understanding the subjective language of pain;223) insufficient knowledge regarding pain management;3,23–254) fears associated with opioid prescription and utilization for pain relief (eg, addiction, tolerance, dependence, and adverse side effects);3,25–275) failure of health care systems to hold clinicians accountable for pain relief;3,26,286) patients’ and family members’ resistance to using opioids;23,297) the “war on drugs and addiction”4and the consequent “pendulum swing”;30,31and 8) cost constraints.3,26,32
How we think about pain exerts an influence on the manner in which we respond to it. Our ability and willingness to hear, detect, trust, treat, and report which rely, to an extent, on our understanding of the essence and meaning of pain come ideally from a phenomenological perspective.39,40Thus, how we think about pain is ideally guided by those unspoken and unconscious assumptions, myths, and metaphors that shape our understanding of the individual sufferer’s reality and experience of pain. Any effort to improve pain management will necessitate working not only at institutional, regulatory, and policy levels but also, simultaneously and explicitly, at the conceptual one.
However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician–patient relationship; 3) insufficient knowledge regarding adequate prescription of analges ics; 4) conflicting notions associated with drug-induced risk of tolerance and fear of addiction ; 5) concerns regarding “last-ditch” treatments of severe pain ; and 6) failure to be accountable and equitable.
In 1965, Ronald Melzack and Partrick Wall published this scientific theory; the Gate Control Theory; which identified that pain signals can’t reach the brain as soon as the brain generated from injured sites, they need to catch, manage, and be faced with some certain neurological gates at the spinal cord. Therefore, these gates determine if the pain signals should reach the brain or not. So if pain gates give permission to pain signals to go away, pain will perceived. Gating mechanisms can be stimulated by three techniques: cutaneous stimulation, distraction, and anxiety reduction. (Melzack, 1996).
There is many antecedents related to pain such as environmental, personal, and cultural values. Environment is related to the event that arouses pain, these events such as venipuncture, painful stimulus or hospitalization, when they occur, the individual’s body, mind, or both may be affected by these events, which causes actual or potential tissue damage. Also, the individual’s knowledge and attitude related to specific event play an important role, this knowledge and attitude such as past pain experience, may affect the expectations and acceptance of pain on individuals, and later it will affect how the individual copes with pain. (“How to Cope With Chronic Pain by Nelson Hendler M.D. (1993, Paperback, Revised) | eBay,” n.d.).
The world pain is derived from the Latin “Poena” meaning a penalty or punishment, it’s an abstract concept, which refers to a personal, individualized sensation of hurt, also pain acts as an important biological safety and defensive mechanism that warns people when something is wrong. It’s a private, personal, subjective, and multidimensional experience, pain intensity varies according and based on various psychological, physiological, social and cultural factors, and because pain is a private experience, it’s impossible to know accurately and precisely what someone else’s pain feels like. (“Pain management – foundation | Nursing Times,” n.d.).
According to the Medical Dictionary, pain is an uncomfortable feeling occurring as a result of disease or injury usually it’s localized in some parts of body. (“Pain | definition of pain by Medical dictionary,” n.d.). Pain is translated to the brain by sensory neurons system, and is not just a sensation or physical awareness, but it also includes the perception and the subjective interpretation of discomfort, the perception give the information and the characteristics of the pain; location, intensity, nature, and etc… (“Pain | Definition of Pain by Merriam-Webster,” n.d.).
According to psychology, pain is not just on physical aspect, it also can be emotional, emotional pain result because of disappointment in expectations or relationships, needs to be acknowledged and to deal with it, failure to do that can result in emotional problems and serious mental issues and consequences. (“Pain definition | Psychology Glossary | alleydog.com,” n.d.). Pain identifies who the people are, explains how life is really work, is always a precursor to significant change and to bring maturity and responsibility, athletes and mature persons believe that when no pain, there is no gain. Pain is Gods instrument to produce strength, to learn, grow, and improve, pain is essential to avoid any bad behaviors, and of course pain reminds persons that they need help and need a team, brings all people together because it is main part of everyone story, that is no one is immune. (“15 Benefits Of Pain | Brian Dodd on Leadership,” n.d.).
Antecedent are the events or incidents that occur before the identify concept, these antecedents help to know further and more and more about the critical attributes of the concept of pain. (Walker & Avant, 2010).
Finally, the cultural aspect of pain, according to Sheridan (1992), culture specify how people and individuals interpret, express, and live with their pain, and how to react to this pain. Therefore, pain and its perception are always culturally shaped. (Sheridan, 1992).
This concept analysis on pain management will provide healthcare providers with defined meanings of pain and its management. It has been learned through the defining concept, uses, defined attributes, cases, antecedents, consequences and empirical referents that pain can be presented in different ways and majority of it has to do with the neurological functioning and cognitive thinking. Patient perception and successful management vary from patient to patient and through it all is subjective. Patient compliance and self-efficacy is the umbrella for pain management. The future research studies will give us all a better understanding, appreciation and interventions for successful pain management.
Antecedents in regards to pain management would include an event or illness that causes pain on the patient. The patient would then recognize the painful stimuli. After recognizing the painful stimuli, they would physically or mentally feel pain.
According to Walker and Avant (2011), empirical referents are the group of ideas that occur and represent the concept itself. They can be similar to the defining attributes. To revisit the defining attributes, they include: Pain as an emotional subjective perception related to neurological functions and cognitive thinking, pain management as the successful alleviation of suffering, and patient compliance is a large factor in successful pain management. The empirical referents for pain management include: The pain scale, observing their facial expressions, and verbal response of successful alleviation.
The purpose of this analysis is to further explore pain management and then use it as a research tool for future projects. This analysis will help clearly define pain and pain management. Furthermore, it will provide a better foundation to describe effective pain management in today’s society.
Dr. Squellati (2017) described a common pain theory known as the Gate Theory . She goes on to say pain and the brain work on a gate system which is the communication between the pain source and the brain. The gates have to be open in order for the pain messenger to progress into the brain (Squellati, 2017, p. 37). Moayedi and Davis (2013) describe many other theories about pain dating back to the early centuries, which include Specificity and Intensity. The Specificity Theory states that there are specific receptors and sensory fibers that are specific to one stimulus (Moayedi & Davis, 2013, p. 5). The Intensity Theory describes pain being an emotion that is based on the strength of the stimulus (Moayedi & Davis, 2013, p. 8).
Pain management presents a challenge for providers because of the opioid epidemic and the increasing laws that have risen. Since the opioid epidemic, there have been many people in our population that has become addicted to opioids and some that have even overdosed.
Related cases are similar, but do not have all of the defining attributes (Walker & Avant, 2011). A related concept that comes to mind is suffer. Suffer is a verb that is defined as “to submit to or be forced to endure” (Suffer, n.d.). The following related case is from a real-life example. Mrs. S, 43-year-old white, female presented to the clinic crying hysterically about the loss of a child one year ago. She had lost 50 pounds and has not been able to go through the progress through the grieving process. She was mentally suffering, but was not having physical pain. Suffering has the emotional characteristic and can be successfully alleviated by cognitive behavioral therapy or medications, but it is not necessarily precepted as pain. Pain can cause suffering, but not all suffering has pain.