Overview
Every individual,
especially patients, experiences and suffers pain. It is associated with a
myriad of causes, and is described depending on the range of its intensity. In
terms of patients’ care, nurses play an important role in after surgery pain
management, such that they spend more time with patients and have the
responsibility for appraising the patients’ pain intensity, administering their
recommended analgesic treatments and checking their efficacy (Chir 2003). In
addition, the regular monitoring of the pain intensity of patients is essential
in evaluating the standard of care provided, and most especially in the
detection of the side effects of administered treatments (Chir 2003). With
this, this paper discusses the concepts related to postoperative or after
surgery pain management, and its use as a means of pain relief. It also seeks
to tackle the physiology of pain and the effects of different pain management
strategies to adults and children in relation to pain physiology.
Physiology of Pain
In biological and
medical terms, the process of feeling pain can be described in its physiology. Primarily,
pain receptors, namely, mechanical, thermal, and chemical, are being stimulated,
as they are present in all parts of the body, most especially in the skin,
surfaces of the joints, walls of arteries, organs, linings around the bone, and
specific areas of the skull. From the pain receptors, the stimuli are
transferred through the peripheral nerve fibers, having two types, namely, the
‘fast pain’ and ‘slow pain’ peripheral nerve fibers. Fast pain is described as
sharp and travels through A-delta nerve fibers, while slow pain is poorly
localized and is diffusely felt. Through the peripheral nerve fibers, pain then
reaches the spinal cord, from where the fast and slow pain is transferred and
processed to the brain (‘Physiology of Pain’ 2007). With this, the individual
then feels the pain sensation and figures out ways on relieving it, depending
on its intensity.
Attitudes to Pain
Because the severity
and intensity of pain is subjective, it has been perceived that groups or
individuals belonging to different cultural, social and religious backgrounds
largely differ in their reactions to pain and their approaches on dealing with
it (cited in King 1991). With the differences in approaches, come the
differences in the development of attitudes in relation to pain. Desy (2007) points
out eight attitudes that have been developed in relation to assessing pain,
namely, hypochondriac attitude, cyberchondriac, researcher, empathic,
complainer, shrugger, juggler, and combination attitudes. Hypochondriacs are
referred to as paranoid thinkers, as they fear the worst illnesses, and as a
response, they habitually visit their doctors for every little scratch or
sneeze. Cyberchondriacs are the high-tech counterparts of hypochondriacs, but
differ from them as they wrongly diagnose themselves with the rarest and fatal
diseases they have read in the Internet. Researchers, as indicated in their
name are intelligent individuals, who surf the Internet and search their local
libraries for illness that match up with their symptoms and investigate
available treatments. Researchers are not contented in seeking only the help of
health professionals, but want to be active participants in their own welfare. Fourth
is developing an empathic attitude, in which empathic individuals, being most
sensitive are considered natural pain magnets, as they naturally take up the sufferings
and pain felt by other people surrounding them. They immediately learn to
detach themselves from other people and create energetic boundaries that would
protect themselves from taking on emotions felt by other people. Fifth is
having a complainer attitude, by feeling as if they are suffering more, as
being self-absorbed and dependent on their sympathizers. Usually, they give
their power over their own sufferings. Shruggers tend to ignore and disregard
the signs of pain and suffer in silence out of fear of knowing that something
is wrong with them. Oftentimes, they are afraid of hearing and facing bad news,
so they adopt a belief that the pain they are feeling is mild or insignificant
compared to what others feel. Jugglers are individuals, who are highly coordinated
with their own systems, such that before feeling a slight change and imbalance
in their bodies, they have already taken necessary steps in bringing themselves
back to normal. Lastly is the attitude that combines some or all of the previously
discussed attitudes, which depend on the severity or intensity of pain an individual
is experiencing (Desy 2007).
The changes that can
be perceived from the discussion of the attitudes toward pain involve the seen
initiative of individuals to find the diagnosis and treatment of the illnesses
themselves, with or without the guidance of a healthcare professional. With
this, it can be recognized that with the high initiative of individuals to
learn and gather information from their illness, they would have greater
knowledge and chances of survival. Another change is the fact that because the
use of the Internet has been utilized to gather information, many individuals
use it to learn and diagnose themselves in relation to the pain they are
feeling. However, such endeavors may lead many to feel paranoid and neglect
seeking medical attention from specialists.
Methods and Effects of Pain Assessment Strategies in relation
to Pain Physiology
Postoperative pain
or after surgery pain is regarded as pain that is usually felt after surgery or
operations, such that is exposes patients to severe stress (Svedman, Ingvar and
Gordh 2005), and increases the body’s sympathetic response, with successive rises
is heart rate, cardiac work and oxygen consumption (Charlton 1997). In
addition, pain may lead to anxiety, and increased anxiety may lead to
accentuated perception of pain, which further increases the levels of anxiety
(King 1991). Because assessment of the patient who is experiencing pain is the
foundation of the best possible pain management strategies or methods (Fink
2000), it must be done in accordance to the healthcare professional’s ability
to focus, listen and empathize with his or her patients. With this, several
methods have been developed in order to minimize the effects of postoperative or
after surgery pain.
The initial response
to alleviating pain is through taking available pain-killing medications,
including aspirin and aspirin-like drugs, paracetamol, opioid drugs, such as
codeine and morphine, and taking local anaesthetics (‘Pain Management’ 2007).
However, taking pain-killing medications poses side effects in the long run,
thus, affecting the individual’s quality of life, such as becoming immune to
the drugs and losing its ability to ease pain, destabilize the value of
self-management skills (‘Pain Management’ 2007), becoming drug-dependent, and
the deterioration of the function of organs. With this, new researches have
been made and found that along with the use of pain-killing medications, pain
management alternatives can also be used. Pain management alternatives involve
the use of a trimodal classification system. The first category includes
cognitive strategies, which are self-initiated strategies that involve thoughts
and private events, such as imagery, self-statements and attention diversion. Second
category is behavioral manipulation, which is public, externally manipulated,
high in external control, and engages actions or behaviors. Strategies included
in this category include hypnosis, biofeedback, modeling, and attribution and
perceived controllability (King 1991). The third and final category is of
physical interventions (King 1991), which include complementary therapies like acupuncture,
massage, relaxation techniques like yoga and meditation, the TENS or
transcutaneous electrical nerve stimulation therapy, and cognitive-behavioral
therapy (‘Pain Management’ 2007).
In relation to pain
physiology, the effects of such strategies can be seen as having changes in the
intensity of pain, for in the physiology of pain, pain perception is considered
a dynamic state (Hargreaves and Keiser 2002). The effect of the implementation
of pain management strategies to the physiology of pain can be seen through the
change in the pain system, which can be measured in two dimensions, mainly,
allodynia and hyperalgesia. Allodynia is referred to as the reduction of pain
threshold to the point where non-noxious stimulus is now recognized as painful,
while hyperalgesia is referred to as an increase in the magnitude of pain
perception, such that a previously painful stimulus is now recognized as having
a larger magnitude of perceived pain (Hargreaves and Keiser 2002). From this,
it can be understood that the effects of pain management strategies can be
perceived using two measures or dimensions, which would either produce a
positive or negative effect to the individual. This just means that the use and
implementation of such strategies would either alleviate or enhance the
intensity of pain a patient feels.
Achievement of Pain Management
It has already been
mentioned that the management of pain is related to anxiety, which is viewed as
a major contributor to the perception of pain (King 1991). Thus, anxiety’s
contribution can be addressed in terms of the improvement of open communication
between health care professionals and patients appear to be the most
appropriate strategy for intervention (King 1991), especially concerning the
health conditions of children, elders, disabled and severely ill adults. Achievement
of pain management among patients can be done through effective communication,
for its lack is the perceived major problem in the relationship that must exist
between patient and healthcare professional, and may be one reason why pain
patients are under-treated (King 1991). It has been reported that due to the inability
to communicate to patients when using a highly specialized vocabulary, status
differences, the inability for patients to ask questions while in pain, and a
perception on the part of some physicians that patients cannot comprehend
medical information (King 1991), contributes to ineffective pain management.
In achieving
effective pain management, it must be kept in mind that the increase in the
knowledge and understanding of patients regarding pain may be helpful in pain
management. With this, doctors and nurses can maintain contact and free
communication with patients, not only to reduce perceived pain but also to
reduce the need for post-surgical narcotics and extended hospital stays (King
1991). With increased communication, a clear and effective relationship can
exist between the pain patients and healthcare professionals, thus, making the
process of pain management more manageable and effective. Second, reduction of
pain associated with increased communication appears to come directly from the
attenuation of state anxiety, and with this in mind, doctors and nurses can
provide descriptive information regarding the sensations involved in procedures
that must be done. The interpretation that patients have indicates that the
sensory information obtained presents a cognitive and evaluative response,
while pain information elicited an affective and emotional response (King
1991). The balance of the amount of information the patients receive from doctors
and nurses gives them confidence in managing pain. In addition, providing the
patients with the information they need to know alleviates their anxiety and
stress, thus, reducing their pain. Third, healthcare professionals can
institutionalize the use of the term stress inoculation, which is a process
whereby patients learn to cope with anxieties of surgery (cited in King 1991).
This is done through providing realistic information, including details of
inherent risks, by reminding patients of their personal resources and abilities
to cope, and by asking the patient to develop a personal coping repertoire,
such as strategies for dealing with pain and injury (cited in King 1991).
Fourth strategy emphasizes the fact that part of the nursing profession is nurturing
(Wright 1987), which stresses the importance of touch. As a strategy in pain
management, therapeutic touch must be applied to patients in pain, to help
alleviate the pain that they feel. With therapeutic touch, the patient in pain
would feel the sense of belongingness and that somebody cares and empathizes
with his or her situation. Lastly, pain management would be improved if
healthcare institutions would stress on the importance of the visitation of the
patient’s family and friends. With this, the patients would have the
opportunity to develop and heal with the assistance of his or her family
members, such that the family members would help the patient go through the
situation without making him or her feel alone, thus, alleviating anxiety and
pain that would hasten recovery.
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