Chronic Pain Explanatory Model

Per medical report dated 11/24/15 by Dr. Cano, the patient is complaining of severe numbness in the right hand, tightness around the right worse than left hand. She also associates this with dropping items. She is unable to button her shirts or raise her arms up to her elbows. This is continuous all day long. Also, associated is severe low back pain with numbness, radiation, and muscle spasm in the thoracic area, and numbness and radiation down the right sciatic nerve with severe low back pain. She continued to work, sixteen-hour shifts, seven days a week. At this time, she is unable to function. She states that she has had 24 sessions of physical therapy that has definitely helped her.

Lower limb lymphedema (LLL) induced by standard surgical and radiation treatment for gynecological cancers is a serious complication that can lead to adverse physical and mental patient outcomes1. It is estimated that between 7 and 78 percent of patients treated for gynecological cancers develop LLL after beginning their medical treatment regimen2,3,4. This substantial disparity is likely due to variable definitions of lymphedema, bias regarding how lymphedema is

Some of the most common signs and symptoms patients experience with the disease of Lymphedema is swelling and a feeling of “fullness” in their arms and legs. Patients at times have described the loss of flexibility due to the increase in pain. In addition, the inability to wear their clothes, rings, and wristwatches due to the feeling of them being too tight.

The proper way to ensure that this is not a constant problem is to make sure that initial pain assessments as well as re-assessments are done in a timely manner. It seems as though the initial pain assessment was completed using the pain scale but the re-assessment was not complete and documented in the proper amount of time. In order to ensure proper documentation of the re-assessment once the first pain assessment has been completed and an intervention has properly been administered, the first action step will be to make sure that the reassessment is complete within one hour of pain intervention. With electronic mars it is easy to build in a recheck into the system to alert the nurse that a reassessment is needed once the pain medication has been administered to the patient. When a pain intervention is done, a flag will come up to remind the nurse taking care of the patient that a reassessment is due. This will also resolve the issue on the tracer audit of how does the nurse know the intervention worked. Another issue on the audit was if no pain intervention was done what was the reason for it not being done.

Conceptual analysis is integral in understanding nursing theory. According to Walker and Avant (1995), concept analysis allows nursing scholars to examine the attributes or characteristics of a concept. It can be used to evaluate a nursing theory and allows for examination of concepts for relevance and fit within the theory. The phenomena of pain will be discussed in this paper and how it relates to the comfort theory.

The lymphatic system is excellent at protecting the human body from foreign organisms that cause cancer, bacterial and viral infections. Like other body systems, the lymphatic system has many disorders. Lymphedema is when body tissues starts to swell resulting in water retention after a mastectomy or radiation therapy. A mastectomy is surgically removing a tumor from the infected breast. The axillary lymph node is removed along with the tumor; after surgery, lymphedema occurs. To determine whether the patient has lymphedema, press a finger or thumb down on the swollen area then release it to see an indentation.

Lymphedema is a condition that causes abnormal swelling of the leg, arm or any other part of the body due to an accumulation of fluid in the tissues. Both men and women who have received infection, surgery, radiation, dissection, abnormalities and treatment within the lymph codes are at the risk of developing lymphedema. However, some individuals can get it for no apparent reason, while others may be born with the swelling.

Chronic pain is complex bio-psychosocial phenomenon. It is a diseases and long term chronic condition that is complex and unrelated to any specific injury or tissue trauma.((())). However, it might also be an exacerbation of symptoms related to some other medical conditions. There are several dimension of pain hence, it is very important for a nurse to classify types of pain to conduct assessments and treatments. The common type of pain include nociceptive and neuropathic pain. Mr. John is experiencing spinal stenosis which is a type of neuropathic pain and reason for his numbness on both feet. On the other hand, he is also experiencing chronic back pain due to degeneration of left hip, which can be classified as nociceptive pain. Besides that,

‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage’ (International association for the study of pain 2014). Pain can be made up of complex and subjective experiences. The experience of pain is highly personal and private, and can not be directly observed or measured from one person to the next (Mac Lellan 2006). According to the agency for health care policy and research 1992, an individuals self-report of pain is the most reliable indicator of its presence. This is also supported by Mc Caffery’s definition in 1972, when he said ‘Pain is whatever the experiencing patient says it is, existing whenever he says it does’.

As a Northwestern University professor of Anesthesiology, Honorio T. Benzon, defines chronic pain is “a demoralizing state that confronts individuals not only with the distress created by the symptoms but also with many other ongoing difficulties that compromise all aspects of their lives” (Benzon). Therefore, chronic pain is rooted in a variety of neurologic functions, integrated from the brain that affects the individual internally and externally. According to David B. Reuben MD, a professor at the David Geffen School of Medicine,

The most common reason that people seek medical care is pain, and pain is the leading cause of disability (Peterson & Bredow, 2013, p. 51; National Institute of Health, 2010). Pain is such an important topic in healthcare that the United States congress “identified 2000 to 2010 as the Decade of Pain Control and Research” (Brunner L. S., et al., 2010, p. 231). Unfortunatelly, patients are reporting a small increase in satisfaction with the pain management while in the hospital (Bernhofer, 2011). Pain assessment and treatment can be complex since nurses do not have a tool to quantify it. Pain is considered the fifth vital sign, however, we do not have numbers to guide our interventions. Pain is a subjective expirience that cannot be shared easily. Since nurses spend more time with patients in pain than any other healthcare provider, nurses must have a clear understanding of the concept of pain (Brunner, et al., 2010). Concept analysis’ main objective is to clarify ideas, to enhance critical thinking, and to promote communication (Rodgers & Knafl, 2000). This paper will examine the concept of pain using Wilson’s Steps of Concept Analysis (Rodgers & Knafl, 2000).

Pain is a basic mechanism in life that helps the body identify that something is wrong or dangerous. Without pain, the body would be severely damaged without realizing it. Pain can become an inconvenience when it spirals out of control; chronic pain, for example, leaves many miserable and unable to enjoy life to its fullest extent even with traditional medical intervention. Around 80% of people report chronic pain in their lifetime (Holtzman & Beggs, 2013). People afflicted by chronic back pain turn to modern medicine for relief, but even these alternatives are not always 100% effective.

Chronic pain is defined as a pain that doesn’t go away for a long time. The pain can last for weeks, more than 3 months, years, and might make someone feel hopeless. Chronic pain does not relief with regular pain medication. It is important to address chronic pain because is physically and psychologically stressful. Its persistent discomfort can lead to irritation and frustration with the person’s self and with other people. Pain affects not only mental health but interfere also with someone’s sleep pattern.

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (1979). Pain is actually the culprit behind warranting a visit to a physician office for many people (Besson, 1999). Notoriously unpleasant, pain could also pose a threat as both a psychological and economic burden (Phillips, 2006). Sometimes pain does happen without any damage of tissue or any likely diseased state. The reasons for such pain are poorly understood and the term used to describe such type of pain is “psychogenic pain”. Also, the loss of productivity and daily activity due to pain is also significant. Pain engulfs a trillion dollars of GDP for lost work time and disability payments (Melnikova, 2010). Untreated pain not only impacts a person suffering from pain but also impacts their whole family. A person’s quality of life is negatively impacted by pain and it diminishes their ability to concentrate, work, exercise, socialize, perform daily routines, and sleep. All of these negative impacts ultimately lead to much more severe behavioral effects such as depression, aggression, mood alterations, isolation, and loss of self-esteem, which pose a great threat to human society.

    Pain Management is a specialty in modern medicine, which focuses on treating all categories of pain such as spinal, neuropathic, sickle cell, and musculoskeletal pain disorders. According to Johnson, Collett, and Castro-Lopes (2013) pain management cases constitute about a third of PCPs (Primary Care Physicians) appointments. However, only sixty-percent or less of patients treated for chronic pain in routine practice setting achieves adequate pain relief. Some of the issues attributed to low success rate in chronic pain management can be associated with information management. In that regard, the process