Symptoms And Treatment Of Pain

Gate control theory was first described in 1965 by Melzack and Wall. (Gate Control Theory. 2012). The gate control theory recognizes that stimuli other than pain pass through the same gate. (DeWit, S., Stromberg, H., & Dallred, C. 2017, p.124). The gate control theory states that when the gate is open, pain sensation is allowed through; when the gate is closed, pain is blocked. (DeWit, S., Stromberg, H., & Dallred, C. 2017, p.141). The theory relates to nursing practice in several ways: two type of nerve fibers – small-diameter and large-diameter – carry pain stimuli, activity in small-diameter nerve fibers open the gate, and activity in large-diameter closes it, increase in anxiety open the gate, and decrease in anxiety closes it. Fear that pain will not be controlled may increase pain intensity, and knowing pain is being controlled reduces pain. (DeWit, S., Stromberg, H., & Dallred, C. 2017, p.124). Pain is a “neuromatrix” where pain is a multidimensional experience, which stimuli are influenced by experience, cultural learning, and

First pain is an everyday experiences that is expressed through the use of language and is then legitimized (Waddie, 1996). If a patient as a history of depression or chronic pain they have pain every day and the concept is used to help explain their pain. As nurse we use the concept of pain to find a base line of the pain and to assess new pain. In surgical patients they may have multiple types of pain from the incision, emotional, and history. The concept educates the nurse of the different form that pain can present itself. Pain can also guide how we treat the patient. Emotional pain would not be treated with the “so know pain pills”, but with talking or listening to patient. Concept of pain also address the different form of patient and how the nurse and patient response to it. If a patient is having somatic pain from an incision the nurse could react by applying heat or ice. Pain is what the patient says it is.

According to The World Health Organisation (1999), defined pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is traditionally described as acute or chronic pain. The prevalence of chronic pain (CP) is higher than of acute of pain, as it affects 7.8 million people of all ages in the UK (Chronic Pain Policy Coalition., 2006). The current leading cause of mortality that is accounting for 60% of all deaths is due to chronic diseases and is also a problem as causes an increasing burden on the health care service (World Health Organisation., 2007). CP can affect a person’s quality of life if managed poorly, statistics shows that 25% of people lose their job and 22% leads to depression. (Chronic Pain Policy Coalition.,

Nursing assessment is a substantial way of gathering physiological, psychological, spiritual, and emotional condition of the patient. It creates a whole picture of an individual and assist the health care providers to formulate a diagnosis. Assessing the comfort of the patient is equally important as taking the blood pressure or temperature. Pain is the fifth (5th) vital sign that is subjective in nature when performing an assessment of a patient. Various studies were conducted in finding the most appropriate evidence-based nursing practice in assessing and managing the pain of a cognitively impaired patient, whether it is acute or chronic or the underlying cause is cancer or post-operative incision. As emphasized by Song, Eaton, Gordon, Hoyle, and Doorenbos (2015), it is vital to ensure that “pain management is based on the best evidence” (p. 456). Perhaps knowing the causes of inability to assess and manage the pain in a cognitively impaired patient would give a clearer understanding of the practice.

To provide the best care for their elderly patients, nurses must incorporate pain assessment into their daily care of patients. Pain assessment is a key aspect of the nurse’s role. There are many factors to consider when assessing patients’ pain such as if they are verbal or non-verbal, what language they speak, their age and their cultural background. There are many tools that a nurse can use to assess a patient’s pain but one of the most common tools is the 0-10 scale. This tool can be asked verbally by asking what

“Pain is a complex, multidimensional experience that can cause suffering. [While] pain is inevitable, suffering is optional” (Kinder, 2014, p. 114). The control of pain is, as Kinder puts it very complex, without appropriate measures it can be easily side stepped especially in the elderly. To ensure patient center care it is important that all aspect of one’s quality of life is address, this is emphasizing by pain being a component of vital signs. Being a vulnerable population the elderly is often under assessed as they minimized their problems so as not to be a burden in addition to the fact that they may believe that their pain is a normal part of aging.

The first 48 hours of pain analysis and treating the pain of the patient to the hospice (or end-of-life patient in any other stetting) are crucial. However, the patient may be unable to speak and articulate his pain, or may be able to inadequately express the symptoms. One of the major concerns for those who are at the end of life is

The concept selected is pain management. The reason this topic was selected, is many nurses in the critical care setting are unable to recognize the non-verbal signs and symptoms of pain in a sedated patient. It is often forgotten that sedation does not equal pain management. Pain is subjective. Its existence relies on the ability of the patient to report to the nurse. Ventilated and sedated patients are unable to report pain verbally. This causes patients to unnecessarily feel pain. This paper will examine the concept of pain

The American Pain Society (APS, 2008), defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (p.1). According to McCaffery (1968), “pain is whatever the experiencing person says it is, existing whenever he says is does”. Pain is a complex, multidimensional experience. It is present in all clinical settings and in many different patient groups. It is one of the main reasons why people seek medical attention. Many health professionals involved in pain control (Lewis, Heitkemper & Dirksen, 2004). In order to measure the level of knowledge of medical and nursing staff about pain management in critical care patients and the economic impact I make

‘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’.

In the United States, pain is the most common reason for patients to seek medical attention. According to an Institute of Medicine report in 2011, at least 116 million people in the United States suffer from acute and chronic pain every year, including up to 80% of the elderly population, affecting more American adults than heart disease, diabetes, and cancer combined.1 The national annual economic cost associated with chronic pain is estimated to be $560-635 billion (or $2000 for each American), spent on medical treatment ($260-300b) and in lost productivity ($297-336b). In 2008, 14% of all federal Medicare expenditures are spent on pain management. Chronic pain is often associated with other co-morbidities such as

Managing acute pain in patients, along with post-operative recovery pain, is an essential part of nursing. Because it can affect each and every part of the human body, managing pain is important for the health and safety of patients. Effective pain management can increase patient satisfaction and overall well-being, fulfilling the role of a nurse. A nurse must be able to look at ways to manage patients’ pain, the ethical aspects of managing pain, along with how to educate patients on the matter.

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).

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.

The Mid-Range Theory that is appropriate to my practice setting is the gate control theory. Ronald Melzack was a Canadian researcher and Patrick David Wall, a British neuroscientist presented this theory in 1965. Due to financial instability, Melzack was the only sibling to attend college. Melzack’s research advisor was conducting a study on dogs that have not been socially normal. Melzack gained interest in how to dogs responded to pain when they put their nose in a flame repeatedly. Today, Melzack is a psychologist and a researcher. He is also a professor at a university. After earning his doctorate, he began working with patients who suffered with phantom pain. Wall studied medicine at a university, where he gained interest in studying pain. He met Melzack at the Massachusetts Institute of Technology and together, with the same interest wrote a paper on the gate control theory of pain (Wall, 1965, p. 472).