Adaptation to Chronic Pain - Essay Example

? Adaptation to Chronic Pain Adaptation to Chronic Pain Karen Dunn is an associate whose expertise lies in surgical, gerontological, and critical care nursing. Over many years, she actively participated in research work on chronic pain, stress and coping, aging and spirituality, and self-care practices. In the past years, she has taught about chronic illnesses, pathophysiology, theories of aging, and nursing care for old adults. Her research and education on chronic illness led to the formulation of her theory of adapting to chronic pain. Older adults experience chronic pain, which if undertreated can affect the physical, emotional, social, and religious wellbeing. Old adults experiencing chronic pain turn to several cognitive and behavioral strategies that might help them cope with such pain. During her research on chronic pain, she realized that about 50 percent of old people in the society experience chronic pain. This theory aims at controlling chronic pain based on Merton’s description. The Roy Adaptation Model was used to deduce the adaptation to chronic pain model utilized in this theory. Several old adults suffer due to extreme chronic pain that has been undetected or undertreated by their care givers. This theory provides the coping process starts by identifying the causal stimuli and managing it effectively. Dunn’s theory was developed through induction, which is starting with observation and working towards generalization. During her research and teaching on chronic illnesses, Dunn observed the levels of chronic pain experienced by old people. For example, individuals suffering from arthritis attempt several cognitive and behavioral pain coping strategies due to high levels of chronic pain. Patients with arthritis used at least one coping strategy per day which includes coping self statements, exercise, diversion, and praying. Having made these observations, she aimed at describing chronic pain experiences, the frequency of occurrence, and the effectiveness of different coping strategies used. The main concept in this theory is chronic pain which is an unpleasant sensory or emotional experience due to actual or potential tissue damage. Elderly people experience pain that persists beyond the normal tissue healing time of three months. Another major concept is the use of religion as a coping strategy. Elderly people suffering from pain engage in prayer in order to get relief or the ability to cope with such pain effectively. They turn to take their feelings away or give them the right procedure of treating their pain. Elders also utilize non-religious coping strategies such as exercise in order to cope with chronic pain. Another major concept is the psychological state of people experiencing chronic pain. Elderly people suffer from anxiety, depression, and stress due to prolonged pain. Psychological pressure caused by chronic pain causes death or social isolation. Coping strategies is also a major concept in this theory which refers to different actions taken by people experiencing chronic pain. Nurses and physicians treating people with chronic people have to engage various strategies in order to help their patients. A minor concept in this theory is the difference in the rate at which men and women utilize different strategies to cope with pain. Women turn to religious strategies more than men, while men may engage in more exercise activities than women. Major concepts in this theory have been developed operationally. For example, in 2004 a research work aimed at developing the theory engaged 200 elderly people over 65 years old. This research aimed at investigating the effect of religious and non-religious strategies in chronic pain management. The presence, duration, intensity, and location of pain were measured during the development period. Individuals from different religious involve the supernatural beings as a strategy of coping with pain. Patients seek spiritual intervention before engaging in medication, and their spiritual faith helps them adapt to the pain. Non-religious strategies such as cognitive and behavioral activities are also used during pain management. Most elderly people experience moderate pain levels care givers require knowledge of different strategies to help patients cope with their pain. Terms have been used consistently throughout the theory framework. The model creates a framework of coping with pain and terms such as such as chronic pain and adaptation have been used consistently. This consistency creates a link between different strategies that can cause adaptation to chronic pain using the Roy adaptation model. The major concepts are related in order to create simplicity and consistency when applying the theory. The framework outlined is to help patients adapt to chronic pain especially elderly people suffering from chronic illnesses. Coping with this pain has proven difficult for these patients and they usually suffer from different psychological disturbances. Depression, stress, social isolation, and trauma are some psychological disturbances experienced by patients. For example, patients suffering from arthritis have reduced movement and engage less in physical activities. Lack of participation in social and family activities causes depression and anxiety that affect patients psychologically. This makes it necessary for patients to engage in various therapy sessions that help them cope with the pain. Adaptation strategies such as exercise and positive pain perception can help the patient cope with the pain and reduce its intensity. Nurses and other care givers have to identify the causal stimuli and manage it effectively. Religious beliefs have a major role during adaptation since patients may seek supernatural intervention in order to cope with the pain. This theory assumes that patients suffering from chronic seek medication in hospitals or nursing homes through which the framework can be applied. Patients require the help of nurses when attempting or engaging in different adaptation strategies. Patients experiencing chronic pain require extensive care from hospitals and nursing homes. Therefore, this theory assumes that health centers are mostly suitable for this framework. The theory also assumes that all caregivers are familiar with the Roy adaptation model that has been used to develop this theory. Nurses and caregivers have to identify the environmental stimuli causing the pain. They also have to help patients control the stimuli through different coping strategies, including spiritual interventions. Merton postulates are also used in this theory, which assumes that this theory can be functional in all social systems. Dunn formulated a theory that deals with chronic pain regardless of the source or location on the body. The theorist assumes that the proposed adaptation strategies can be applied to help patients adapt to any type of pain located in any part of the body. Another assumption is patients experiencing chronic pain will adapt one or more adaption strategies. Some patients experiencing chronic pain may not seek help from medical facilities where they can learn how to use one or more strategies. Dunn clearly explains the Roy adaptation model when developing her own theory. The procedure of identifying and managing pain causing stimuli has been explained systematically in the theory. Different strategies used for pain management have been simply explained, and the different application modes have been explained. For example, cognitive strategies such as changing the pain perception have been explained, and how to effectively utilize them. Clarity and simplicity makes it easy to understand and apply this theory in a nursing home or home based nursing care. The explanation of different strategies involving behavior, religion, and thinking make this theory applicable for patients from different cultures in the world. According to Dunn, a patient experiencing chronic pain is a spiritual being in constantly interacting with the environment. The environment can be the source or the stimulating agent for the pain. Effective adaptation depends on the thinking and consciousness of the patient, and how well they interact with the environment. The effectiveness when applying different strategies determine the extent to which the patient will cope with the pain. A person seeks medication due to the pain and nurses have to use different nursing processes to promote adaptation. Nurses have to meet individual needs and engage patients in healthy adaptation activities. This may include medication and special care for persons with limited mobility. The health of a patient experiencing chronic pain is affected by psychological disturbances. Limited mobility and long adaptation periods cause anxiety and depression. These mental disturbances affect the general health of patients and their quality of life. Adaptation helps patients effectively manage mental pressure by reducing depression, which improves the general health of the patient. Patients suffering from various arthritic conditions seek surgery as an intervention strategy. Patients suffering from osteoarthritis (OA) may opt for a total knee arthroplasty to get rid of the pain (Mahome et al, 2005). The recovery process and the pain caused by the disease affects the patients’ quality of life. The number of surgeries performed increases annually and nurses have to help patients adapt effectively. However, surgery has other effects such as bleeding, fractures, reduced nerve function, and nerve injury. The removal of anti-inflammatory agents such as Bextra has made the management of OA difficult. There are no curative treatments for OA and therapy is the only solution to lessen the pain. Therapy is used to reduce joint stiffness and increase mobility. Prolonged use of opioids to relieve pain causes addiction and patients find it hard to withdraw. Dunn’s adaptation theory can be utilized during pain management for people suffering from OA and other nonmalignant diseases. Patients suffering from OA experience chronic pain and the use of medication, assistive devices, and the help of caregivers help them cope with the pain. The integration of human development and the environment results to adaptation. Postoperative recovery forms a new environment, which requires pain adaptation strategies. Pain experienced from musculoskeletal diseases acts as a trigger for the adaptive process conceptualized by Roy (Jone et al, 2005). Self-management is a technique utilized to ease the impact of pain on the patient’s mood and their social roles. Hospitalized patients rely on pain medications, but they are fully dependent on nurses and therapists after surgery. Patients who have undergone knee replacement experience pain for almost three months, and coping with the pain is quite difficult. Age, psychosocial factors, and genetic predisposition cause the shift from acute to chronic pain of OA. According to Felson (2004), 6 percent of US citizens less than 30 years experience symptomatic knee pain daily while 10-15 percent of citizens over 60 years old experience this pain. According to Dunn (2005), patients have to deal with this pain everyday and require effective adaptation in order to improve their quality of life. However, the rehabilitation period is a great challenge for several patients. Patients experience a decrease in activities such as work, physical, and participation in social functions, which causes depression. Patients undergo surgery depending on their health conditions. Disabled patients undergo surgery sooner than normal patients, who might stay for up to six months. Research conducted by Marcinkowski, Wong and Dingnam (2005), indicates that the mentality of patients regarding the pain helped patients cope with the disease. Patient’s faith enables them to handle frustration and fear caused by the pain. Nurses utilize realistic teaching modules during rehabilitation and emphasize that results are not realized immediately. This helps patients handle the pain throughout the long and frustrating rehabilitation process. Patients received pain medication such as Tylenol and Sulindac during the rehabilitation process. Exercise performed as patients wait for surgical operation helps them cope with post operation pain. Patients who engage in physical exercise develop a different view of the pain and they stand a better chance of handling the pain effectively. Stimuli such as the waiting period and medication have different effects on pain rehabilitation. Patients who use pain medications and have short operation waiting periods adapt faster to the pain compared to patients who wait for long. The thinking or mentality of the patient determines the adaptation period. Patients who possess positivity towards the pain recover faster than patients with negative mentality. Depression experienced by patients also depends on the mentality of the patients. Patients who manage the mental pressure and frustration caused by the rehabilitation process suffer from less depression. Patients may also associate OA pain with supernatural causes. Superstations and religious beliefs affect how fast patients adapt to OA pain. Some patients are completely immobilized by the pain and post operation effects, which calls for extensive nursing care. Previous research has shown that patients who underwent surgical operations were able to adapt to pain within six weeks. Some patients who seek help from physicians and therapists have experienced pain for over two years. Adaptation methods applied help patients cope with postoperative pain for a period of up to seven years. The Roy’s adaptation model utilized in this theory has proven to be effective during pain management. In most cases, high pain levels experienced by patients may cause hesitation before they opt for surgery. The hesitation period is believed to increase the environmental stimuli causing pain. Patients develop high anxiety and stress when waiting for surgery, which affects their general health and quality of life. References Dunn, K. (2005). Testing a middle-range theoretical model of adaptation to chronic pain. Nursing Science Quarterly, 18, 146-56. Felson, D. (2004). An update on the pathogenesis and epidemiology of osteoarthritis. Radiologic Clinics of North America, 42, 1-9. Jones, C., Beaupre, L., Johnston, D., Suarez-Almazor, M., (2005). Total joint arthroplasties: current concepts of patient outcomes after surgery. Clinics in Geriatric Medicine, 21, 527-41. Mahome, N., Liang, M., Cook, E., Daltroy, L., Fortin, P., Fossel, A., and Katz, J. (2002). The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. Journal of Rheumatology 29, 1273-9. Marcinkowski, K., Wong, V. and Dignam, D. (2005). Getting back to the future: A grounded theory study of the patient perspective of total knee joint arthroplasty. Orthopaedic Nursing 24, 202-209. Read More