Managing Adult Pain - Assignment Example

Managing Adult Pain Name Student Number Institution Course Code Instructor Date Introduction This assessment tries to demonstrate the understanding of the key mechanisms of pain and the associated clinical signs and symptoms of the various types of pains. The first question outlines the pathophysiology of nociceptive and neuropathic pains, as well as their similarities and differences. The second question addresses the historical, cultural and psychological factors that can influence the perceptions and experience of pain by individuals, as well as discuss how they contribute to pain assessment. Finally, the last questions compares and contrasts three pain assessment tools appropriate for use within a clinical area. Question 1: The Pathophysiology of Nociceptive and Neuropathic Pain Nociceptive pain involves the kind of pain resulting from activity of neural pathways brought about by actual tissue damage or potentially tissue-damaging stimuli. Examples of pain in this context incorporate pain after surgery, arthritis pain, pain associated with sport injuries, and mechanical low back pain (Nicholson 2006). Nociceptors involve nerves that are sensitive and respond to suffering that occur to any part of the body. They generally signal tissue irritation, impending or even the occurrence of an actual injury within the body system. In the event that nociceptors are activated, pains signals are transmitted through the peripheral nerves and the spinal cord to the brain for interpretation and the body responds to the pain (Daniel, et al. 2008). The pain is characterised by being localised, persistent, and repeatedly occurring in aching or throbbing manner. In the event that the pain is exhibited by internal organs, it is termed as visceral pain and tend be to occur in an episodic manner and is poorly localised. This form of pain is time limited in the sense that it diminishes upon the healing of damaged tissue or part of the body by resolving itself (Nicholson 2006). However, arthritis is a notable exception type of pain that is not time limited. Further, nociceptive pain is also characterised by responding well to treatment through application of opioids. Nociceptive occurs from activity impacting on the neural pathways that are secondary to actual tissues damage or potentially tissue-damaging stimuli. Neuropathic pain is chronic pain that emanates from the nervous system after occurrence of a lesion or a dysfunction which can be maintained by varying mechanisms within the system (Leone, et al., 2011). Generally, it is the pain resulting from an injury or malfunction with the peripheral or central nervous system but often triggered by an injury that may or not involve damage to the nervous system. Examples of neuropathic pain involve excess stimulation of nociceptive pathways or damage to the inhibitory pathways that result to alteration of balance between pain and non-painful sensory inputs with the pain resulting to absence of nociceptor stimulation (Daniel, et al. 2008). In context, the neuropathic pain can present itself without any prevailing or observable physical signs. From a critical context, nerves can be affected by tumors through compression or infiltration or even inflamed through an infection. The occurrence of the pain presents burning sensation, or electric shock feeling or even lancinating; with persistent pain that occurs upon exposure to light touch through non-painful stimulus (Leone, et al., 2011). Both forms of pain are common problems that affect clinical practice and adversely affect the quality of patient’s lives (Nicholson, 2006). They are associated with changes within the body system are transmitted by the nervous system for detection. However, nociceptive arises from damage of body tissues and organs, while neuropathic pain results from injuries to the body nerves. Nociceptive or somatic pain is the most obvious discomfort experienced as a result of injury in the body, broken bone, or appendicitis (Leone, et al., 2011). It makes sense when referred to as pain experienced by a patient. One notable difference between nociceptive and neuropathic pains is that the latter is not fully reversible while nociceptive pain is reversible upon treatment and healing of damaged tissues (Daniel, et al. 2008). Further, neuropathic pain is chronic and tends to possess less robust response to treatment with opinions unlike nociceptive pain that is non-chronic and effectively treated by opioids. However, treatment of neuropathic pain is utilised in the management of pain but not fully eradicating the pain. From a general perspective, nociceptive pain typically responds well to anti-inflammatory agents and opiated whereas neuropathic pain for unknown reasons responds poorly to these agents (Nicholson, 2006). The reason behind the chronic nature of neuropathic pain is predicted to be connected to the anatomic and physiological changes occurring within the spinal cord and maybe the brain. The consequential plasticity of nervous system means that some processes within the system that generate neuropathic pain become hardwired in the nervous system after a short period of experiencing the pain (Leone, et al., 2011). This means the pain can recur later even with the absence of the stimuli or the cause within the nervous system. Question 2: Historical, Cultural and Psychological factors that can influence a person’s perception and experience of pain and discuss how these may contribute to pain assessment Pain is a unique experience in respect to each patient and is majorly affected by a number of factors (Gupta, Daigle, Mojica, et al. 2009). It is influenced by historical, cultural and psychological factors that affect the way individuals perceive and experience pain in their lives. For a clinical professional, these factors may have an impact in the overall assessment of pain and eventually affect the management process in a client. These factors also have a direct contribution to the assessment of pain within a clinical and community setting. The historical factors seem to arise from the trends that have been experienced in the past by individuals and embraced as a norm. Occurrence of pain in the historical background of a patient can critically influence pain assessment giving probable clues on the actual problem resulting to the pain (Daniel, et al. 2008). The experience of pain presentation can give certain perceptions with individuals making conclusions from an uninformed point of view. The historical aspect of pain is very crucial in the assessment and management of pain, by having a clear analysis of the former cases and their mode of presentation, interpretation of the prevailing situation is carried out and effective pain management measures effected (Gupta, et al. 2009). The cultural aspect has little on the factors affecting perception to individual pains and eventual expression. Some cultures are such that showing pain is a natural aspect in life while others embrace a much reserved mode in showing pain by adapting to it (Lautenbacher and Fillingim 2004). Within some cultural practices, cutting certain parts of the body is a norm, distorting others like ear lobes, lips or even walking on hot coals, and even piecing the skim with metal rods. From a general perspective, individuals that have cultural practices incorporating exposure to pain, there is a higher tendency towards having lesser sensitivity to pain (Gupta, et al. 2009). Cultural variables in pain perception are crucial in clinical pain assessment. For example, although individuals from Nepal areas sensitive as westerners in detecting electric shock, Nepalese required higher shock prior to reporting the effect as painful (Gupta, et al. 2009). This can be attributed to the individuals having a cultural affinity to pain due to their lifestyle; their pain response requires higher intensity. Thus, during pain management, it is imperative to take into consideration such a factor that may impede effective realisation of actual pain level. The physiological factors involving pain perception critically show the actual intensity of pain. Generally, pain perception varies with respect to the age, gender and area of originality (Lautenbacher and Fillingim 2004). The perception of pain regarding to physiological aspect incorporates expectation upon encountering an experience that brings about pain, interpretation of pain experience, context of pain, attention to the stimulus, emotions and coping strategies. Individuals believe that paying too much attention to a given incoming pain stimulus may escalate the level of pain (Gupta, et al. 2009). In respect to interpretation, the manner of assessment varies in respect to context and experience, for example, an individual who have experience a heart attack before may be in a position to easily detect an irrelevant muscle twitch in the right part of the body signalling cardiac arrest (Lautenbacher and Fillingim 2004). In respect to context, a player or a fighter might not even feel the pain during an actual play due to excitement, unlike an individual falling on the floor of the living room. Looking at emotions, individuals having depression will have a higher tendency of experiencing pain and seeking treatment with states of fear, general distress or anxiety may aggravate the intensity of pain in an individual (Lautenbacher and Fillingim 2004). Finally, the coping strategies involve ways aside medications that help in bringing down the effect of pain especially with respect to chronic pain. Such strategies involve distraction, having positive affirmations and visualisations. Question 3: Three Pain Assessment Tools which would be appropriate for use in your clinical area Pain assessment is critical to optimal pain management interventions. Pain is a subjective symptom and assessment tools are therefore based on the perception of patients to their pain and its severity (Lautenbacher and Fillingim 2004). This evaluation looks into Pain Scales in Multiple Languages, Psychosocial Pain Assessment Form and Pain Assessment Packet or Chart Form. One critical aspect of the tools is that they are dynamic in nature and ensure evaluation of pain within a diversified point of view providing a wide berth of pain assessment and resulting effective management strategies. The need for effective pain management strategies is evident not only among clinicians, but also among relatives of patients experiencing chronic pains to be in apposition to establish severity of pain experienced by a client (Gupta, et al. 2008). With a diverse community in the working setting, there is need for assessment tools that are elaborate and that embrace diversity like pain scales in multiple languages. This enhances understanding of the assessment process giving effective results to initiate credible management strategies of the pain. The Pain Scales in Multiple Languages has been devised by the British Pain Society in various dialects to ensure effectiveness in understanding the tool (City of Hope 2015). One advantage is the fact the tool can be understood by a wide variety of patient and clinicians from all over the world. This promotes the process of pain assessment eventually impacting positively on the pain management strategies. Diversity in the initial point of assessment brings about effectiveness in the evaluation thus; the management process initiation is bound to come up with positive results (Lautenbacher and Fillingim 2004). Having to use a language understood by the patient, communication is enhanced. The use of appropriate, validated pain assessment tools is crucial to patients experiencing severe pains. This tool is well-defined to work is areas with culture and language diversity reducing the significant barrier to pain assessment (Cade 2008). Utilisation of a pain assessment tool incorporating the patient’s own language has the potential of enhancing probably one of the elements that is within the complex situation. This promotes the process resulting to critical measures to devising effective management strategies. Looking at the Psychosocial Pain Assessment Form, it was developed by Shirley Otis-Green incorporating an eight page assessment and guided interview for measuring the impact of pain over a span of five domains (City of Hope 2015). The domains incorporated economics, social support, emotional problems, daily activities in life and coping strategies as perceived by the interviewer, as well as patient and significant person in the process of pain assessment and management. The reason for choosing this tool is due to the fact that it is effective in respect to interdisciplinary pain service. The inclusion of various disciplines approach results to covering various probable causes of pain targeting crucial pointers towards initiating best outcome of pain assessment (Iqbal, et al. 2015). With a guided interview process, the medical personnel evaluate the impact resulting from unrelieved pain on a patient, the emotional impact and any prevailing coping style. Pain Assessment Packet or Chart Forms involve nursing assessment and care plan that incorporate comprehensive pain assessment at the initial point of evaluation of pain (City of Hope 2015). It also involves pain rating scales that include 0-10 visual analog scale, Wong-Baker Faces Rating Scale and the Verbal Scale that critically raises the level of understanding the root cause of pain. These assessment scales presents crucial attributes that are critical in the eventual assessment of pain to devise an effective management procedure (Cade 2008). Having a clear understanding of any pain emanates from a well outlined and understandable pain assessment tool. The diverse qualities of the tools give the capacity to effectively devise mechanisms and strategies to effectively assess pain and bring successful management strategies. The charts are crucial in assessment of pain after surgery and flow of pain within a patient’s history (Iqbal, et al. 2015). This tool creates a continuum of results towards ensuring effective recovery of a critical illness and prevents hospital acquired infections. Pain is an indicator of acquisition of re-infection after surgery and thus, this tool is very critical in the context. From critical evaluation, the above outlined tools present effective methods of pain evaluation for effective management. According to Iqbal, et al. (2015) effective assessment tools provide predictive validity and eventual effectiveness in the pain score thus, enhancing the management process. The need to have elaborate and understandable tools is prompted by the diverse community within the globalised world. The tools have demonstrated the increased need for effectiveness in the assessment in order to come up with efficient management strategies and treatment plans. Further, for cases of chronic pains, the tools are helpful in identifying coping styles that may be effective in pain management. References Cade, C.H., 2008. Clinical Tools for the Assessment of Pain in Sedated Critically Ill Adults. Nurs. Crit. Care. Vol. 13, no. 6, pp. 288-297. City of Hope, 2015. Pain and Symptom Management: Pain Assessment Tools. City of Hope Pain and Palliative Care Centre. Accessed September 16, 2015 from . Daniel, H.C., Narewska., J., Serpell, M., et al., 2008. Comparison of Psychological and physical Function in neuropathic Pain and Nociceptive Pain: Implications for cognitive Behavioral Pain Management Programs. Eur. J. Pain. Vol. 12, pp. 731-741. Gupta, A., Daigle, S., Mojica, J., et al., 2009. Patient Perception of pain Care in hospitals in the United States. Journal of Pain Research. Vol. 2, pp. 157-164. Iqbal, M., Spaight, P.A., Kane, R., Asghar, Z. and Siriwardena, A., 2015. Assessment Tool for Improving Pre-hospital Pain management. Emerg Med J. Vol. 32, no. 6, pp, e12-18. Lautenbacher, S. and Fillingim, R. (Eds.), 2004. Pathophysiology of Pain perception: Plenum Series in Rehabilitation and Health. New York: Kluwer Academic/ Plenum Publishers. Leone, C., Biasiotta, A., La Cesa, S., di Stefano, G., Cruccu, G. and Truini, A., 2011. Pathophysiological Mechanisms of Neuropathic Pain. Future Neurology. Vol. 6, no. 4, pp. 497-509. Nicholson, B., 2006. Differential Diagnosis: Nociceptive and Neuropathic Pain. Am J Manag. Care. 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