Pain management in pallative care - Essay Example

The perception of pain and its threshold are the result of complex interactions between sensory, emotional and behavioural factors. Inflammation and nerve injury can reduce pain thresholds and increase sensitivity to sensory stimuli (Hudspith et al, 2005). Acute pain is frequently caused by tissue damage and resultant inflammatory reactions causes' local release of mediators such as prostagladines, histamine, bradykinin, substance P and noradrenaline (Williams and Asquith, 2000). In conditions where excitation of pain fibres become greater as the pain stimulus continues, hyperalgesia develops which is an extreme sensitivity to pain and in one form is caused by damaged to nociceptors in the bodies soft tissues ( Wikipedia, 2006).

Pain receptor or nociceptors are naked ending of A and C nerve fibres through which the body is able to detect the occurrence, location, intensity and duration of noxious stimuli that stimulates pain sensation (Dalgleish, 2000). Fast pain is meditated by A nerve fibres which are felt within a tenth of a second of the application of the pain stimulus which can be described as sharp and acute pain. Slow pain meditated by type C nerve fibres is an aching throbbing and burning pain (Wikipedia, 2006).

The A fibres transmit signals at approximately 10 m/s compared to the slower C fibres at 1-2 m/s. The peripheral nerves have a well defined anatomic path through the body to the central nervous system. The nerve fibres transmit their messages in the other nerve fibres in the dorsal horn, and much of the modulation of pain transmission occurs here. Nerves which carry the pain impulses passed through the spine to the thalamus. There are other tracts as well which carry pain sensation travelling up the spinal cord to other parts of the central nervous system (Munafo and Trim, 2000).

Apart from pain pathways that ascend from the peripheries via the spinal chord to the brain, there are other nerve fibres that descend from the brain and affect the transmission and hence the sensation of the pain. This modulation of pain may occur anywhere but happens particularly in the early synapses in the dorsal horn of the spinal chord (Munafo and Trim, 2000). In order to understand the overall mechanism of pain, knowledge of ascending pathway and descending inhibitory pathway is essential.

Palliative care in literal terms is refers to the provision of active care for a person whose condition is not responsive to curative treatment. The World Health Organisation (WHO) has defined palliative care as "the active total care of patients whose disease no longer responds to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is achievement of best possible quality of life for patient and their families (Lugton and Kindlen, 2002).

A number of complementary therapies are employed; on an average a third of cancer patients use alternative and complementary medicine during their illness (Ernest and Cassileth, 1998). Constipation and associated and associated problems affects approximately 50% of patients admitted to Hospices in the U.K. There is growing interest in the role that abdominal message play in relieving constipation. A recent research paper explains how a safe non-invasive easily learnt technique of