Psychological Support of Pain - Essay Example

Psychological Support of Pain by Part I: Psychological Support of Pain Introduction The insight touching on the concept of pain reigns far more than the mere sensation. The perception of pain involves far more than mere sensation. The evaluative and effective elements of pain are usually significant just like the production and transmission of the pain signal itself. Such emotional facets are majorly prominent in chronic pain patients (Fields, 1991, 84). The contributing factor is that the knowledge of pain psychology can immensely improve acute treatment. Evidence-based practice (EBP) is an interdisciplinary methodology to clinical practice that has tremendously gained growth since its inception in 1992. At first, it started as evidence-based medicine (EBM) in medicine, and then later spread to the rest of the fields like nursing, dentistry, education, library, information science, and psychology. The solid principles underlying EBP state that every practical decision made should be based on research studies. The said research studies ought to be designated and interpreted based on particular norms features for EBP (Vastag, 2003, 2390). Simply put, the associated norms do disregard qualitative and theoretical studies, and thus consider qualitative studies according to the set of standards as what counts as evidence. In case an array of methodological criteria is not applied, then it is better taken as research-based practice. Evidence based behavioral practice involves coming up with decisions regarding health promotion or provision of care through integration of the best available evidence involving practitioner expertise, resources, and with the needs, preferences, and characteristics of those are likely to be affected (Lambert, Libman, Poser, 1960, 355). The whole process is done in a manner that is companionable with both organizational and environmental context. The best evidence should comprise of research findings that are extractible from the systematic assemblage of data by use of observation, experiment, and formulation of questions as well as the testing of hypotheses (Beecher, 1960, 1612). Research Question Does greater emphasis on pain worsens the level of pain in a patient? How do patients with hypochondriasis or somatic preoccupation feel about bodily sensations? By attending to these sensations, do they amplify them to the point of feeling painful? Search Strategy Search Observation Distracting of patients has been seen as a good effective tool of reducing patients’ pain. Burn patients who undergo physical therapy or treatments experience excruciating pain, regardless of the level of opioids injected to them. These patients show only a fraction of this pain if they are distracted with a virtual-reality type of video game when undergoing the procedure (Horstman & Flax, 199, 33). Pain can be a learned response, and not just a purely physical problem. Cancer patients are likely to develop nausea as a learned response when being treated, and thus experience it being the administering of chemotherapy (Sternbach, 1968, 23). Patients can learn to experience pain even in the absence of a physical stimulus. This is because pain is conceived to be in the mind; the best example is that of a butcher who slips and caught his arm on meat hook, thus suffers a great agony. The moment he learned that the hook had merely caught on his sleeve, and that his arm was injured, his pain slowly resolved. Patients feel different amounts of pain by just viewing other people. When laboratory subjects saw models demonstrating high pain tolerance, they needed 3.48 times greater stimulus before rating it as painful. This was the opposite of those subjects who observed models and later showed poor tolerance (Ferrari, 2002, 529). Non-aversive shock, known as ‘‘tingling,’’ was rated as painful by those who had seen tolerant model; 77 % of subjects who viewed models recorded poor performance. Problem The limbic system, that houses the processing of emotions, functions by modulating the capacity of pain experienced for a respective noxious stimulus. The basic observation from cancer patients is that the effective element of pain can be entirely blocked by frontal lobectomy. Patients who are lobotomized tend to experience severe pain, yet it does not bother them. We can view pain as a merely a signal that something is not right in the body; until the same reaches the emotional brain, and now the signal attains the state of what we feel as pain (Hoffman & Patterson, 2001, 232). The emotional response to pain entails the right ventral prefrontal cortex and the anterior cingulate gyrus. Social rejection is responsible for activating these centers. Norepinephrine serotonin circuits are involved in the intonation of sensory stimuli. The later affects how antidepressant and depression medications influence the perception of pain in a human body. Intervention It has been observed that a sense of loss, fear, anxiety largely contribute to the suffering of a patient. Treatment of anxiety and provision of psychological support has been seen as large contributors of boosting pain, and reducing analgesic use. It is beneficial and recommendable for patients’ sense of control to be uplifted, and patients to be permitted to participate in their own care. On the part of physicians, they should create an environment that is non-threatening. The simple procedures should be the one that start by preparing needles and other equipment out the patient’s sight (Ready, 2000, 2335). All procedures should therefore be performed in the least painful possible way by use of non-threatening terms like ‘‘mild discomfort’’ instead of pain. It is imperative distract patients with conversations about subjects that are of interest to them, such as their family, favorite pet of hobbies. Pain management is significant for ongoing pain control, particularly if you suffer with long term or chronic pain. The pain management team should encompass clinical psychologists, physiotherapists, clinical nurse specialists, occupational therapists, medical practitioners, and nurse practitioners. The same team may include other mental health specialists, as well as massage therapists. Of key to note is that pain may just resolve promptly upon the healing of the pathology or trauma. A singular practitioner, armed with drugs such as anxiolytics and analgesics can work on patient who is also on drugs. Successful management of chronic pain often requires all the coordinated efforts of the concerned management team (Paris & Stewart, 1992, 219). The purpose of medicine is to treat injury and pathology ton provide support and speeds up healing; distressing symptoms are meant to relieve suffering in the course of treatment and healing as well. The core task of medicine is to relive suffering whenever there is a resistance of the painful injury or pathology, when pain persists after injury and when medical science cannot identify the cause of pain (Feine, 1988, 140). Treatment measures to chronic pain can take the form of pharmacological measure. This can comprise tricyclic, antidepressants, and analgesics; physical therapy, application of heat or ice, interventional procedure, and cognitive behavioral therapy. Comparison Features of an innovation or EBP topic that influence adoption include the comparative advantage of the EBP; such as relevance to the task, effectiveness, and social prestige. Norms, perceived needs of users, compatibility with values also affect the complexity of the EBP topic. EBB topics that are normally perceived users as moderately simple are more easily adopted in a short duration than those that appear more complex such as acute pain management for hospitalized older patients.   Studies ascertain that computerized decision support, prompts that support practice, and clinical systems pose a positive influence on aligning practices with the evidence base (Craig, 1978, 100). Computerized knowledge management has over the years shown improvements in patient outcomes and provider performance. By use of a just-in-time e-mail reminder in home health care, majority of physicians have skillfully demonstrated improvements in evidence-based care and outcomes for patients who suffer from heart failure. Pain intensity for cancer patients has also been seen to reduce considerably. There is a call for clinical information systems to deploy the evidence base to the point of care, and thus integrate computer decision-support software that can incorporate evidence for use in clinical decision-making regarding individual patients. Much is still needed to explore the best strategies of positioning evidence-based information by use of electronic clinical information systems meant to support evidence-based care. Outcome Patients’ anticipation of how much pain they would incur greatly affects how they feel, if their condition can turn out to be chronic or disabling, and their responses to treatment as well. Resultantly, whit plash injuries are highly variable depending with the region. The attributing actor here is the effect of local cultures and expectations as well (Turner, Deyo, & Loeser, 1994, 1612). The kind of messages communicated to patients that they possess a serious or debilitating injury also leads to maladaptive or deconditioning postures that do worsen their pain. Prescribing of medications is likely to worsen the problem. Patients who do not have sick leaves and often told to act as usual enjoy much better outcomes. Both physicians and patients’ expectations also experience placebo effect. Nocebo effect refers to the sensitivities of harm that result from a patient’s belief. Assumingly, the ``nocebo’’ effect can lead to messages that unconsciously increase patient’s anxiety and the anticipations of pain. Search analysis and Implication The best way of managing pain, according to -, is by using both interventional and pharmacological procedures. There exist various procedures available for pain purposes. Interventional procedures that are suitable for chronic back pain include facet joint injections, spinal cord stimulators, and epidural steroid injections. Practitioners specialized in pain management come from all spheres of medicine (Gamsa, 1994, 20). Apart from medical practioners, a pain management team regularly benefit from the input of clinical psychologists, physiotherapists, and occupational therapists. The combined team can assist in creating a package of care appropriate to the patient. Part II: Critical appraisal paper Article The article looks at various approaches adopted by healthcare providers in managing pain in cancer patients. The research was done on five tertiary care hospitals for 100 patients with chronic and acute pain from cancer. The research aimed at establishing different parameters of pain relieve that should be used by healthcare providers. Despite clinical guidelines regarding pain management in cancer patients, there is lack of awareness on the part of doctors and nurses regarding parameters of pain management such as comprehensive assessment, chances of addiction and adequate dosage. This is a cross sectional study that is relevant to general practice as doctors and nurses need to know the part they play in pain management. This article lacks literature review; hence the research is not comprehensive. The objective of the article is to look at various pain management approaches, but it only looks at the effects of opioids. Introduction Pain varies in cancer patients. Apart from the treatment, there are other causes of pain in cancer victims, the first cause being bone metastasis. Breast, lung, prostate and kidney cancer usually metastasize to the bones, and it causes untold pain. Peripheral neuropathy is another cause of pain that results from chemotherapy and radiation. Peripheral neuropathy can cause pain, numbness and weakness in hands and feet. Treatment methods in particular radiation, surgery and steroids cause chronic pain. Pain from treatment techniques should be treated immediately because it can cause delay in recovery (Elwood, 1998, 58). Pain affects a patient’s ability to sleep, eat and spend time with loved ones. Hence cancer patients deserve good pain care that works for their condition. Physicians should test patient in order to identify causes of pain, and use methods that works best for relieving that particular pain. The article looks at patterns of pain in different patients, and how the pain is being managed. This critical appraisal paper will use the rule of evidence to check the validity of the study (Rosenfield, 2003, 123) Methods The target population was patients with chronic and acute pain from cancer in five different tertiary care hospitals. The target number was 130, but only 100 patients responded. It is an observational qualitative research as the researchers had to observe the respondents during the process. The research design is sensible in that the experience of patients cannot be derived in a quantitative research; the patients had to describe what they were going through. There are no quantitative ways of measuring pain in cancer patients (Goudas & Bloch, 2005, 106). The sample population was representative since it comprised of patients from different hospitals with acute and chronic pain from cancer. Patients were from different age groups; hence the results of the process can be applied generally. Patient who had surgery in the past 30 days of the study were not part of the research because they presented post- surgical pain and not cancer related pain. The duration of the study was two months, hence the researchers had ample time to collect and process information. The research instruments used were questionnaires and interviews since some of the patients were illiterate. The questionnaires had 30 questions which dealt with aspects of pain management such as severity of pain, duration of pain, treatment, reluctance to take opioids. Researchers also interviewed doctors regarding the patients’ treatments, non-pharmacological treatment, and patients’ response among other factors. I believe that the research questions were not structured well, in line with the research objective. The research objective was to establish parameters of pain management in the part of care givers. The questionnaire focuses more on patients, and neglects how care givers affect the pain management process. Sample The only intervention being studied is the use of opioids. The sample being studied comprised of children and older people, this can affect the validity of results because children and adults pose difference in pain and reactions to treatments. Apart from excluding people who had surgery in the past one month, there was no other criterion for selecting a sample population and it can affect the credibility of the results. 26 respondents were selected from different hospitals, and with no proper criteria for selection and analysis the study could be flawed. Ethical considerations In this kind of research, ethical values should be followed. The researchers must seek participants’ consent since they are divulging very personal information. Confidentiality is maintained in that the research is not divulging personal information. According to the article people involved in the research were qualified personnel with vast history in pain management, hence they related well with the respondents (Deandrea et al, 2008, 88). Since the research involved patients from different age groups, the researchers had to get consent from physicians and parents regarding children being a part of the research. Getting information from a minor without parental consent is illegal and unethical. Another ethical consideration is the vulnerability of the individuals being studied. Since they were studying about pain management, the researchers are meant to be empathetic and cautious since they are interviewing people in pain. Researchers should not keep interviewing patients when they are in pain, and they should not interfere with the treatment process. From the look of the first two questions, it seems that the questions were structured well and they did not cross any ethical boundaries. The researchers are meant to give equal attention to all the respondents. It is ethical that the study is comprehensive and it should entail all the proper information from all respondents. Researchers should not focus on a few patients, and draw conclusions from them. The article acknowledges the contribution of all writers, and organizations that contributed towards the success of this process. Conflict of interest Conflict of interest in a research occurs when personal factors influence the role of the researchers. Researchers should put the patient’s interest first. During this kind of research, it is obvious that respondents might need medication and to see the doctors hence the research process would be interrupted. Since many people were involved in the research process, conflict of interest issues were bound to rise. 130 patients from different hospitals were studied, and in many cases the researchers’ programs clashed with hospitals’ programs. The research can be classified as a cohort study as it involved different groups of patients from different hospitals, hence there could be a conflict of interest regarding the pain management policies. Each hospital has its guidelines regarding treatment of cancer patients, and they can be conflicting. Data analysis Ms Excel was used to analyze data in this study. I believe that there are other methods for analyzing this kind of data apart from tables. Some of the questions in the questionnaires and the interviews were open ended, and they cannot be analyzed well through tables. The researchers should have categorized questions into distinct groups, and analyze them by establishing related patterns. Coding and labeling helps in demarcating this kind of data into groups will enable easy analysis. When coding is complete the data, the codes can be easily compared. Hence it will easily give a comparison between the different questions. Because it is a qualitative research, some results cannot be documented. The researchers should have used other instruments of qualitative research such as narratology, induction, metaphorical analysis among others. Such instruments of analysis will help give a generalized conclusion in that visual aspects of communication will account. For instance, facial expressions can express the severity of pain a patient is in. Result The researchers used Wong- Baker faces to express the kind of pain the respondents were in. It is hard to express pain physically, and usage of Wong-Baker faces could help patients tell the pain they were in. The results were also interpreted using verbal rating scale (VRS) which is a good way of measuring the severity of pain in cancer patients. VRS and numerical rating scales have proven to be reliable and valid in pain measurement (Portenoy, 2011, 63). The results have been presented well in that it starts with first incidences of pain, intensity of pain and how pain is being managed. The results also showed how different patients reacted to opioids and NSAIDs. The results are comprehensive, through when compared to other studies there is a slight variation. Other studies have shown that over 60% of cancer patients seemed to be having intense pain. From the results we learn that over 65% of patients who experienced intense pain were give NSAIDs, which does not help them with the pain. Physicians seem to be limiting the use of opioids because of its addictive effects (Staats, 2001, 67). Conclusion In conclusion, this study aimed at looking at a patient’s history and establishing how health care providers can adjust their patterns of pain management. The study has its own weaknesses for instance the lack of literature review, limited measures of analysis among others, but the questions give us a broad perspective into a patient’s history and how physicians can use such information in effective pain management. Reference List American Cancer Society, 2001. A Guide to Pain Control. Atlanta: American Cancer Society. Beecher H.K. 1956. Relationship of significance of wound to the pain experienced. JAMA; 161:1609–13. Breivik H, Cherny N, Collett B, et al. 2009: Cancer-related pain: a pan-European survey of prevalence, treatment, and patient attitudes. Annals of Oncology 20:1420-33. British Journal of Pain, 2010. Management of Acute Pain in Cancer Patients. British Journal of Pain Vol. 4, No. 2. Craig K.D. 1978. Social modeling influences on pain. In: Sternbach R.A, editor. The psychology of pain. New York: Raven Press; p. 73–110. Deandrea S, Montanari M, Moja L, Apolone G, 2008. Prevalence of undertreatment in cancer pain. A review of published literature. Ann Oncol 2008;19:1985-91. Elwood J. M., 1998. Critical Appraisal of Epidemiological Studies and Clinical Trials (2nd Edn). Oxford: Oxford University Press Feine J.S, et al. 1988.Memories of chronic pain and perceptions of relief. Pain; 77(2):137–41. Ferrari R. 2002. Prevention of chronic pain after whiplash. Emerg Med J 19(6):526–30. Fields H. 1991. Depression and pain: a neurobiological model. Neuropsychiatry Neuropsychol Behav Neurol; 4(1):83–92. Fordyce WE. 1991. Behavioral factors in pain. Neurosurg Clin N Am 2(4):749–59. Gamsa A. 1994. The role of psychological factors in chronic pain. II. A critical appraisal. Pain 57:5–30. Goudas LC, Bloch R, Gialeli-Goudas M, et al. 2005. The epidemiology of cancer pain. Cancer Invest 23:182-90. Hoffman H.G, Patterson D.R, et al. 2001. Effectiveness of virtual reality-based pain control with multiple treatments. Clin J Pain 17(3):229–35. Horstman J, & Flax P. 1999. Controlling chronic pain. Hippocrates; May:29–35. Lambert W.E., Libman E, Poser E.G. 1960. The effect of increased salience of a membership group on pain tolerance. J Pers;38:350–7. Lewis, N. L. 2005. Acute pain management in patients receiving opioids for chronic and cancer pain. Continuing Education in Anaesthesia, Critical Care & Pain Vol. 5, No. 4. McCaffery, Margo, Pasero, Chris. Pain: Clinical Manual. 2nd Edition. St. Louis: Mosby, 1999. Paice JA, Ferrell B.2011. The management of cancer pain. CA Cancer J Clin; 61:157-82. Paris P.M, Stewart R. 1992. Analagesia and sedation. In: Emergency medicine: concepts and clinical practice. 3rd edition. St. Louis (MO): Mosby-Year Book, Inc.; p. 202–29. Portenoy RK. 2011. Treatment of cancer pain. Lancet 2011; 377:2236-47. Ready L.B. 2000. Acute perioperative pain. In: Miller RD, editor. Anesthesiology. 5th edition. Philadelphia: Churchill Livingstone. p. 2323–50. Rosenfeld, A.2003. The Truth about Chronic Pain, Patients and Professionals on How to face it, Understand It, Overcome It. New York: Basic Books Staats, Peter S. 2001. A Physicians Guide to Pain and Symptom Management in Cancer Patients. Journal of Pain and Symptom Management Vol. 21, No. 6. Sternbach RA. 1968. Pain. A psychophysiological analysis. New York: Academic Press Sundus Sonia Butt et al, 2013. Pain management in cancer patients in tertiary care hospitals. JPMI Vol. 27 No. 04: 387-391 Turner J.A, Deyo R.A, Loeser J.D, et al. 1994. The importance of placebo effects in pain treatment and research. JAMA 271:1609–14. Vastag B. 2003. Scientists’ find connections in the brain between physical and emotional pain. JAMA; 290(18):2389–90. Read More