Pain, a subjective physical and emotional response, is whatever the patient says it is. It is regarded as the fifth vital sign in assessing a patient’s over-all health, according to Kozier (Kozier, 2004). One can’t estimate pain just by simply glancing at a patient, because it is relative. The healthcare team relies on how the patient describes the intensity of the pain. There are many categories by which pain can be grouped into, and clinical pain is the most recognizable one because if requires professional treatment (Sarafino, 2006). There are two types of clinical pain, acute pain and chronic pain. Acute clinical pain is experienced technically for less than six months, just a short period of time. It is experienced by a person abruptly with trauma or an illness and usually disappears once the illness is gone or the trauma healed. On the other hand, chronic clinical pain is experienced by an individual for a longer period of time, technically more than 6 months. It can be a prolonged or even lifetime illness like cancer or arthritis that causes this pain and more often than not it is very hard to manage. The psychosocial effect of chronic clinical pain can become a hindrance in the individual’s over-all management of his or her life.
Pain management involves different kinds of medical treatment. There are surgical and chemical treatments available for patients with clinical pain (Sarafino, 2006). Aside from that, there are also other treatments that can be utilized like behavioral and cognitive therapies for pain (Sarafino, 2006). Depending on the presenting complains and nature of the disease or physiological effects of pain on the body, the type of pain management will differ. Three cases are presented, each of them clinically different. Because pain management is solely dependent on the nature of the patient’s condition, the preferred management for each varies, and may be affected by certain factors like age and gender. Hence, albeit these are standard, they will still be slightly altered per patient’s needs.
If the patient had a below-the–knee amputation due to diabetic neuropathy, he or she will be suffering from first of all, his or her surgical incision pain and later on, phantom pain. Post-operative surgical wound is very painful, especially when the anesthesia is wearing off. The patient will start to feel the tension of the disturbed tissues, the cut nerves and muscles, and the sharpness of the stitches against the layers of the skin and will usually be under pain medication on a daily basis. To manage post-operative surgical incision pain, which is usually an acute clinical pain, the mediation of chemical treatment is needed. An in-depth discussion is found in the second case, abdominal hysterectomy, which focuses its treatment more on the chemical pain management approach. When the patient has fully recovered from the surgery, he or she will now deal with phantom sensation, phantom pain, and residual limb pain (Jeffries, 2008). Phantom sensation is described as feeling as though the amputated limb is still there (Jeffries, 2008). Normally, this occurs without any problems as long as the sensations felt are not as unpleasant as pain. Of the three, phantom pain is the hardest to manage. It is defined as the pain that comes from the missing amputated limb, it feels as though the pain when the body part was still there is recurring (Mayo Clinic Staff, 2007). Phantom pain management, due to the nature of the situation, requires a different approach than the usual surgical or chemical pain management. Sarafino suggests the employment of a cognitive strategy called pain redefinition. In this strategy, the patient will have to substitute constructive or realistic thoughts about the pain experience for thoughts that arouse feelings of threat or harm (Sarafino, 2006). Utilizing this technique does not mean that physicians and therapists do not consider phantom pain to be serious, since it is pain coming from a no longer existing part of the body. By providing realistic information, therapists are able to help these patients redefine the pain they are experiencing and therapists can also help by letting the patients realize that they have illogical beliefs, making their discomfort worse (Sarafino, 2006). Residual limb pain is described as pain felt in the stump (Jeffries, 2008). These can be caused by a number of reasons like poor prosthetic socket fit, which requires that fitting be repeated, bruising of the limb or chafing or rubbing of the skin hence stump care should be monitored, and several other mechanical factors, all of which can be avoided with proper care and monitoring (Jeffries, 2008). Pain can also be cause by poor circulation and nerve damage from diabetes (Jeffries, 2008).
Acute pain from an abdominal hysterectomy is a different circumstance from the below-the-knee amputation post-operative pain but its treatment course is more or less the same. Sarafino asserted that pharmaceuticals are the best management for this acute clinical pain (Sarafino, 2006). There are of course, a few clinical factors to consider before actually recommending a drug for this. Normally, operations occurring in the thoracic cavity and upper half of the abdomen bear the most painful post-operative pain, next are the lower abdominal surgeries, and then less painful than both are peripheral surgeries involving the limbs (Charlton, 1997). Pain management in the immediate post-operative period will bear excellent recovery for the patient, and the epidural block is highly recommended (Jeffries, 2008). An epidural block requires the injection of narcotics or local anesthetics in the epidural membrane that surrounds the spinal cord (Sarafino, 2006). Epidural drugs used are Morphine, with a single dose lasting for 6 to 24 hours, Pethidine, single dose of which can last from 4 to 8 hours, Methadone, bringing pain relief for 6 to 10 hours per dose, and Fentanyl, a single dose providing 2 to 4 hours of pain relief (Charlton, 1997). However, as with any medications, there are side effects which include urinary retention, vomiting, nausea, and itching and a greater risk of respiratory depression (Charlton, 1997). Due to the high risk involved in giving these opium-derived analgesics, there should be constant monitoring of the patient’s level of conscious and respiratory condition.
Lastly, for chronic, non-migraine headaches, relaxation and biofeedback treatments are recommended. Usually triggered by stress, poor posture and depression, these headaches occur when muscles in the face, neck, scalp and jaw tighten up (Lehigh Valley Hospital, 2004). By focusing one’s attention on specific muscle groups while alternately tightening and relaxing the muscles is the technique introduced in progressive muscle relaxation (Sarafino, 2006). Biofeedback is also a treatment considered because through this method patients will learn how to control the tension of specific muscle groups, such as those causing the tension headaches (Sarafino, 2006). This will enable the patient to be independent from using medications often and not only making him financially smart but it also helps him or her take control of his body. Not being dependent on medication has its advantages. If the tension headache happens and there are no available medications, the patient can perform the learned techniques. Furthermore, these therapies have been proven effective (Sarafino, 2006).
Alternative treatments to clinical pain, most especially to those who are receiving treatment inside the hospital will definitely benefit from not using pharmaceutical and surgical methods. Not only because they are costly, but also time consuming. But if the patient is willing to buy medication or go under the knife to remove pain sensation, then it is the patient’s choice. However, behavioral and cognitive therapies help the patient become independent from medications, and this will prove to be a benefit in the long run. The availability of a variety of pain treatments is very beneficial because the physicians will be able to choose which therapy is best for a patient and personalize it to cater to the patient’s needs. Also, the patient having many options will give him certain control over his treatment, lessening the anxiety. Pain should not be ignored; it should be recognized and properly addressed, because not until the healthcare team is in the patient’s shoe will they realize how painful everything is.
Charlton, E. (1997). The Management of Postoperative Pain. Retrieved September 6, 2008, from http://www.nda.ox.ac.uk/wfsa/html/u07/u07_003.htm.
Jeffries, E. (2008). Post-Amputation Pain. Retrieved September 6, 2008, from http://www.amputee-coalition.org/inmotion/mar_apr_98/pain_mgt/page1.html
Kozier, B. Erb, G., Berman, A., & Snyder, S. (2004). Fundamentals of Nursing. USA: Pearson Education.
Lehigh Valley Hospital and Health Network. (2004). A Guide to Non-Migraine Headaches. Retrieved September 6, 2008, from http://www.lvh.org/downloads/hy_septoct_04/headaches.pdf
Mayo Clinic Staff. (2007). Phantom Pain. Retrieved September 6, 2008, from http://www.mayoclinic.com/health/phantom-pain/DS00444
Sarafino, E. P. (2006). Health psychology: Biopsychosocial interactions (5th ed.). Hoboken, NJ:
John Wiley & Sons, Inc.