Pain Management: Theories, Strategies, and Ethical Issues

This document discusses the theories, strategies, and ethical issues related to pain management. It explores different types of pain, management strategies, and the role of MDT in providing effective care. The document also highlights the importance of minimizing disparities and ensuring quality care for patients.

PAIN
MANAGEMENT

TABLE OF CONTENTS
INTRODUCTION 1
Pain theories..................................................................................................................1
Management strategies.................................................................................................2
Ethical issues.................................................................................................................5
Role of MDT...................................................................................................................6
Implications of practice..................................................................................................7
CONCLUSION 7
REFERENCES 8

INTRODUCTION
International association for the study of pain (IASP) defines it as an unpleasant
sensory and emotional experience associated with actual or potential tissue damage
(Jones, 2012). The intensity of pain can be felt and experienced by only a person who is
actually dealing with it. Medical staff, doctors and nurses has developed a system
where the intensity of pain can be analysed and expected. Medical science has
categorised pain into a wide range which includes acute, chronic, superficial, deep, etc.
This affects the individual in a critical manner creating an ineffective experience for
them (Rosser and Eccleston, 2011).
Pain is a complex issue in medical and nursing practices as it occurs at different
intensity and dealing with pain is a challenge for the patient as well as for medical staff.
The experience of pain for patients has a direct impact on the strategies they undertake
to deal with the treatment (McPhee, Papadakis and Tierney, 2010). Nursing staff face a
significant issue in managing strategies to analyse the aspects of pain management and
to handle the same for attaining fast recovery measures for patients. It has been
analysed that beliefs, expectations and priorities regarding pain management are
critically examined and evaluated by the patients who affect the level of patient's
anxiety. The study will understand pain theories and its Pathophysiology (Ripamonti,
Bandieri and Roila, 2011). Different aspects of management strategies and models will
be applied in analysis to attain a clear picture about the subject. The present study will
evaluate the studies and theories associated with chronic pain which is one of the
crucial aspect of pain theories and analysis.
Pain theories
Pain is caused by dysfunction or damage of cells on human body which causes
an immediate sensory experience causing high rate of discomfort for the individual.
Medical science has categorised pain into different levels and categories (Macintyre and
Schug, 2014). Acute pain is associated with progressive disease state or injury caused.
The major cause of acute pain may be surgery, bone injuries, dental aspects, burns or
cuts, childbirth. Elvir-Lazo and White, (2010) however states that sometimes, pain
persists ever after the injury or disease is healed.
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Elvir-Lazo and White, (2010); Arnstein, (2010); Chandok and Watt, (2010)
revealed many cases where acute pain has sustained after the healing of injury. These
pains come at different intensities and remain active in nervous system for weeks,
months or even years. This is categorised as a chronic pain for an individual. Some of
the common examples of chronic pain are headache, back aching, cancer impact,
neurogenic agony, psychogenic discomfort. Effective analysis and management of this
type of pain is significant for the medical team to cure patient from an ongoing suffering
and discomfort. Neuropathic pain is one of the most critical chronic pain where the
transmission of sensitivity is transferred from one part of the body to different fibres. The
impact of this pain is high and for long term. Chronic pain has both physical and
emotional impact on an individual. Physical effect includes muscle’s tension, low
mobility, lack of energy and impact on appetite while emotional effects include
depression, anger, anxiety and fear of re-injury (Chandok and Watt, 2010). The
alteration of brain stem or transmission and signals of these pain creates a significant
impact on management aspects of the pain.
Neuropathic pain is one of the most intense and chronic pain for the patients.
These pains result from the damage of nerves. The cost of managing stated pain is high
as it deals with nervous system of individuals (Narayan, 2010). Major challenge for the
stated issue is that there is no proven treatment for the neuropathic pain. The
unresolved pain is balanced effectively to create a significant impact on patient's
recovery. Effective strategies to manage and minimise the pain is highly demanded.
The Pathophysiology of pain can be effectively analysed by understanding pain
pathway for individuals. Four stages of pain pathway include transduction, transmission,
modulation and perception. Transduction stage is the one where different nerve endings
participate to translate noxious stimuli in the form of nonceiptive impulses. Pain fibres
are then developed by responding to the noxious stimulation. In the next stage,
transmission process is carried out in which impulses are transmitted to brain through
pain affected which develop electric signals to the sender and receiver’s nerves.
Modulation stage gives the pain related signals at multiple levels where receptors gets
the sensory feeling about the stated aspect. At this stage, incoming and outgoing
signals of the periphery are blocked entirely at the gate of dorsal horn. The entire
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process then develops a perception of pain for an individual which creates high intensity
impact.
Gate control theory is one of the interesting approaches which has been
proposed by Melzack and Wall (1965) to deal with chronic neuro pains. Gate control
theory focuses on modulation of pain by working on the sensory nerves and by acting
as a pain mechanism for body (Arnstein, 2010). This strategy is highly effective for
acute as well as chronic pains. According to this theory, pain stimulation is carried by
small and slow fibres (T cells) that enter the dorsal horn of spinal cord and then other
cells transmit impulses from spinal cord up to the brain (Waldman, 2011). As analysed
in the process, T cells carry out vibrations of pain stimulation from spinal cord to the
brain. Gate control theory is a well-defined mechanism in which communication
between the small and large fibre cells is restricted which minimizes pain perception for
an individual. Theory focuses on controlling the communication of fibres which works in
the transactional stage where communication is transmitted between brain and body
(Schiavenato and Craig, 2010). In other words, body develops a hypothetical gate which
opens and closes the system of pain stimulation. This strategy is an effective aspect of
managing pain for the individual however, there are certain issues associated with the
same. It has been analysed that sometimes, this strategy is ineffective for high level of
pain. In other words, it is analysed that greater the level of pain, less will be its impact
on blocking the gate because controlling multiple fibre communication is a challenge.
Theory is effective for Neuropathic pain as it can create a significant impact on
the resistance of pain if effective control is managed on the hypothetical gate. It has
been argued that the assumption; 'higher pain leads to less control on gate' may prove
the theory to be ineffective for chronic pain (Kipping and et. al., 2012). However,
Mezlack analysed that neuropathic pain is continuous yet number of communicating
fibres are less which can be easily controlled. Moreover, effective medications and
stimulation actions may result in attaining high control over the gate which results in
effective control of chronic pains in patients.
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Management strategies
Managing pain is a vital subject in the present era when health inequalities are
rising significantly at a continuous rate. Patients of every age are succumbed to different
types of discomforts at different levels. It is difficult to be handled by the family members
because intensity of pain can only be experienced by the person who is dealing with it.
Different theories and aspects have been proposed and adopted within economy to deal
with the issue of pain management (Abdalrahim and et. al., 2011). Chronic pains on the
other hand are challenging aspects for nursing staff. It has been analysed that high
intensity of these pain makes patients highly anxious and weak.
Neuropathic pain is a frequent problem in many peripheral and CNS diseases.
There are many significant causes of this which creates a well-defined impact on the
overall health aspects of employees. It arises due to complex pathophysiological
mechanisms (Keefe and Somers, 2010). It is analysed that young age people has the
strength to deal with stated pain however, within elderly people, it has become a
challenge to treat and provide relief to the patients. In order to manage pain in an
effective manner both pharmaceutical and non-pharmaceutical measures for the stated
aspects. The impact of neuropathic pain is widely emotional as it creates a significant
impact on dealing and surviving with the pain. In order to overcome the mentioned
aspect different pain management theories such as physiotherapy, exercise and
hypnotism is used. The international measures for the same includes and injections,
medications, drugs and stimulation (Ripamonti, Bandieri and Roila, 2011).
On the basis of above mentioned measure physiotherapy is one of the most
effective and successful aspect which delivers effective and well defined results for the
patients suffering form neuropathic pain. The mentioned pain management tool is used
to manage various painful conditions including vulvodynia, radiculopathy, fibromyalgia,
post-stroke and complex regional pain syndrome (Elvir-Lazo and White, 2010). It is one
of the most successful therapy used for neuropathic pain caused by injury of tissues
and nerves. This physical therapy is very useful measure to deal with the functionality of
the body parts which helps in effectively dealing with and recovering with and pain
arising in the nerves (Macintyre and Schug, 2014). The stated therapy sessions focuses
on different types of activities such as low impact aerobic training, strengthening
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exercises and stretching are the common measures used for the pain (Jeon, 2012). The
therapy includes manual therapies, acupuncture and different rage of exercises which
helps in delivering effective and well defined results for patient recovery. Chronic pain
can impact significantly upon physical, emotional and social wellbeing (Jones, 2012).
Physiotherapy utilising a broad scope of practice can safely and cost-effectively support
and guide people with long term pain towards the best possible quality of life.
Ethical issues
Pain management has become a significant issue in the present market scenario
which has created a well-defined impact on the medical professionals and practitioners.
Its care issues demand the nursing staff to adopt ethical aspects of working in order to
attain significant and successful results for patients. Chronic pain issue involves multiple
participants in the stated aspect (Arnstein, 2010). Patients, service providers, insurance
and pharmaceutical company, legal agents and advocacy groups are the key
stakeholders involved in overall process. Ethical considerations are the critical aspects
which need to be taken into account by every stakeholder involved in procedure.
Numerous aspects are considered while dealing with chronic neuropathy pain for
the patients. Nursing staff needs to consider the following ethical aspects while using
non pharmaceutical measures to attain the stated results.
Minimizing disparities is an ethical obligation of nursing staff that the
discrimination or disparities in access to treatment to young, elderly person and different
social groups is kept to be minimum. This will help in ensuring effective care services to
every individual irrespective of their age, nationality or income status (Song, Popescu
and Bell, 2014.). It will ensure that disparity in treatments is minimised and every patient
attains required treatment for managing chronic Neuropathic pain.
Quality of care aspect is one of the most significant aspects of ethical obligations.
The nursing staff is expected to deliver quality care to every patient. Pain management
focuses on this aspect effectively. For neuropathic pain, use of quality services is
critically important (Jeon, 2012). The level of technical procedures demands a team of
qualified and trained staff.
Medications and procedural steps of pain management is to be managed and
maintained as per the legal framework. Ethical considerations of the organisation
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demand staff to adopt regulatory framework and procedural aspect for the use of opioid
and other medical aspects. Nursing and care giving staff must use aspects as per the
national and international laws.
Ethical aspects regarding training and development of nursing staffs are
important or providing services regarding chronic pain. Patients are needed to be made
aware about the medical aspects available in order to create a significant impact on
enhancing awareness about the different pain management issues (Ethics, law, and
pain management as a patient right, 2009). This helps the patients in enhancing their
decision making aspects.
Role of MDT
The analysis represents that pain management is a critical aspect of nursing and
care giving practices. It focuses on attaining a significant and well defined impact on
patient's health and recovery. The analysis of different types of pain reflects significance
of pain management in the present era (Acute vs. Chronic Pain, 2015). Neuropathic
pain is one of the most challenging aspects of pain management because it is related
with the nerves and central nervous system. The role of MDT in this aspect is very
important. It has been evaluated that the application of gate control theory can only be
partially successful if physical and emotional aspects of patients are not effectively
managed. MDT team will help the patients in effectively analysing significance of pain
management and supporting the nursing team in developing well defined impact on
mental and physical state of patients (Schiavenato and Craig, 2010).
Impact of neuropathic pain within children, young people and elders is different.
Care units has adopted well defined means of managing different aspects of the
process while effectively coordinating with patients' need and requirements. Nursing
staff plays a central role in the overall process of delivering services while adopting
different measures to deal with critical patient's health. Professional doctors or
physicians are referred for the physical aspects of patient's health and recovery
(Abdalrahim, M.S., Majali, S.A., Stomberg, M.W. and Bergbom, I., 2011). The technical
aspects of treatment is monitored and evaluated by the doctors. To manage the
emotional aspect of patients, psychologists are called and referred. They focus on
controlling the emotional stress and tensions related to treatment. Moreover they also
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focus of calming the anxieties related to pain within patients. The elderly patients are
more prone to such distress because distraction within these patients is a challenging
task for the care staff. Moreover, specialised help from nutritionist or paediatrician is
looked for only if the patient needs services to develop a treatment regime.
Implications of practice
Different theories and practices have been proposed and adopted for pain
management within country. Pain has been classified into two wide categories, that is,
acute and chronic. Chronic pain is difficult to deal as it is of high intensity and remain for
long term. The present study is focused on Neuropathic pain within different age groups
of people. It has been analysed that the stated pain is a wide challenge for care staff as
it creates an ineffective impact on patient's recovery. Management of such pain is
crucial for which gate control theory has created a revolutionary change. The theory has
developed a wide impact in clinical aspect. The simulation control on large diameter of
nerve fibres has helped in creating a significant impact on pain control.
Many invasive and non-invasive electrical stimulation techniques have been
found to be useful in various chronic pain conditions like arthritic pain, diabetic
neuropathy, fibromyalgia, etc. However, some cases have revealed non favourable
results as well which has posed question on the theory and its techniques. The overall
evaluation reflects an effective and well defined aspect by which pain management can
be successfully implemented and applied for the patients that will help them in attaining
a pain-free lifestyle for chronic aches.
CONCLUSION
Increasing health inequalities and rising fatality of medical issues has enhanced
the demand for pain management aspects in economy. The nursing and care staff in
present era are focusing on enhancing a pain free lifestyle to patients that are suffering
from chronic or acute pain in order to manage a favourable lifestyle for them. To
manage the stated aspect, different theories and techniques have been analysed and
adopted. Neuropathic pain is one of the most challenging aspect of chronic pain which
has affected the lives of people widely. Gate control Theory developed in 1960 made a
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revolutionary impact on clinical services. It has dramatically revolutionised the field of
pain research and has helped patients in leading a pain free lifestyle.
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REFERENCES
Books and Journals
Abdalrahim, M.S., Majali, S.A., Stomberg, M.W. and Bergbom, I., 2011. The effect of
postoperative pain management program on improving nurses’ knowledge and
attitudes toward pain. Nurse education in practice. 11(4). pp.250-255.
Arnstein, P., 2010. Clinical coach for effective pain management. FA Davis.
Chandok, N. and Watt, K. D., 2010, May. Pain management in the cirrhotic patient: the
clinical challenge. In Mayo Clinic Proceedings (Vol. 85, No. 5, pp. 451-458).
Elsevier.
De Ridder, D., Vanneste, S., Plazier, M., van der Loo, E. and Menovsky, T., 2010. Burst
Spinal Cord Stimulation: Toward Paresthesia‐Free Pain
Suppression. Neurosurgery. 66(5). pp.986-990.
Elvir-Lazo, O. L. and White, P. F., 2010. The role of multimodal analgesia in pain
management after ambulatory surgery. Current Opinion in Anesthesiology. 23(6).
pp.697-703.
Jeon, Y. H., 2012. Spinal cord stimulation in pain management: a review. The Korean
journal of pain. 25(3). pp.143-150.
Jones, L., 2012. Pain management for women in labour: an overview of systematic
reviews. Journal of Evidence‐Based Medicine. 5(2). pp.101-102.
Keefe, F. J. and Somers, T. J., 2010. Psychological approaches to understanding and
treating arthritis pain. Nature Reviews Rheumatology. 6(4). pp.210-216.
Kipping, B., Rodger, S., Miller, K. and Kimble, R.M., 2012. Virtual reality for acute pain
reduction in adolescents undergoing burn wound care: a prospective randomized
controlled trial. Burns, 38(5), pp.650-657.
Macintyre, P. E. and Schug, S. A., 2014. Acute pain management: a practical guide.
CRC Press.
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McPhee, S. J., Papadakis, M. A. and Tierney, L. M. eds., 2010. Current medical
diagnosis & treatment 2010. New York:: McGraw-Hill Medical.
Narayan, M. C., 2010. Culture's effects on pain assessment and management. AJN The
American Journal of Nursing. 110(4). pp. 38-47.
Ripamonti, C. I., Bandieri, E. and Roila, F., 2011. Management of cancer pain: ESMO
clinical practice guidelines. Annals of oncology. 22. pp.vi69-vi77.
Rosser, B. A. and Eccleston, C., 2011. Smartphone applications for pain management.
Journal of telemedicine and telecare. 17(6). pp.308-312.
Schiavenato, M. and Craig, K. D., 2010. Pain assessment as a social transaction:
beyond the “gold standard”. The Clinical journal of pain. 26(8). pp.667-676.
Sinatra, R., 2010. Causes and consequences of inadequate management of acute pain.
Pain medicine. 11(12). pp.1859-1871.
Song, J. J., Popescu, A. and Bell, R. L., 2014. Present and potential use of spinal cord
stimulation to control chronic pain. Pain physician. 17(3). pp.235-246.
Waldman, S. D., 2011. Pain management. Elsevier Health Sciences.
Online
Ethics, law, and pain management as a patient right. 2009. [Online]. Available through:
<http://www.ncbi.nlm.nih.gov/pubmed/19461819>. [Accessed on 21st September
2016].
Acute vs. Chronic Pain. 2015. [Online]. Available through:
<http://my.clevelandclinic.org/services/anesthesiology/pain-management/
diseases-conditions/hic-acute-vs-chronic-pain>. [Accessed on 21st September
2016].
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The Gate Control Theory of Chronic Pain in Action. 2011. [Online]. Available through:
<http://www.spine-health.com/conditions/chronic-pain/gate-control-theory-
chronic-pain-action>. [Accessed on 21st September 2016].
Theories of pain: from specificity to gate control. 2013. [Online]. Available through:
<http://jn.physiology.org/content/109/1/5>. [Accessed on 21st September 2016].
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APPENDIX
Illustration 1: Gate control theory mechanism
(Source: Theories of pain: from specificity to gate control,
2013)
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