Pain Management: Theories, Strategies, and Ethical Issues

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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