Submitted By: Winston P. McDonald
Pain, sometimes called the fifth vital sign, is unquestionably the oldest affliction of mankind. We all experience pain each day of our lives to one degree or another. It might be a headache, a stubbed toe, a hangnail or a paper cut, but we all experience pain.
As the oldest affliction of mankind, it follows that pain is also the oldest medical problem.
Pain has a very long history of misinterpretation and misconception. Pain was once regarded as necessary to the healing process. Only in the last 400 years, beginning with the great 17th century philosopher, mathematician and physiologist Rene Descartes, has any legitimate inquiry into the etiology and mechanism of pain occurred.
Descartes first suggested the possibility of a link between the sensation of pain and the brain. Today, everyone knows that the brain processes pain sensations, but 400 years ago, it was a breakthrough! The mind-body connection Descartes made would lead to tremendous progress in the reduction of suffering due to pain. The concept of nerves carrying information to the brain for processing was revolutionary. Descartes’ hypothesis was borne out by anatomical studies conducted during the 19th century and has endured until fairly recently.
In the 1960’s, the notion of a hard-wired system was challenged. The view now held by neuroscientists is that sensory information undergoes the integration of information from a variety of sources. The strength of the pain signal is modified by emotional and behavioral information coming back from the brain. In short, a two way rather than one-way street. Perhaps this explains the differences in pain thresholds among patients.
Moreover, biologists now think the integration of this sensory information may actually occur in the spinal cord, not in the brain, before being carried up to the brain for further processing.
All these findings have given rise to new approaches to pain management. Pain management is one aspect of the general medical specialty known as palliative care.
In the United States, palliative care is defined as reducing the symptoms of disease. It is not dependent on prognosis and is conducted in parallel with curative medical treatment.
Hospice care is defined as the delivery of palliative care to those at the end of life.
Both share similar goals and principals, some of which are listed here.
*Keep the patient active physically and positive mentally, in order to maintain the patient’s relationships and work skills
*Ensure the patient plays an active role in his/her ongoing pain management.
*Establish an alliance with the patient’s family in long term care and self-management.
*Begin pain management early. Aggressive management of acute pain may mitigate its progress to chronic pain.
*Establish realistic goals and expected results with the patient.
*Carefully evaluate and investigate failed treatments prior to changing therapies or dosages.
*Do not fail to manage medication side effects such as constipation and nausea.
*Schedule reviews to discuss and monitor treatment outcomes so that pain management strategies can be changed as required.
Remember, pain is a subjective experience. It is what patients say it is. Be sure you understand the etiology (cause) of the pain. It is good practice to maintain a pain history using standardized and quantifiable plan assessments. Finally, it is important to maintain focus on patient comfort. This is, after all, the goal of pain management.
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