Postoperative pain management

Postoperative Pain Management

 

            Every individual, especially patients, experiences and suffers pain. It is associated with a myriad of causes, and is described depending on the range of its intensity. In terms of patients’ care, nurses play an important role in postoperative pain management, such that they spend more time with patients and have the responsibility for appraising the patients’ pain intensity, administering their recommended analgesic treatments and checking their efficacy ( 2003). In addition, the regular monitoring of the pain intensity of patients is essential in evaluating the standard of care provided, and most especially in the detection of the side effects of administered treatments ( 2003). With this, this paper discusses the concepts related to postoperative pain management, and its use as a means of pain relief. It also seeks to tackle the physiology of pain and the effects of different pain management strategies to adults and children in relation to pain physiology.

 

Physiology of Pain

            In biological and medical terms, the process of feeling pain can be described in its physiology. Primarily, pain receptors, namely, mechanical, thermal, and chemical, are being stimulated, as they are present in all parts of the body, most especially in the skin, surfaces of the joints, walls of arteries, organs, linings around the bone, and specific areas of the skull. From the pain receptors, the stimuli are transferred through the peripheral nerve fibers, having two types, namely, the ‘fast pain’ and ‘slow pain’ peripheral nerve fibers. Fast pain is described as sharp and travels through A-delta nerve fibers, while slow pain is poorly localized and is diffusely felt. Through the peripheral nerve fibers, pain then reaches the spinal cord, from where the fast and slow pain is transferred and processed to the brain (‘’ 2007). With this, the individual then feels the pain sensation and figures out ways on relieving it, depending on its intensity.

 

Attitudes to Pain

            Because the severity and intensity of pain is subjective, it has been perceived that groups or individuals belonging to different cultural, social and religious backgrounds largely differ in their reactions to pain and their approaches on dealing with it (cited in  1991). With the differences in approaches, come the differences in the development of attitudes in relation to pain.  (2007) points out eight attitudes that have been developed in relation to assessing pain, namely, hypochondriac attitude, cyberchondriac, researcher, empathic, complainer, shrugger, juggler, and combination attitudes. Hypochondriacs are referred to as paranoid thinkers, as they fear the worst illnesses, and as a response, they habitually visit their doctors for every little scratch or sneeze. Cyberchondriacs are the high-tech counterparts of hypochondriacs, but differ from them as they wrongly diagnose themselves with the rarest and fatal diseases they have read in the Internet. Researchers, as indicated in their name are intelligent individuals, who surf the Internet and search their local libraries for illness that match up with their symptoms and investigate available treatments. Researchers are not contented in seeking only the help of health professionals, but want to be active participants in their own welfare. Fourth is developing an empathic attitude, in which empathic individuals, being most sensitive are considered natural pain magnets, as they naturally take up the sufferings and pain felt by other people surrounding them. They immediately learn to detach themselves from other people and create energetic boundaries that would protect themselves from taking on emotions felt by other people. Fifth is having a complainer attitude, by feeling as if they are suffering more, as being self-absorbed and dependent on their sympathizers. Usually, they give their power over their own sufferings. Shruggers tend to ignore and disregard the signs of pain and suffer in silence out of fear of knowing that something is wrong with them. Oftentimes, they are afraid of hearing and facing bad news, so they adopt a belief that the pain they are feeling is mild or insignificant compared to what others feel. Jugglers are individuals, who are highly coordinated with their own systems, such that before feeling a slight change and imbalance in their bodies, they have already taken necessary steps in bringing themselves back to normal. Lastly is the attitude that combines some or all of the previously discussed attitudes, which depend on the severity or intensity of pain an individual is experiencing ( 2007).

            The changes that can be perceived from the discussion of the attitudes toward pain involve the seen initiative of individuals to find the diagnosis and treatment of the illnesses themselves, with or without the guidance of a healthcare professional. With this, it can be recognized that with the high initiative of individuals to learn and gather information from their illness, they would have greater knowledge and chances of survival. Another change is the fact that because the use of the Internet has been utilized to gather information, many individuals use it to learn and diagnose themselves in relation to the pain they are feeling. However, such endeavors may lead many to feel paranoid and neglect seeking medical attention from specialists.

 

Methods and Effects of Pain Assessment Strategies in relation to Pain Physiology

            Postoperative pain is regarded as pain that is usually felt after surgery or operations, such that is exposes patients to severe stress (,  and  2005), and increases the body’s sympathetic response, with successive rises is heart rate, cardiac work and oxygen consumption ( 1997). In addition, pain may lead to anxiety, and increased anxiety may lead to accentuated perception of pain, which further increases the levels of anxiety ( 1991). Because assessment of the patient who is experiencing pain is the foundation of the best possible pain management strategies or methods ( 2000), it must be done in accordance to the healthcare professional’s ability to focus, listen and empathize with his or her patients. With this, several methods have been developed in order to minimize the effects of postoperative pain.

            The initial response to alleviating pain is through taking available pain-killing medications, including aspirin and aspirin-like drugs, paracetamol, opioid drugs, such as codeine and morphine, and taking local anaesthetics (‘’ 2007). However, taking pain-killing medications poses side effects in the long run, thus, affecting the individual’s quality of life, such as becoming immune to the drugs and losing its ability to ease pain, destabilize the value of self-management skills (‘’ 2007), becoming drug-dependent, and the deterioration of the function of organs. With this, new researches have been made and found that along with the use of pain-killing medications, pain management alternatives can also be used. Pain management alternatives involve the use of a trimodal classification system. The first category includes cognitive strategies, which are self-initiated strategies that involve thoughts and private events, such as imagery, self-statements and attention diversion. Second category is behavioral manipulation, which is public, externally manipulated, high in external control, and engages actions or behaviors. Strategies included in this category include hypnosis, biofeedback, modeling, and attribution and perceived controllability ( 1991). The third and final category is of physical interventions ( 1991), which include complementary therapies like acupuncture, massage, relaxation techniques like yoga and meditation, the TENS or transcutaneous electrical nerve stimulation therapy, and cognitive-behavioral therapy (‘’ 2007).  

In relation to pain physiology, the effects of such strategies can be seen as having changes in the intensity of pain, for in the physiology of pain, pain perception is considered a dynamic state ( and  2002). The effect of the implementation of pain management strategies to the physiology of pain can be seen through the change in the pain system, which can be measured in two dimensions, mainly, allodynia and hyperalgesia. Allodynia is referred to as the reduction of pain threshold to the point where non-noxious stimulus is now recognized as painful, while hyperalgesia is referred to as an increase in the magnitude of pain perception, such that a previously painful stimulus is now recognized as having a larger magnitude of perceived pain ( and  2002). From this, it can be understood that the effects of pain management strategies can be perceived using two measures or dimensions, which would either produce a positive or negative effect to the individual. This just means that the use and implementation of such strategies would either alleviate or enhance the intensity of pain a patient feels.

 

Achievement of Pain Management

            It has already been mentioned that the management of pain is related to anxiety, which is viewed as a major contributor to the perception of pain ( 1991). Thus, anxiety’s contribution can be addressed in terms of the improvement of open communication between health care professionals and patients appear to be the most appropriate strategy for intervention ( 1991), especially concerning the health conditions of children, elders, disabled and severely ill adults. Achievement of pain management among patients can be done through effective communication, for its lack is the perceived major problem in the relationship that must exist between patient and healthcare professional, and may be one reason why pain patients are under-treated ( 1991). It has been reported that due to the inability to communicate to patients when using a highly specialized vocabulary, status differences, the inability for patients to ask questions while in pain, and a perception on the part of some physicians that patients cannot comprehend medical information ( 1991), contributes to ineffective pain management.

In achieving effective pain management, it must be kept in mind that the increase in the knowledge and understanding of patients regarding pain may be helpful in pain management. With this, doctors and nurses can maintain contact and free communication with patients, not only to reduce perceived pain but also to reduce the need for post-surgical narcotics and extended hospital stays ( 1991). With increased communication, a clear and effective relationship can exist between the pain patients and healthcare professionals, thus, making the process of pain management more manageable and effective. Second, reduction of pain associated with increased communication appears to come directly from the attenuation of state anxiety, and with this in mind, doctors and nurses can provide descriptive information regarding the sensations involved in procedures that must be done. The interpretation that patients have indicates that the sensory information obtained presents a cognitive and evaluative response, while pain information elicited an affective and emotional response ( 1991). The balance of the amount of information the patients receive from doctors and nurses gives them confidence in managing pain. In addition, providing the patients with the information they need to know alleviates their anxiety and stress, thus, reducing their pain. Third, healthcare professionals can institutionalize the use of the term stress inoculation, which is a process whereby patients learn to cope with anxieties of surgery (cited in  1991). This is done through providing realistic information, including details of inherent risks, by reminding patients of their personal resources and abilities to cope, and by asking the patient to develop a personal coping repertoire, such as strategies for dealing with pain and injury (cited in  1991). Fourth strategy emphasizes the fact that part of the nursing profession is nurturing ( 1987), which stresses the importance of touch. As a strategy in pain management, therapeutic touch must be applied to patients in pain, to help alleviate the pain that they feel. With therapeutic touch, the patient in pain would feel the sense of belongingness and that somebody cares and empathizes with his or her situation. Lastly, pain management would be improved if healthcare institutions would stress on the importance of the visitation of the patient’s family and friends. With this, the patients would have the opportunity to develop and heal with the assistance of his or her family members, such that the family members would help the patient go through the situation without making him or her feel alone, thus, alleviating anxiety and pain that would hasten recovery. 

References

Credit:ivythesis.typepad.com