The Management of Chronic Pain for a Patient with Breast Cancer
Introduction
Humans express many emotions during the span of their lives. Most of these emotions result from different circumstances and from different situations. Humans can express diverse emotions at the same time and change them according to the given condition. One of the distinct characteristics of humans is expressing pain in different ways. Pain can be felt and expressed either physically, mentally and emotionally, and often times, this emotion can lead to serious problems. A lot of things can cause pain from sickness, heartbreak, age, gender, social situation, disability and many other problems.
However, a disease or a sickness causing pain must be the biggest challenge a person will experience. This pain may or may not be endured by the person and may even result to death, such as when it is caused by a serious disease such as cancer. This may affect how the person may function and perform on his or her daily activities. With these, many treatments are being improved and used, to at least, alleviate the pain being experienced by many persons inflicted with a disease. In this paper, the concept of pain will be discussed and its relation to different aspects. The pain associated with breast cancer will also be evaluated, its treatment and how the healthcare professionals do about it to help many patients.
The Concept of Pain
(2001) reports that pain has existed since time in memoriam, and perhaps the first documented mention of pain was in the papyrus dating back to the fourth century B.C., indicating the use of opium for the treatment of headaches (). Since then, pain has been the focus of speculation and scientific attention, and has continued to remain a challenging problem to the sufferer, healthcare providers and the society. The International Association for the Study of Pain defines it as an unpleasant sensory emotional experience associated with actual or potential tissue damage or described in terms of such damage ( 2006). Pain is essential for survival because of its alarm function ( 2001), and can be classified in a number of different ways, such as acute, chronic and many others. It was reported that acute pain is defined as short-term pain or pain with an easily identifiable cause (2006). It is the body’s warning of present damage to tissue or disease and is often fast and sharp, followed by aching pain. Usually, acute pain is centralized in one area before becoming somewhat spread out. It is a normal response to injury and may be accompanied by anxiety or emotional distress, but responds well to medications, and can usually be diagnosed and treated. In comparison, chronic pain is a pain that persists longer that the normal course of time associated with a particular type of injury (2006). This constant or intermittent pain has often outlived its purpose, as it does not help the body to prevent injury, and is believed to represent the disease itself. It is often more difficult to treat than acute pain and can be made much worse by environmental and psychological factors. Expert care is generally necessary to treat any pain that has become chronic and coordinated treatment from an interdisciplinary healthcare team, including medical physicians, physical therapists, and psychologists or psychiatrists, is often beneficial (2006).
Pain and the Pain Gate Theory
Pain is a common symptom in people who seek medical assistance accounting for over 70 million office visits to physicians each year (2001). However, to better know what to do about pain, we must know how it is generated and processed. A stimulus causes pain and activates the nervous system. It has been reported that there are specialized “receptors” in the skin and internal organs that are sensitive to stimuli that are painful, which are called nociceptors (2006). These are free nerve endings connected to small diameter myelinated A and unmyelinated C nerve fibers. Nociception, then, is the response of the nervous system to painful stimulation, so when nociceptors detect a nociceptive stimulus, they send a message to the spinal cord (2006).
A famous theory concerning how pain work is called the Gate Control Theory, which was devised by in 1965 (2006). As reported, the basic concept is that signals elicited in afferent neurons by noxious stimuli can be blocked or filtered by a synaptic gate in the dorsal horn of the spinal cord ( 2006). Furthermore, the gate is believed to be located in the substantia gelatinosa (SG) of the dorsal horn, where the neurons of the SG make connections with the terminals of primary afferent fibers and the dendrites of dorsal horn cells. Through either pre-synaptic or postsynaptic inhibition, the substantia gelatinosa neurons appear to be able to block or reduce activation of second order neurons by nociceptive inputs ( 2006). These gating effects of the SG neurons can be activated either by (a) inputs of large diameter A afferent innervating the injured are, where it provides the basis for pain relief by selective activation of large diameter afferents, as in transcutaneous electrical nerve stimulation, or, (b) by activation of neurons in certain brainstem regions, which send axons to the spinal cord ( 2006).
Dimensions of Pain
It has been reported that it is now widely believed that pain affects men and women differently ( 2006). Many investigators are turning their attention to the study of gender differences and pain, as more experts agree that women recover more quickly from pain, seek help more quickly for their pain, and are less likely to allow pain to control their lives, compared to men. This is so, as sex hormones estrogen and testosterone certainly play a role in this phenomenon, psychology and culture, too, may account at least in part for differences in how men and women receive pain signals ( 2006).
According to (2001), clinicians working with chronic pain patients are aware that patients having similar pain histories and reports of pain may differ greatly in their beliefs about pain (). It was suggested that behavior and emotions are influenced by interpretations of events, rather than solely by objective characteristics of the event itself, thus, pain when interpreted as signifying ongoing tissue damage, is likely to produce considerably more suffering and behavioral dysfunction that if it is viewed as being the result of a stable problem that may improve (2001). Due to the fact that the different aspects (such as culture, gender, social status, personality and behavior) of the person experiencing pain affects his illness, gives us an idea that some factors may help the person on how to cope up with it. The author added that certain beliefs might lead to maladaptive coping, increased suffering, and greater disability (2001). This happens when patients who believe their pain is likely to persist may be quite passive in their coping efforts and fail to make use of cognitive or behavioral strategies to cope with pain. In addition, patients who consider their pain to be an unexplainable mystery may negatively evaluate their own abilities to control or decrease pain, and are less likely to rate their coping strategies as effective in controlling and decreasing pain (2001). People’s beliefs, appraisals and expectancies regarding the consequences of an event and their ability are hypothesized to impact functioning in two ways, and may have a direct influence on mood and an indirect one through their impact on coping efforts.
Chronic Pain and Pain Assessment
As mentioned earlier in the paper, chronic pain lasts longer than acute pain, and some of its common types include back pain, headaches, arthritis, cancer pain and neuropathic pain, which results from injury to nerves (2004), where breast cancer is also included. Due to the presence of so many toxins around us, these produce carcinogens or cancer-causing substances. These carcinogens increase many people’s susceptibility of having cancer, including breast cancer in men and women. Older men and women are more susceptible to breast cancer nowadays and is one of the fatal diseases present. With this, the elderly must be given care and attention by applying different tools and techniques in the evaluation of their disease. Specific tools can help the health providers in assessing the patient’s suffering from chronic pain. (2002) reports that although several pain intensity assessment tools exist, the tools most frequently used by nursing practitioners are numeric rating scales, such as the Visual Analog Scale and the Numeric Pain Intensity Scale, where each scale has pain descriptors ranging from 0 or 1 (indicating no pain) to 10 (indicating extreme pain). Other scales include the Present Pain Intensity Rating from the McGill Pain Questionnaire, which rates pain from 1 (indicating no pain) to .3 and 6 (which indicates excruciating pain); the Simple Verbal Descriptive Pain Intensity Scale, which is a line scale that rates pain from no pain to worst possible pain; and the Wong Baker Face Scale, which uses a scale with faces having features ranging from a big smile to tears, linked with a number or letter indicating pain intensity. This scale assesses pain in pediatric or cognitive impaired patients from .1 to 5.
As reported, there are advantages to using numeric rating scales for assessing pain and function (2006). Among the pain assessment tools, the Numeric Pain Intensity Scale has been found to be valid and reliable, and to be sensitive to changes in acute, cancer and chronic pain (2006). In addition, research indicates that “least” and “usual” pain ratings provide the best estimate of actual pain intensity (2006). Measurement of other aspects of pain-related functioning may be accomplished using one or more validated measures of pain interference or functional status (2006). Overcoming barriers to assessment is important, as underassessment of pain is a major cause of inadequate pain management. As reported, the most common reason for the under treatment of pain in the hospitals is the failure of clinicians to assess pain and pain relief (2006). Thus, healthcare providers must bear in mind that pain is subjective, and therefore the patient’s report of pain is the single most reliable indicator. Therefore, the treatment of the patient depends on the pain reported to the healthcare professional, especially in the case of breast cancer patients.
Evidence Based Nursing and Breast Cancer
It was reported that evidence based nursing (EBN) is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient references (2001). In addition, there are three areas of research competence in EBN, namely, interpreting and using research, evaluating practice, and conducting research. These are very important especially in its application and approach in breast cancer patients. As mentioned, extensive research is done to obtain proper knowledge regarding the disease. Before certain interventions are given to patients, its effects and proper dosages must be known. It has been reported that breast cancer can be treated with surgery, radiation and drugs, such as chemotherapy and hormonal therapy, and doctors may use on of those or a combination, depending on factors such as the type and location of the cancer, whether the disease has spread, and the patient’s overall health ( 2000). While doctors once believed that the spread of breast cancer could be controlled with extensive surgery, they now believe that cancer cells may bread away from the primary tumor and spread through the bloodstream, that is why drugs are now used to reach them, as these cells cannot be felt by examination or seen on x-rays or other imaging methods. In line with this is the pain associated with having breast cancer. Taking painkillers are often the best way of treating cancer pain, and sometimes very high doses of these drugs are needed to control the pain. Aside from morphine, which is an opioid painkiller used, other drugs include diamorphine, fentanyl, buprenorphine, codeine, oxycodone, and anti-inflammatory drugs such as aspirin, ibuprofen, diclofenac and celecoxib, and other available drugs ( 2002).
The education and the skills of the healthcare professionals giving attention to the breast cancer patients matter a lot due to the intensive and delicate conditions of the breast cancer patients. Every healthcare provider must realize that his or her role is very important for the treatment of each patient, as each will be crucial in giving out information to the patient. It would also be better if nursing practitioners will be pursuing doctorate studies and continue education, as the doctoral program is crucial for added skills and knowledge in the nursing profession, and is involved in discovering and disseminating knowledge. Through this, the nursing practitioner can learn more regarding the different diseases and improve on their skill to further develop their expertise in service.
Conclusion
Experiencing pain is unavoidable, especially in relation to cancer. Cancer is a vicious disease, which pose negative effects on its victims. With this, the role of the healthcare practitioners is crucial in giving out information and proper care for the breast cancer patients, and not only to help in their treatment, but also to give courage and hope for their survival. As pointed out by (2001), pain is a subjective, perceptual experience, and one characteristic differentiating it from pure sensation is its affective quality (). Pain associated with cancer may be physical and emotional but because of this pain, the patient will never learn to fight for his or her life. Due to pain, humans will never get to appreciate the importance and the beauty of expressing and having many emotions. Experiencing pain can be a good venue for a cancer patient to realize that there is always hope and cure for the illness.
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