Page 63 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

36 Chapter 2. Pain

experience. Furthermore, this theory allows for the
management and shaping of painful experiences due to the
multi- faceted nature of it (Novy et al. 1995 ). For example, in
addition to the physiological aspects, it accounts for affective,
behavioural, cognitive and sensory factors. Building upon the
theory, Melzack ( 1993 ) argued that there was an interrelation
of physiological and psychological facets, with affective,
behavioural, cognitive and sensory-physical factors each
being part of an integrated chronic pain system.
Although this theory has been subject to specific criticisms,
particularly in relation to points of particular anatomical
mechanisms, and suitably revised, it has been of enormous
value in pushing forward and stimulating research surrounding
the science of pain and the development of new clinical
treatments (Melzack and Wall 1982 ). Furthermore, the model
has led to the development of various pain management
techniques, including that of neurophysiological procedures,
behavioural treatments, pharmacological advance, and tech-
niques targeted towards the alteration of attentional and
perceptual pain associated processes (Novy et al. 1995 ).

Factors Influencing Pain

As discussed, pain is not a physiological symptom, but rather, a
;
biopsychosocial phenomenon (Adams et al. 2006 Upton and
Solowiej 2010 ). Pain, and its experience, is a complex and multi-
faceted phenomenon, being subjective and often difficult to
describe. In addition to the pathophysiological causes of wound
pain, the patient’s psychological state of mind, environment and
cultural background can each impact on the way in which the
;
patient perceives it (Briggs et al. 2002 Soon and Acton 2006 ; see
Table 2.2 ). Indeed, there are whole ranges of factors that can
influence whether the gate is open or closed, for example:
• The amount of activity in the pain fibres: the greater the
injury the more active the pain fibres, the more open the
gate, meaning larger injuries often cause more pain than
smaller ones.