Page 402 - Encyclopedia of Nursing Research

P

or health context include pain in infants, the
Pain critically ill, the cognitively impaired, and at
the end of life.
The undertreatment of pain has been
Pain is a symptom, defined as an “unpleasant well documented for the past 37 years (Marks
sensory and emotional experience associated & Sachar, 1973). Barriers to the effective
with actual or potential damage or described treatment of pain include clinicians’ lack of
in terms of such damage; pain is always sub- knowledge of pain management principles,
jective” (International Association for the clinician and patient attitudes toward pain
Study of Pain, 1979, p. 250). Pain is a common and drugs, and overly restrictive laws and
component of illness and is the most common regulations regarding use of controlled sub-
reason that people seek medical attention. stances. The undermanagement of pain has
Nurses assess patients for pain and in collab- been particularly pronounced in children, in
oration with the patient and the physician; the elderly, and in those who cannot speak.
they endeavor to reduce or relieve pain and Pain relief in palliative care and at the end
to minimize the risk for long-term adverse of life is receiving increased attention around
effects of unrelieved pain. People experience the world.
pain in different ways and only those who Pain management includes pharmaco-
are experiencing pain know what it is really logical, cognitive-behavioral, physical, radia-
like. Communication of that pain to caregiv- tion, anesthetic, neurosurgical, and surgical
ers is dependent on the verbal abilities of the techniques. Analgesics administered orally
patient; those who are very young and those or intravenously are needed for moderate to
who are cognitively impaired are at risk for severe pain, and cognitive-behavioral tech-
being misunderstood by the caregiver. niques such as relaxation, music, and distrac-
Pain generally is classified into two tion can increase the relief. More complex
types: acute and chronic. However, there pain may require evaluation and treatment
are many different types and causes of pain. by a multispecialty pain management team.
There is acute pain after surgery and injury The successful management of pain gener-
and during labor, sickle cell crisis, and health ally depends on a careful assessment of the
care procedures. Acute pain subsides as heal- pain, patient education for pain management,
ing takes place. Acute pain has a predictable appropriate pharmacological and nonphar-
end and is of brief duration, usually less than macological intervention, reassessment to
3 to 6 months. Chronic pain is said to be that determine the effectiveness of interventions
which lasts longer. Chronic pain can occur in used, and reintervention until satisfactory
any system and can be recurrent or constant. relief is obtained (Good & Moore, 1996).
Cancer pain is from the enlarging tumor, its Pharmacological management of pain
metastases, or its treatment and can increase usually is treated by three types of drug:
in intensity and extent as the disease pro- (a) aspirin, acetaminophen, and nonsteroi-
gresses. “Breakthrough pain” are acute per- dal anti-inflammatory drugs; (b) opioids;
iodic increases in chronic cancer pain. The and (c) adjuvant analgesics. Nonsteroidal
types of pain that are classified by the age anti-inflammatory drugs decrease the levels