Page 403 - Encyclopedia of Nursing Research

370 n PAIN

of inflammatory mediators generated at the nerves. Neuroablation techniques surgically
site of tissue injury, thus blocking painful interrupt the nerve and the transmission of
P stimuli. They are useful in the management painful impulses.
of mild pain and may be used in combina- The gate control theory published by
tion with opioids for moderate to severe Melzack and Wall (1965) provided a theoret-
pain. Opioids are morphine-like compounds ical basis for explaining how pain, transmit-
that produce pain relief by binding to opiate ted as electrical signals from the periphery
receptors. They are used with moderate and to the brain, can be influenced by cognitive,
severe pain. Patient-controlled analgesia is affective, and physiological factors. Theories
the use of equipment that is set to prescribed of pain have evolved in recent years to the
parameters to administer opioids intrave- idea of a mind–body unity that Melzack
nously, subcutaneously, orally, or epidurally. (1996) calls a neuromatrix. An active brain is
Adjuvant drugs are used to increase the effi- part of a whole person who has been shaped
cacy of opioids and to treat other symptoms by genetics and learning to respond to nox-
that exacerbate pain. ious stimuli in individually characteristic
Physical modalities for pain management patterns. Recent studies of the role of genet-
include use of heat and cold, counterstimula- ics, endorphins, and immune factors and
tion such as transcutaneous electrical nerve imaging studies of the thalamus, anterior
stimulation, and acupuncture. Cognitive cingulate, limbic system, and cortex sup-
techniques are focused on perception and port a holistic theory that goes beyond the
thought and are designed to influence inter- mechanics of transmission of noxious mes-
pretation of events and bodily sensations. sages. An appreciation of the mind–body
Providing information about pain and its experience of pain provides a basis for multi-
management, helping patients think dif- disciplinary research and practice, multicul-
ferently about pain, and distraction strate- tural responses, and multimodal strategies
gies are examples of cognitive techniques. for managing pain. Middle-range nursing
Behavioral techniques are directed at helping descriptive theories of pain have focused on
patients develop coping skills to modify their the whole person and prescriptive theories of
reactions to pain. Cognitive–behavioral tech- pain management have focused on prescrip-
niques commonly used by nurses and other tions for relief.
clinicians include relaxation, music, imagery, In recent years, various agencies and
distraction, and reframing. Psychotherapy, organizations have published guidelines for
social support, and hypnosis also have been the management of pain. These have included
used successfully in pain management. guidelines published the American Pain
Other management techniques may be Society: on analgesic use and pain in cancer,
used when the use of drugs is not adequate arthritis, sickle cell disease, fibromyalgia, low
to manage pain. The choice of techniques back pain. In addition, there are American
depends on the cause of the pain and these Pain Society guidelines for the use of chronic
therapies may be either temporary or per- opioid therapy in chronic noncancer pain.
manent. Radiation therapy is used to relieve The Joint Commission for Accreditation of
metastatic pain and symptoms from local Healthcare Agencies includes policies and
extension of primary disease. Nerve blocks procedures for pain management in their
are the injection of a local anesthetic into a standards. Pain relief is a patient’s right, but
spinal space or peripheral nerve destruc- there is greater consensus regarding man-
tion. Surgical procedures are used to remove agement of acute and cancer pain than for
sources of pain, such as debulking a tumor chronic nonmalignant pain.
that is pressing on abdominal organs or
removing bone spurs that are compressing Marion Good