Pain Management essay
Introduction to Pain Management
Notably, pain management, commonly referred as algiatry is discipline in medicine that is involved in easing of pain to help improve the lives of individuals living with chronic pain. Pain management is mainly done by the use of drugs and physical treatment, and it is a responsibility that is spread over a wide array of pain management team including occupational therapists, clinical psychologists, nurses, medical practitioners, and pharmacists. In the management of chronic pain, effective management is required, and this is achieved through efficient coordination of the management team. Evidently, pain can have many causes, and thus there are various possible management and treatment methods. The pain management approach adopted by a nurse or a medical practitioner is dependent on various variables such as the source of the pain, the intensity of the pain, the time when the pain started and how the pain feels (D’Arcy 2007, p.11). In this regard, there are many types of pain management approaches and which include physical approach, psychological approach, and medication (Tollison et. 2002, p. 32). Noticeably, people experiencing pain might find it difficult to explain the nature and the source of their pain. In this regard, there is always a risk that a patient might be subjected to pain management approaches that might not be effective.
Role of the Multidisciplinary team involved in Pain Management
Due to the fact that pain is multidimensional, there is always the need to have a multidisciplinary team in the management of pain. A coordinated approach is always needed to ensure that there efficient communication between each member of the team to ensure efficient and effective pain management. The role played by each member of the multidisciplinary team is dependent on the qualification and the professional requirement of the pain management. The central figure in multidimensional pain management is the pain specialist. This is a professional who specializes in assessing the pain giving guidelines on the best approach to use in pain management (Gatchel et al. 2014, p.134). The second professional is the primary care physician. He or she acts as the gatekeeper and helps in coordination of the treatment strategies that are adopted by the team. Don't use plagiarised sources.Get your custom essay just from $11/page
Anesthetist is the third professional, and his role is to apply advanced pain management procedures such as device implantation, peripheral and central nervous block, advanced use of potent analgesic drugs among other approaches. In this regard, Anaesthetist plays a central role in assessment and planning process for pain management. The fourth professional is the Orthopaedist. These are individual who offers collective surgery to the patients in the attempt to alleviate their pain.
Another professional is a neurologist. He or she performs extensive neurological analysis of the patient’s pain and makes the necessary recommendations on the best therapeutic pain management options. Nurses also play a central role in pain management in that they perform on-going review and assessment of the patient pain and help in treatment plan establishment. Psychologists help in the day to day physiological care of patients with chronic pain while the occupational are involved in both vocational and physical care of the patients (Gatchel et al. 2014, p.135). Finally, the physiotherapists help in designing the recovery plan for the patients through the incorporation of physical activities to help treat the musculoskeletal conditions.
Critical analysis of pain management care using evidence-based guidelines
Critical analysis of Pain assessment strategies
Notably, proper and valid assessment is essential for both effective pain management and clinical tries. The assessment strategy applied is dependent on the nature of the pain, and it accrued effective on the physical, emotional functioning of the patient. In this regard, pain assessment strategies should aim at establishing the intensity, nature, location, duration alleviating and aggravating factors of the pain and consequently offer a template in relation to the observations made (Herr 2011, p.35). It is worth noting that pain assessment processing is an interactive and collaborative process thus it should involve all the available parts and resources for accurate determination and evaluation of the pain.
Various strategies can be applied in assessment of pain and which are dependent on the nature and intensity of the pain. One of the strategies is the single dimension pain assessment strategy. This is a simple strategy of pain assessment which involves the use of simple tools. In this approach the most commonly used tools and scales include visual, verbal and numerical or combination of the three. The visual approach uses the picture of the anatomy of the patient to help indicate where the pain located. An example is the faces pain scale which is essential for patients without the verbal abilities to explain the nature and location of their pain. The verbal approach is an approach which has quantitative words such as low and mild and they are used to describe the intensity of the pain (Herr 2011, p.41). The terminologies used are always relative thus a physician can have a relative notion of the nature of the pain. The numerical scales are an approach that helps the medical practitioner to quantify pain using numbers. From the three approaches there are three available pain assessment scales which include visual analog scales (VAS) , the Verbal Rating Scale (VRS) and the numerical rating scale. All the scales are different based on their mode of evaluation and the aspect of the pain they evaluate.
Another strategy is the Multidimensional pain assessment strategy. Notably, the use of single dimension pain assessment strategy is not always sufficient in the determination of the nature and identity of the patient’s pain and quality of life. In this regard, practitioners always apply the multidimensional pain assessment strategy which helps in increasing diversity and effectiveness of pain assessment and profiling. The approach can assess pain more complexly and create a link between the pain intensity and disability. One of the commonly used multidimensional pain assessment tools are the Short-Form (SF) MPQ, McGill Pain Questionnaire (MPQ), Chronic Pain Grade and Brief Pain Inventory (BPI) (Breivik et al. 2008, p.17)
Other forms of pain assessment strategies include fatigue assessment strategy, sleep pain assessment strategies and psychological pain assessment strategies. The essence of these approaches is to accurately assess the pain orientation for both responsive and non-responsive patients.
Critical analysis of Pharmacological pain management strategies
Notably, pharmacological pain management strategies are strategies that utilize a various type of pain-relieving medications which are available. In this regard, these strategies are based on the type of medication that is applied. Evidently, it is sometimes very difficult to plan effectively for pharmacological therapy for pain. However, various combinations of drugs have been used as pharmacological strategies and approach in the treatment and management of various types of pain.
One of the medications is the Nonopioid analgesics. These are aspirin-based medications that are effective and have three pharmacological effects. They include analgesic, anti-inflammatory and pharmacological effect (Persons 2009, p.34). Notably, the medications appear effective in the treatment of pain. However, their accrued cardiovascular effect on patients has gained a lot of interest which has led to their limited use.
Another medication for pain management is Tramadol. Though there is limited knowledge of the working of the Tramadol, the drug has been shown to work in two ways in the management of pain. Notably, two-thirds of the activities of the drug are due to a mechanism that is similar to that of amitriptyline while a third of its activities is due to activity similar to that of the opioid-like mechanism. The drug has shown to be effective in the treatment of neuropathic pain. Due to the opioid effect, the drug should be used carefully for persons recovering from drug abuse. Serotonin syndrome has been reported in the form of seizures thus this drug should not be administered to patients with a history of seizure.
The third group of pharmacological pain management drugs is the Opioid analgesics. These are drugs with high affinity for the µ-opioid receptor. Notably, controlled release opioid has a central role in pain management for patients with chronic pain. They are most effective for patients with neuropathic and nociceptive pain. The recommended Opioid analgesics include hydromorphone, morphine, and oxycodone which are used both in contingent and oral basis (Persons 2009, p.16). Use of patches has also been applied for patients whose oral route has failed in the previous application.
The fourth group of pharmacological pain management drugs is the Antidepressants. Though the drugs are effective, their side effects are more rapid than for other groups of drugs. Patients must always be informed of the intention to use the Antidepressants to ensure that the patient understands the rationale of the use of the drugs in pain management rather than in psychological treatment. Notably, these drugs work at the spine level by preventing the reuptake of the neurotransmitters and serotonin.
Another pain management group of mediation are the Anticonvulsants. They are mainly used along with antidepressants in pain management. They are used in chronic pain management especially in a situation where the pain is described as burning or lancinating. Among the most famous drug in this group is pregabalin due to their strong evidence in pain management.
Critical analysis of non-Pharmacological pain management strategies
Notably, pain is a complex thing whose causes and issues are inclined to a wide array of causes. In this regard, pain can be controlled by the use methods that do not depend on medications. Various strategies have been applied in the management of pain without the use of medication. One of the approaches is exercise. When patients are subjected to physical movements such as ambulation and bed movement it helps in increasing blood flow; increasing prevents spams of the muscle which eventually result in pain relief. Another approach is the Transcutaneous Electrical Nerve Stimulation (TENS) (Leslie and Marlow 2006, p. 246). This is an approach that applies electrical stimulation to the skin resulting in pain relief. It can be used in the management of both acute and chronic pain. Hot, cold treatment is another nonpharmacological strategy in pain management that relieves pain by the use of heat receptors and the vasodilatation effect. The approach is effective as it has little side effect and can be used regularly.
Another strategy or approach is massage. It is a type of manipulation that is applied to the soft tissues. Research indicates that massage relieves the mind and muscles and consequently reduce the pain threshold of the patient. Another approach is the hydrotherapy which uses water for pain therapy using the temperature effect.
Apart from the Physical and peripheral pain management approaches, there are various cognitive-behavioral therapies which are part of the multimodal approach to the management of pain. One of the strategies is the relaxation technique which causes an increase in slow brain waves in EEG through reduction of blood pressure, oxygen consumption and the rate of respiration. This reduces pain sensitive by the brain and reduces the patient’s pain. Another strategy under this approach is the distraction technique which involves getting the attention of the patient away from the pain. This, in turn, increases the patient’s tolerance to pain. Another approach is meditation. This is a situation where the patient focuses on a certain moment. For instance, the patient can focus on his or her respiration rate. These helps in relaxation of the patient and finally relieve the pain.
Hypnosis has also been applied in the non-pharmacological cognitive management of pain strategy. It is a state of consciousness that is similar to that of sleep. In the approach, the patient is required to focus on a given object or memory which then allows him or her to relax. It is an approach where the subconscious is reached resulting in a reduction of the active activities of the brain. This approach has extensively been used in the management of cancer pain and phantom pain. Finally, Yoga has also been applied to pain management. It is an approach that uses respiration exercises and meditation with slow movement technique, and it is effective in the management of musculoskeletal pain. Research has indicated that the approach has been effective in the relief of acute pain and the need to use painkillers.