Most people print off a copy of the post test and circle the answers as they read through the materials. Then, you can log in, go to "My Account" and under "Courses I Need to Take" click on the blue "Enter Answers" button. After completing the post test, you can print your certificate PAIN MANAGEMENT A COMPREHENSIVE REVIEW ABSTRACT Pain can be defined as a complex, multi-dimensional provocation. It is one of the major reasons that people seek health care. Pain is a response to noxious stimuli and can function as a protective mechanism of the body to prevent further injury. The sensation of pain as the warning of potential tissue damage may be absent in people with certain disorders, such as diabetic neuropathy, multiple sclerosis, and nerve/spinal cord injury. There are a number of approaches in the management of pain, each with respective advantages and disadvantages. According to a recent medical report titled ‘Relieving the pain in America' published by A Blueprint for Transforming Prevention, Care, Education, and Research, pain is a significant public health problem that costs Americans at least $560-$635 billion annually, an amount equal to about $2,000.00 per person living in the U.S. Consequently, the total incremental cost of health care for controlling pain ranges between $261 and $300 billion, and $297-$336 billion is attributable to a loss in manpower productivity. Ultimately, there should be proper pain management measures in place in order to reduce the root cause of pain, the length of pain, and the effectiveness of pain management. This course aims to offer a comprehensive review of the pain management methods that are currently available, as well as offer some new insight into the modern and innovative measures of pain management. ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 1 LEARNING OBJECTIVES 1. Define pain 2. Describe the magnitude of pain 3. Enumerate the characteristics of pain 4. Explain the types of pain 5. Describe the negative consequences of pain 6. Describe the pathophysiology of pain 7. Elaborate the theories of pain 8. Identify the factors affecting the pain 9. Demonstrate appropriate use of pain measurement instruments 10. Explain the pharmacological management of pain 11. Describe the non-pharmacological management of pain 12. Explain alternative therapies for the relief of pain 13. Discuss the patient self care method to relieve pain ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 2 OUTLINE I. Introduction Pain is considered a “universal disorder” [1] that comes in many forms. Regardless of the form it is seen in, everyone experiences pain, with the perception of pain occurring differently in each individual. In the most benign form, pain serves to warn the individual that something is not quite right. Pain can, however, disrupt productivity, well-being, and indeed, the entire life of the individual experiencing the pain. At its core, pain is complex and differs greatly among individuals, including those who seem to have identical injuries or illnesses. Pain has a long history. Ancient civilizations recorded accounts of pain and the various treatments and cures used on stone tablets. Early humans also related pain to magic, demons, and evil. In early times, the responsibility of pain relief fell on shamans, priests, and sorcerers, who utilized herbs, rites and ceremonies to treat pain. The Romans and Greeks were the first peoples to advance the idea that the brain and nervous systems are key in producing pain sensations. However, evidence was not available to support this theory until well into the Renaissance in the 1400 and 1500s. It was not until the 19th century that real advancements in science led to advancements in pain treatment. Physicians discovered that such drugs as morphine, codeine, cocaine, and opium could be used to treat pain. These drugs then led to the development of aspirin as a pain treatment; even today this is the most commonly utilized pain reliever. Finally, anaesthesia advanced and became the standard for surgery. As we have moved into the 21st century, scientists and physicians are gaining an ever greater understanding of pain and pain treatment [1]. Pain today is a costly and very serious public health issue [2]. It is also a challenge for friends and family as well as health care practitioners there to offer support to the individual suffering from the pain. Pain related issues currently account for approximately 80% of doctor’s visits [3]. There are many things that affect how pain is felt. One is the type and extent of the injury itself. Another big thing that affects how pain is felt is the emotions the individual feels during the injury and recovery periods. Emotions strongly affect the perception of pain. Pain is not something that has any unit of measure. While practitioners can ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 3 measure the extent of severity of an injury, there is no way for them to measure how or why some people feel more or less pain than others with the same injury [4]. However, there are a number of ways to address pain conditions, from pharmacological to nonpharmacological options as well as alternative therapies. It is also important to address the education of both practitioners as well as the individual, friends and family to ensure that pain is managed effectively. The better practitioners communicate with and educate their patients, the more likely that pain will be effectively addressed and managed. Additionally, there is a treatment gap that exists in pain management, which cannot be ignored. Women, children and older adults are at greater risk of being negatively affected by chronic pain and frequently end up receiving treatment that falls short. Understanding why this happens as well as what to do about it is essential for practitioners who are seeking to adequately and fully treat a variety of pain conditions that are experienced differently from individual to individual. II. Definition. The word pain is derived from the Latin word poena, which means a fine, or penalty. The International Association for the Study of Pain defines pain as: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. [5]. Pain is an unpleasant sensation that ranges from mild, localized discomfort to extreme agony. There are physical as well as emotional components to pain. The physical component is the result of nerve stimulation [6]. Emotions have the ability to affect the way a person perceives pain. While all human beings have the same anatomical structures that convey nociception to the central nervous system, there are quite a few factors that alter the intensity of the pain perception [7]. It is important that practitioners consider both physical and emotional factors when treating patients, as these both influence a patient’s recovery [8]. Some people indicate that they tolerate pain well, whereas other individuals indicate that they are highly sensitive to pain [9]. III. Magnitude of pain. Magnitude of pain is a difficult thing to measure, primarily because different people experience pain in different ways [10]. However, there are some instruments designed to measure pain that apply universal standards to pain sensation and can be used across the board for all individuals. ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com 4 One such instrument is the visual analog scale. This scale is utilized to measure pain characteristics in a way that ranges across a scale of numerical values, with the number 1 being no pain and the number 10 being the worst pain imaginable. This pain scale is ideal for use with those individuals who possess a strong ability to define their pain. Another scale that is commonly utilized is the faces pain scale. This scale is frequently utilized with children or with those who are better able to provide a description of what their pain feels like according to the expression depicted on a face. This scale ranges from a smiley face that represents no pain to a face with a frown and tears on it to describe the worst pain imaginable. There are special descriptive scales to measure pain in infants. Since infants are unable to talk to describe their pain as well as being not cognitively developed enough to identify a face representative of their pain, practitioners rely on descriptions of the infant’s behaviour to determine the magnitude of pain. The use of these scales has its advantages as well as disadvantages. An advantage of utilizing scales such as these is that there is a universal standard by which practitioners may assess pain and in turn determine an initial idea of the severity of injury. However, since these pain scales are universal, people who are more or less sensitive to pain don’t necessarily fit into the pain “norm”, which can make an initial determination of how severe a condition or injury is difficult to make. This can mean that some patients are not receiving adequate care for their pain. One scale that may help correct pain discrepancies is the magnitude matching scale. Applying this scale to pain, for instance, would be particularly useful in hospital settings; for example, it can be argued that a woman undergoing childbirth is in more pain than any pain a man could experience. Therefore, even if a pregnant woman rates her pain as a 4 on a scale of 10, it is probable that they are in more pain than a man who provides the same rating. IV.