Knowledge and Attitudes of Pain Management

Question: Discuss about the Knowledge and Attitudes of Pain Management. Answer: Introduction: Pain management is one of the desired skills required in nurses and physicians to provide relief to patients with acute clinical manifestations of disease (Barr eta l., 2013). It helps in improving the quality of care through effective pain assessment and management at regular intervals. Ineffective pain management can lead to adverse physical and psychological health outcome in patients, therefore pain management in critical to enhance delivery of care (Stang et al., 2014). This reflective essay particularly describes method of pain assessment and management of patient with cholecystitis after undergoing laparoscopic cholecystectomy. Pain is often described as an unpleasant sensory and emotional experience related with actual or potential tissue damage or injury that stimulate the nociceptors and invoke the sensation of pain in the affected person (Wiech, 2016). The perception of pain can range from mild, to discrete localized distress or agonizing ache and comprise of both physical and emotional aspects. Recent evidences suggest that pain perception is intimately related to cognitive processes and learning mechanisms and efforts are in progress to harness the power of the mind in treating pain and associated noxious stimuli. Classification of pain can be done depending upon the extent and duration of the perceived sensation and encompass acute and chronic types (Wiech, 2016). Acute pain has a sudden onset and lasts for limited time compared to the chronic pain that lasts longer. Acute pain results from impact on tissues such as bone, muscle or any organ that cause tissue injury and accompanies anxiety and other emotional disturbances (Hadzic, 2016). Contrarily, chronic pain is attributable to long term debilitating diseases accounting for tissue damage or nerve injury (Barr et al., 2013). However, chronic pain is resistant to medication and the sufferers are more prone to encounter mental health issues pertaining to depression or anxiety. The pathophysiology of pain has a complex interaction. It follows a long pathway by which neuron establishes connection with brain and spinal cord and stimulates them to perceive pain. Sensory neuron senses the pain at specific location and sends impulses to the spinal cord and then it travels to the thalamus of brain. The thalamus organizes the information and the sensory cortex interprets this message as pain. This signal is directed back to the location of pain by the motor neurons which lead to reaction of pain in individual (Rodriguez, 2015). During my nursing practice, once I came across a 32 years old patient who was admitted in the emergency department with severe abdominal pain on the upper right quadrant of the abdomen. The grimacing pain that the patient was encountering due to her prevailing clinical condition prompted me to undertake a suitable treatment regime in keeping with her clinical manifestations and signs. At this stage, my first nursing priority was to properly assess the patient with the use of an evidence based assessment tool to determine the cause and severity of pain (Bourdel et al., 2015). Numerical Rating Scale (NRS) is a pain assessmenttool to measure the pain intensity by virtue of 11 point scale or a 101 point scale in which 0 is applicable to the lowest perception of pain while 10 or 100 denotes highest intensity ofpain. NRS is a valid and feasible technique applicable to a wide range of patients to assess the pain intensity even trough telephonic conversations indicating a positive and signif icant correlation with the measures of pain intensity (Gupta, Drabik, Chakrabortty, 2016). Contrarily Verbal Rating Scale (VRS) is a comprehensible, easy to administer pain assessment tool that consists of a list of a list of adjectives accounting for various levels of pain intensity (Stang et al., 2014). Pain intensities encompassing from no pain to extreme pain can be estimated by virtue of VRS. It is found to be sensitive to the treatments that are further found to influence pain intensity. In a 4 point scale, pain is perceived ranging from no pain, mild, moderate to severe pain. Visual Analogue Scale and graphic rating scale are other tools that may be implemented in clinical setting (Reed Van Nostran, 2014). Verbal Rating Scale (VRS) and Numerical rating scale (NRS) were used as a tool to assess the pain in the patient rated on a 10 point scale. It helped in evaluating the impact of pain as well as severity of pain. The research by (Pag et al., 2012) investigated the validati on of numerical rating scale for measuring pain intensity and unpleasantness in acute pain and it showed that numerical assessment tool has high accuracy and sensitivity for analyzing the pain intensity and patients discomfort level. The first step that I carried out for pain assessment of patient was to inquire about the location, characteristics and pattern of pain. The first step was to document the patients self-report of pain as this helps in getting an initial idea about level of complications and risk of cognitive impairment in patient (Dorflinger et al., 2013, Duke et al., 2013). On inquiry from patient, it was found that pain started first in the epigastrium which then became localized in the upper right quadrant of stomach. The patient also reported that pain worsens during coughing and movement. The second step during pain assessment is to make assumptions of pain if there is lack of reliable self-report of pain. However, in my patients case, she was able to effectively report on duration and location of pain. Now I used the verbal rating scale to assess the behavioral indicators of pain. This tool is also useful to monitor behavioral indicators of pain when critically ill patients cannot self-report o n the severity and characteristics of pain (Chanques et al., 2014, Voshall et al., 2013). On observation of patients behavior, she was found to be anxious and very uncomfortable as her abdominal pain was associated with nausea and vomiting too. This was evident from facial expression and grimacing sign of patient. I also used verbal rating scale which consist of adjectives like no pain and a score of 0, followed by mild, moderate and sever pain in which the score also goes on increasing with increasing intensity. On the other hand numerical rating scale is dependent on judging the severity of pain on a score of 0 to 10. Therefore after pain assessment, the pain score was 10/10 and after trial with analgesics like IM Pethidine and IV tramadol, the pain score subsided to 5/10. Pain assessment helped in predicting the cause and nature of pain, however actual of pain could be diagnosed only after physical test. The main physical test ordered for the patient included liver function test, abdominal ultrasound, CT and X-ray, and cholecystogarm test. Liver function test was important to see elevated level of lipase or bilirubin. Finally diagnosis and cause of pain was finally determined by physician as the reports revealed that the patients gall bladder wall had thickened and there was presence of pericholecystic fluid in it. Therefore the patient was diagnosed with cholecystitis.This was confirmed because cholecystitis occurs when there is stone on bile product or gall bladder and increased bacteria in the bile lead to production of pericholecystic fluid (Allen, S. N. (2013). The psychological aspect of pain perception in patients is vital to improvise novel pain abatement methods and techniques. Psychology in pain is guided by two pivotal components of emotion al and behavioral factors that in turn affect the consequences in healthcare setting and should be adequately addressed by the healthcare professionals to allow a holistic mode of treatment (Stankovi?Valerjev, 2014). The main challenge in pain management occurred after the patient was operated for laparoscopic cholecyctectomy. Post operation also, the pain assessment was done with numerical pain assessment tool and the numerical pain score was 7/10. At this point, it was necessary to provide patient pain medication according to best practice guidelines for pain management. She was given tramadol medicine to relieve pain. This was in compliance with best practice guideline as there are many evidences which prove that tramadol hyrocholride is effective for post-operative pain management (Barr et al., 2013). Study by Husic et al., 2015 also compared the efficacy of this analgesic for treating post-operative pain and it was found that the total pain was single dose of this medication is more effective than combination of analgesics acetaminophen-propoxyphene. However, it is necessary that patients be made aware of complications as taking tramadol caused dizziness in patients. Therefore, use of tramod ol along with arcoxia, nexium and IV unasyn helped in gradually eliminating the patients level of pain. In the next few days, her pain was assessed form time to time and she was encouraged to ambulate. Finally, her pain score subsided form 7/10 in the 1st day post operation to 1/10 on the day of discharge. Pain perception was also reduced through appropriate analgesic administration. However in certain instances patient may refuse to take pain killers due to the notion of having the possibility of side effects or associated health discomforts from consuming the analgesic medicines. Thus congruency was maintained throughout the post operative session to deal with the patients clinical condition. As part of physical therapy the physiotherapist is entitled to look after the pain mitigation strategy to ensure better recovery and improved health status. Autonomic and pain processing are found to be influenced due to deep and slow breathing techniques and hence deep breathing exercises we re recommended for the concerned patient (Busch et al., 2012). For the patient, ambulatory movement was encouraged to allow mobility and improving the range of movement (Long-Lasting Relief, 2015). Careful analysis of the situation as discussed in the preceding sections, I found that following the diagnosis of cholecystitis in the concerned patient the follow up regimes and interventions and medications applied could be better implemented and applied that might have accounted for quicker recovery and improved outcomes in the patient. I also got to know the distinction between normal abdominal pain compared to the type of pain perceived during cholecystitis. It was understood in course of the patient handling by virtue of the data obtained from relevant diagnostic procedures and routine pathological examination. In the future, I would like to take care of this fact to reduce any complication and facilitate better recovery in patient. In the post operative care ambulation was recommended to maintain mobility and relive pain in combination with breathing exercise (Dobson et al., 2014). Research proposed that exercise intervention harbored positive benefits in mitigating pain during post surgery session. In achieving the optimized results, I collaborated with the registered physiotherapist at the hospital to provide respite with the patient in a holistic manner. This was the important learning during my experience of treating the patient and it helped in bringing positive change in my skills of managing pain in critically ill patient. In course of the treatment modality carried in case of the patient, I experienced certain hands on experience and knowledge regarding the symptoms and interventions relevant to the specific situation of acute cholecystitis. The distinction between normal abdominal pain compared to the type of pain perceived during cholecystitis was understood in course of the patient handling by virtue of the data obtained from relevant diagnostic procedures and routine pathological examination. Knowledge regarding choice of medications for case appropriate situations both in pre as well as post operative surgery scenarios was acquired during the treatment regime. An interdisciplinary pain management strategy might serve to address the issue of acute pain in patients that can be studied for bringing about optimum results (Gatchel et al., 2014, Schreiber et al., 2014, Tse Ho, 2014). Therefore, for future practice a collaborative framework for pain mitigation in patients undergoing surgery can be recommended to improve patient condition and resolve the clinical conditions with utmost precision and prudence. Pain management is a crucial aspect for pain reliving in patients with complications. Interventions related to pharmacologic treatment in conjunction with non-pharmacologic techniques are utilized to alleviate the symptoms of pain. Non-pharmacologic treatment includes application of physiotherapy, psychological counseling involving cognitive behavioral therapy and biofeedback mechanisms (Macintyre Schug, 2014).Thus pain management in nursing practice should lay emphasis upon collaborating with the interdisciplinary teams to ensure better heal th outcomes in patients suffering from pain. References Allen, S. N. (2013). Gallbladder disease: Pathophysiology, diagnosis, and treatment.US Pharm,38(3), 33-41. Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Glinas, C., Dasta, J. F., Coursin, D. B. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit.Critical care medicine,41(1), 263-306. Bourdel, N., Alves, J., Pickering, G., Ramilo, I., Roman, H., Canis, M. (2015). Systematic review of endometriosis pain assessment: how to choose a scale?.Human reproduction update,21(1), 136-152. Busch, V., Magerl, W., Kern, U., Haas, J., Hajak, G., Eichhammer, P. (2012). The effect of deep and slow breathing on pain perception, autonomic activity, and mood processingan experimental study. Pain Medicine, 13(2), 215-228. Chanques, G., Pohlman, A., Kress, J. P., Molinari, N., De Jong, A., Jaber, S., Hall, J. B. (2014).Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report.Critical Care,18(5), 1. Dobson, J. L., McMillan, J., Li, L. (2014).Benefits of exercise intervention in reducing neuropathic pain.Frontiers in cellular neuroscience,8. Dorflinger, L., Kerns, R. D., Auerbach, S. M. (2013).Providers' roles in enhancing patients' adherence to pain self management.Translational behavioral medicine,3(1), 39-46. Duke, G., Haas, B. K., Yarbrough, S., Northam, S. (2013).Pain management knowledge and attitudes of baccalaureate nursing students and faculty.Pain Management Nursing, 14(1), 11-19. Gatchel, R. J., McGeary, D. D., McGeary, C. A., Lippe, B. (2014). Interdisciplinary chronic pain management: past, present, and future.American Psychologist,69(2), 119. Gupta, D., Drabik, A., Chakrabortty, S. (2016). A New Nominal Scale (Yes-No-Don't Know-YNDK Scale) and Its Correlation with Standard Ordinal Scale (Numerical Rating Scale-NRS): Our Experience Among University Based Pain Clinic Patients. Hadzic, A. (2016). Textbook of regional anesthesia and acute pain management. Mcgraw-Hill Education. Husic, S., Izic, S., Matic, S., Sukalo, A. (2015).Efficacy and safety of a fixed combination of tramadol and paracetamol (acetaminophen) as pain therapy within palliative medicine.Materia socio-medica,27(1), 42. Long-Lasting, P. B. T. A., Relief, P. (2015).Pain Management Pain Management. Macintyre, P. E., Schug, S. A. (2014).Acute pain management: a practical guide. CRC Press. Pag, M. G., Katz, J., Stinson, J., Isaac, L., Martin-Pichora, A. L., Campbell, F. (2012). Validation of the numerical rating scale for pain intensity and unpleasantness in pediatric acute postoperative pain: sensitivity to change over time.The Journal of Pain,13(4), 359-369. Reed, M. D., Van Nostran, W. (2014). Assessing pain intensity with the visual analog scale: a plea for uniformity. The Journal of Clinical Pharmacology, 54(3), 241-244. Rodriguez, L. (2015). Pathophysiology of pain: Implications for perioperative nursing.AORN journal,101(3), 338-344. Schreiber, J. A., Cantrell, D., Moe, K. A., Hench, J., McKinney, E., Lewis, C. P., Brockopp, D. (2014). Improving knowledge, assessment, and attitudes related to pain management: Evaluation of an intervention. Pain Management Nursing, 15(2), 474-481. Stang, A. S., Hartling, L., Fera, C., Johnson, D., Ali, S. (2014). Quality indicators for the assessment and management of pain in the emergency department: a systematic review. Pain Research and Management, 19(6), e179-e190. Stankovi?, N., Valerjev, P. (2014).Psychology of pain.InTre?isarajevskidanipsihologije. Tse, M. M. Y., Ho, S. S. (2014). Enhancing knowledge and attitudes in pain management: A pain management education program for nursing home staff.Pain Management Nursing, 15(1), 2-11. Voshall, B., Dunn, K. S., Shelestak, D. (2013).Knowledge and attitudes of pain management among nursing faculty.Pain Management Nursing, 14(4), e226-e235. Wiech, K. (2016). Deconstructing the sensation of pain: The influence of cognitive processes on pain perception. Science, 354(6312), 584-587.