Medical Today

Definition

If pain can be defined as a highly unpleasant, individualized experience of one of the body’s defense mechanisms indicating an injury or problem, pain management encompasses all interventions used to understand and ease pain, and, if possible, to alleviate the cause of the pain.

Purpose

Pain serves to alert a person to potential or actual damage to the body. The definition for damage is quite broad: pain can arise from injury as well as disease. After the message is received and interpreted, further pain can be counterproductive. Pain can have a negative impact on a person’s quality of life and impede recovery from illness or injury, thus contributing to escalating health care costs. Unrelieved pain can become a syndrome in its own right and cause a downward spiral in a person’s health and outlook. Managing pain properly facilitates recovery, prevents additional health complications, and improves an individual’s quality of life.

Yet, the experiencing of pain is a completely unique occurrence for each person, a complex combination of several factors other than the pain itself. It is influenced by:

• Ethnic and cultural values. In some cultures, tolerating pain is related to showing strength and endurance. In others, it is considered punishment for misdeeds.

• Age. This refers to the concept that grownups never cry.

• Anxiety and stress. This is related to being in a strange, fearful place such as a hospital, and the fear of the unknown consequences of the pain and the condition causing it, which can all combined to make pain feel more severe. For patients being treated for pain, knowing the duration of activity of an analgesic leads to anxiety about the return of pain when the drug wears off. This anxiety can make the pain more severe.

• Fatigue and depression. It is known that pain in itself can actually cause depression. Fatigue from lack of sleep or the illness itself also contribute to depressed feelings.

Precautions

The perception of pain is an individual experience.

Health care providers play an important role in understanding their patients’ pain. All too often, both physicians and nurses have been found to incorrectly assess the severity of pain. A study reported in the Journal of Advanced Nursing evaluated nurses’ perceptions of a select group of white American and Mexican-American women patients’ pain following gallbladder surgery. Objective assessments of each patient’s pain showed little difference between the perceived severities for each group. Yet, the nurses involved in the study consistently rated all patients’ pain as less than the patients reported, and with equal consistency, believed that better educated women born in the United States were suffering more than less educated Mexican-American women. Nurses from a northern European background were more apt to minimize the severity of pain than nurses from eastern and southern Europe or Africa. The study indicated how health care staff, and especially nursing staff, need to be aware of how their own background and experience contributes to how they perceive a person’s pain.

In a 1990 study reported in the journal Pain, nurses were found to overestimate the severity of pain in patients with severe burns. In most other studies, nurses and physicians ascribe a lower pain severity than do patients.