Project #82679 - response to discussion question

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Acute, Chronic, and Referred Pain

Acute pain is defined by the length of time the pain can last.  According to Huether and McCance (2012), acute pain can last anywhere from seconds to 3 months.  It is relieved when the chemical mediators that stimulate the pain receptors are removed (Huether & McCance, 2012).  Physical manifestations of acute pain include increased heart rate, HTN, diaphoresis, anxiety, and dilated pupils (Huether & McCance, 2012).  Acute pain is further classified by location.  Somatic pain is superficial, usually from the integumentary system, as a cut to the skin (Huether & McCance, 2012).  Visceral pain refers to pain from internal organs and the lining of body cavities (Huether & McCance, 2012). 

Visceral pain can often radiate to other areas or is referred (Huether & McCance, 2012).  Huether and McCance (2012) suggest that referred pain is pain felt an area away from the point of origin.  This could be because many cutaneous and visceral neurons converge on the same ascending neuron resulting with the brain unable to distinguish the different sources (Huether & McCance, 2012).  An example of referred pain that I see almost daily is shoulder pain after a laparoscopic cholecystectomy.  Typically a lap chole requires four lap sites, but sometimes can be done with only one site.  Patients often complain of cramping in their abdomen, but also of referred pain the in the shoulder.   Research suggests some of the reasons for this referred shoulder pain are effects of carbon dioxide and/or residual left in the abdominal cavity and also peritoneal and diaphragmatic stretching or injury (Donatsky, Bjerrum, & Gögenur, 2013).

Chronic pain is described as pain lasting longer than 3 to 6 months or pain lasting longer than the recovery of injured tissue time (Huether & McCance, 2012).  The physiologic response to acute and chronic pain are similar, but with chronic pain the body allows for adaptation such as a normal heart rate and blood pressure (Huether & McCance, 2012).

Age and Ethnicity

Children are typically unable to communicate as effectively as an adult.  When a child is in pain, depending on their developmental level, being able to describe adequately, the pain can be difficult or nonexistent such as in an infant.  Unlike an adult, the child may not understand the pain scale, adjectives used to describe the pain or identify the area impacted.  Special tools to help measure pain and cues from parents show to be successful at identifying and selecting treatment for children (National Institute of Neurological Disorders and Stroke, 2014).  Geriatrics often have a higher pain tolerance due to neuropathies and changes in skin thickness (Huether & McCance, 2012).  Acetaminophen is typically the treatment of choice for mild to moderate pain in both children and geriatrics (National Institute of Neurological Disorders and Stroke, 2014).  Acetaminophen is not known for its bleeding risk as is common with NSAIDs.

Ethnicity or cultural backgrounds can influence the way pain is perceived and therefore treated.  While there are some generalities amongst certain groups, it is best to assess every patient thoroughly regarding what is acceptable, how they deal with their pain, what helps and what doesn’t help, and understand the differences in stoicism and expressivity.  Some patients may feel they are not good patients if they complain of pain based on their background while others may feel it is appropriate to groan and yell (Narayan, 2010).  Tools for reporting pain should also include ethnic considerations.  For instance, reading in Chinese is done vertical, not horizontal in English, therefore the interpreted pain scale should meet such needs (Narayan, 2010).  A better assessment of pain from the patient allows for optimal treatment.

References

Donatsky, A., Bjerrum, F., & Gögenur, I. (2013). Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy. A systematic review. Surgical Endoscopy, 27(7), 2275-2282. doi:10.1007/s00464-012-2759-5

Huether, S., & McCance, K. (2012). Understanding Pathophysiology (Laureate Custom ed.). St. Louis, MO: Mosby.

Narayan, M. (2010). Culture's Effects on Pain Assessment and Management. American Journal of Nursing, 110(4), 38-47.

National Institute of Neurological Disorders and Stroke. (2014). Pain: Hope Through Research. Retrieved from http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm

 

 

 

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