8.1 Section Title
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Critical Thinking Exercise
Pain Management
After reading Chapter 8, you should be aware that pain is multifaceted and includes not only a physical sensation, but also emotional, social, and behavioral components, the last three of which may relate to how well one copes with pain. For instance, the pain from a severe injury that occurred during the winning goal in a soccer game would be interpreted differently than pain from an injury that resulted in the loss of a game.
Pain is all-encompassing and can be debilitating. As noted in the chapter, more than 11% of American adults (25.3 million people) have experienced some pain every day for the last 3 months, and for 18% of them the pain is severe (National Institutes of Health, 2015). Nearly 100 million adults in the United States have severe or chronic pain (Gaskin & Richard, 2012). There are many different types of pain and it is important to understand not only the significance of each type, but how they are differentiated. Apply what you have learned about pain to answer the following questions.
Question
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People with CIPA, a rare genetic disorder, lack any pain perception. The nervous system prevents the sensation of pain, heat, cold, or any real sensation transmitted by nerve fibers. People with this condition do not feel pain, they do not perspire, and they may not be able to feel when they need to urinate. This disorder reminds us that pain is helpful because it acts as a biological alarm for danger. Pain alerts the body that something is wrong, and it begins the process of repair and restoration. People who don’t feel pain are constantly at risk for injuring themselves.
Question
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Acute pain is usually sharp and lasts for a relatively short period of time in the health process. It can last from a couple of seconds to months. A person who fractures a bone or suffers a burn will probably feel acute pain. Chronic pain, on the other hand, involves intermittent periods of pain and discomfort that last more than six months. Migraines, back pain, and joint pain, among others, are examples of chronic pain.
Typically, individuals can cope with the loss of activity related to acute pain, because emotionally they know it is only for a short period of time and that they can rejoin their normal social interactions as soon as the healing process is over. However, chronic pain can be unpredictable and can result in long periods of social loss and feelings of hopelessness. Patients with chronic pain are four times more likely to suffer from anxiety and depression than their counterparts with acute pain.
Question
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Stress can exacerbate and worsen pain and thereby limit the efficacy of some pain management strategies. Feelings of stress can result in hypersensitivity in one’s body, which then interprets the pain as more intense or longer-lasting. It is one of a number of emotional factors that may open the “gate mechanism” in the dorsal horns of the spinal column. It is recommended to lead a calm and less stressful life, as much as possible, to help control issues of chronic pain.
Question
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The gate control theory of pain suggests that there is a gate that helps the body understand pain. The spinal cord and the brainstem control the opening and closing of the gate. A person can only experience pain if the spinal cord and brainstem open the gate. Once the gate is opened, the sensory information, like what the person is seeing, hearing, and feeling, rushes through to the brain. Once all of that information makes it to the brain, the person perceives or recognizes pain.
Question
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Exercise helps manage pain in multiple ways. It removes cytokines, produces endogenous opioids, and increases levels of serotonin, dopamine, and noradrenalin. The removal of the cytokines reduces inflammation, which in turn reduces pain. Endogenous opioids, the body’s natural analgesic, numb the pain. The increased levels of serotonin, dopamine, and noradrenalin will elevate mood and reduce anxiety or depression.