Relief theory[ edit ] Relief theory maintains that laughter is a homeostatic mechanism by which psychological tension is reduced.
Furthermore, evidence suggests that pain is one of the main reasons for primary care consultations, illustrating the need for effective pain management strategies. Here, it is important to reiterate that the perception of pain is quite subjective, and is not always connected to a pathology, further complicating the identification of treatment for the underlying cause.
Nevertheless, pain management can involve surgical, pharmacological and non-pharmacological procedures, depending on the identification of the underlying factors, as well as the multisystemic nature of pain.
Despite the evidence suggesting the importance of pain management in healthcare delivery, there is a dearth of literature analysing and synthesising studies and evidence of interprofessional pain management in palliative care, and the role of the various professionals involved in such a process.
As such, anchored on a review of peer-reviewed and relevant literature, the current paper provides a critical analysis of the process of the management of chronic somatic pain, with the objective of informing evidence-based practice.
Pathophysiology and Theories of Pain An analysis of the management of pain must be anchored on an understanding of the pathophysiology and the various theories underpinning pain management.
As such, any unpleasant stimulus applied to the surface of the skin causes a sensation of pain. However, as scholars and practitioners would come to realise much later, observed facts relating to pain could not be explained using such a simplistic theory.
In other words, since the same kind of injury can trigger varying quality and intensity of pain in different individuals or even in the same person at varying instances, depending on their past experiences, the context they view themselves to be in, and the previous state of their bodies, pain cannot be attributed to some particular stimulus in a predictable way.
An alternative theory that solves the specificity theory problems is the gate theory, which was aimed at explaining the inconsistency in the connection between nociceptive stimuli and pain perception. The main proposition of the gate theory is that there is a gate-like system that controls all information relating to pain on its way to the brain.
As illustrated in figure 1, the gate is seen as a neural system, which functions as a regulating or modulating mechanism that governs the range of nerve-impulse transmission from the fringe to the spinal cord transmission cells. In sum, the gate theory succeeds in explaining the great variability that exists in the connection between stimuli and pain experience.
Illustrating the gate theory mechanism. Adapted from Moayedi and Davis Of these theories, the gate theory is best suited for understanding somatic pain in urologic cancer patients.
As indicated by Buga and Sarriasomatic pain in cancer patients is often caused metastatic bone disease or tissue inflammation. In this respect, bone pain is hypothesised to be caused by either a release of inflammatory mediators, direct stimulation of nociceptors in the periosteum, or an elevation in interosseal pressure.
Such variability in the possible causes of the pain are often reflected in the variability in the way patients describe their pain symptoms, though this type of pain is often described as sharp in nature and well localised.
Pain Management In urologic cancer patients, somatic pain is often characterised by impairment in quality of life as well as overall distress, which may be influenced by any of various losses. While the pain may contribute immensely to such suffering, there are numerous other factors such as progressive physical impairment, experiencing other symptoms, and psychological disturbances.
As indicated by Lovell et al. This view is supported by Mercadante et al. Pharmacologic Therapy One line of treatment in somatic pain is the use of pharmacologic therapies. Evidence show that while somatic pain may be responsive to opioids, using an added three-step therapy approach has established benefits Ripamonti et al.
The mainstay of pharmacologic therapy for somatic pain in cancer patients is Nonsteroidal anti-inflammatory drugs NSAIDswhich function by inhibiting cyclooxygenase.
Cyclooxygenase is responsible for catalysing the conversion of arachidonic acid to leukotrienes and prostaglandins Lovell et al. However, while much of the evidence points to the effectiveness of NSAIDs in relieving pain related to bone metastasis Mercadante et al.
Furthermore, there a review of the available literature did not discover any conclusive evidence to suggest the use prioritisation of any one NSAID as more effective than the others. Nevertheless, the use of nonacetylated salicylates like choline magnesium trisalicylate has been recommended as they tend to have fewer negative gastrointestinal side-effects and fewer negative effects on platelet aggregation compared to aspirin.
Other favoured treatments include rofecoxib and celecoxib, which function as COX-2 inhibitors, and are preferred due to their fewer side effects Elder et al.
In the event that one type of NSAID is not effective in alleviating of pain symptoms due to metastasis, transitioning to another type of NSAIDs may be beneficial before considering the termination of therapy.
As shown by Mercadante et al. Evidence also shows that corticosteroids can be employed as adjuvant therapy, especially if the patient has known hypersensitivity to NSAIDs.
However, corticosteroids are not without their side effects as they have been associated with some incidences of diabetes, and gastrointestinal bleeding.
Generally, radiation therapy is advocated for in all patients presenting with bone metastasis, though for frail and homebound patients in end-of-life care, such therapy is only recommended after other treatment modalities have proven to be ineffective. Nonpharmacologic Approaches While the pharmacologic therapies have been the mainstay of somatic pain management in palliative care, the biopsychosocial approach to pain management recognises the need to address the various social and psychological aspects of pain, which necessitate the involvement of other specialists in an interprofessional approach to care.
In other words, while the pharmacologic therapies treat somatic physiological and emotional aspects of the pain, non-pharmacologic approaches aim to address the behavioural, cognitive, affective, and socio-cultural aspects of the pain.
As noted by Williams, Eccleston and Morleysuch therapies can be used as complimentary or adjuvant treatments for moderate or severe pain.(August and Educator; Born An analysis of dreams in rudolfo anayas bless me ultima August analysing theories relating to experience of pain a mother (a working an analysis of song john brown by bob dylans mother).
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srmvision.com- By reducing the pain, the client will then be able to get involved in developing his abilities and care for himself. 2. Developmental self care requisites- The client would have to adjust to the changes of the body due to his condition/5(12). The evidence questioned the standard treatment of withholding analgesia and the theories that babies cannot experience pain.
The four hourly hospital drug round expresses positivist beliefs that clinical norms and standard treatments can be set for effective pain control. Leadership theories seek to answer this question and usually fit into one of eight basic types.
Some more recent theories propose that possessing certain traits may help make people nature leaders, but that experience and situational variables also play a critical role. Sep 18, · Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.