Clinical Pain 🏥🤕
Not all of our pain experiences receive professional treatment 🩺, and not all of them require it. The term clinical pain 🏥 refers to any pain that receives or requires professional treatment. The pain may be either acute ⚡ or chronic ⏳ and may result from known or unknown causes ❓. Clinical pain calls for treatment in and of itself 💊, and not only because it may be a symptom of a progressive disease 📈, such as arthritis 🦴 or cancer 🎗️.
Relieving pain 😌 is important for humanitarian reasons 💝, of course—and doing so also produces medical 🏥 and psychosocial benefits 🧠💪 for the patient. Let's look at medical and psychosocial issues 🔍 that are associated with controlling clinical pain 🎯, beginning with acute pain ⚡.
A. Acute Clinical Pain ⚡🤕
By using techniques to prevent or relieve acute pain ⚡, practitioners 👨⚕️ make medical procedures go more smoothly ✅, reduce patients' stress 😰 and anxiety 😟, and help them recover more quickly ⏱️. Much of the acute pain people experience in today's world 🌍 has little survival value 🤔. What survival value would there be in feeling the pain 🤕 as a dentist drills a tooth 🦷 or a surgeon removes an appendix 🏥? How would people's survival be enhanced by feeling the intense pain 😣 that accompanies normal healing 🩹 while resting in a hospital 🏥 during the days after surgery? But one thing is important ⚠️; i.e., if acute pain is ignored ❌, it can sometimes develop into more severe conditions 📈 or chronic pain ⏳.
B. Chronic Clinical Pain ⏳🤕
When pain persists ⏳ and becomes chronic, patients begin to perceive its nature differently 🔄. Although in the acute phase ⚡ the pain was very aversive 😖, they expected it to end 🔚 and did not see it as a permanent part ♾️ of their lives. As the pain persists ⏳, they tend to become discouraged 😞 and angry 😠 and are likely to seek the opinions of many other physicians 👨⚕️👩⚕️. This can be constructive ✅. But when this is not successful ❌, and as patients come to see less and less connection 🔗 between their discomfort 😣 and any known or treatable disorder 🏥, increasing hopelessness 😔 and despair 😢 may lead them to resort to consulting quacks 🚫👨⚕️.
The transition ➡️ from acute ⚡ to chronic pain ⏳ is a critical time ⏰ when many of these patients develop feelings of helplessness 😞 and psychological disorders 🧠, such as depression 😢, especially if the pain is disabling ♿. These changes typically parallel alterations 🔄 in the patients' lifestyles 🏡, employment status 💼, and family lives 👨👩👧.
Chronic pain ⏳ often creates a broad array of long-term psychosocial problems 🧩 and impaired interrelationships 👥❌, which distinguish its victims from those of acute pain ⚡.
Chronic Pain Syndrome 🔄🤕
Individuals who receive treatment 🏥 for their pain after it has progressed 📈 and become chronic ⏳ tend to exhibit certain physical 🦴 and psychosocial symptoms 🧠 that characterize a chronic pain syndrome. According to psychologist Steven Sanders 👨🔬 (1985), these symptoms include:
- Persistent pain complaints 📢 and other pain behaviors 🧍♂️, such as grimacing 😬 or guarded movement 🛡️, when in discomfort 🤕.
- Disrupted daily activity patterns 📅❌, characterized either by a general reduction 📉 or by recurrent large fluctuations 📊.
- Disrupted social 👥, marital 💑, employment 💼, and recreational activities 🎾.
- Excessive use of drugs 💊📈 or repeated use of surgical procedures 🏥 to relieve pain 🤕.
- Disturbed sleep patterns 😴❌.
- Increased anxiety 😰 and depression 😢.
Chronic pain patients ⏳ usually exhibit the first two symptoms 1️⃣2️⃣ and at least one of the remaining ones. Generally speaking, the more symptoms the patient presents 📊, the greater the impact 💥 the pain has had and the greater the maladjustment 😔 it has produced.
Because of the differences ⚖️ between acute pain ⚡ and chronic pain ⏳ in their duration ⏱️ and the effects they have on their victims 🎯, these conditions usually require different treatment methods 🩺. Health care professionals 👨⚕️ need to distinguish between acute ⚡ and chronic ⏳ pain conditions and provide the most appropriate pain relief techniques 💊 for the patient's needs ✅. Failing to do so ❌ can make the condition worse 📈. Keeping this caution ⚠️ in mind, we will now turn our attention to the many medical 🏥, psychological 🧠, and physical 💪 techniques available to help control patients' pain 🎯.
1. Medical Treatments for Pain 💊🏥
Historically, most of the pain relieving practices adopted by the medical professionals was brutal 😱 especially if they involved some form of surgery 🔪. In 19th-century America 🇺🇸, alcoholic beverages 🍺 and medicines laced with opium 💊 were readily available. Today when patients suffer from pain 🤕, physicians 👨⚕️ and doctors 👩⚕️ try to reduce the discomfort 😣 in two ways 2️⃣— surgically 🔪 and chemically 💊.
A. Surgical Methods for Treating Pain 🔪🏥
Treating chronic pain ⏳ with surgical methods 🔪 is a relatively radical approach 😨, and some surgical procedures are more useful ✅ than others ❌. In some procedures, the surgery removes or disconnects portions of the peripheral nervous system 🧠 or the spinal cord 🦴, thereby preventing pain signals 🚫⚡ from reaching the brain 🧠. These are extreme procedures 😱—and if they are successful ✅, they produce numbness 😶 and, sometimes, paralysis ♿ in the region of the body 🧍♂️ served by the affected nerves 🧠.
But these procedures seldom provide long-term relief ⏳❌ from the pain 🤕, which is often replaced after some days or months ⏰ by pain and other sensations that are worse 📈 than the original condition 😖. Because of the poor prospects 📉 of permanent relief and the risks involved ⚠️ in these surgical procedures 🔪, they are rarely used today 📅.
Other surgical procedures 🔪 for relieving pain do not remove or disconnect nerve fibers 🧠 and are much more successful ✅. One example is the Synovectomy, a technique whereby a surgeon 👨⚕️ removes membranes that become inflamed 🔴 in arthritic joints 🦴. Surgery procedures 🔪 are commonly used in the United States 🇺🇸 to treat back pain 🦴, but there is little evidence 📊❌ that they produce better long-term pain reduction 📉 than non-surgical methods 💊, and they are used at a far lower rate 📉 in other developed countries 🌍, such as Denmark 🇩🇰 and England 🏴.
Surgery 🔪 for chronic skeletal pain conditions ⏳🦴 is most appropriate ✅ when the person is severely disabled ♿ and non-surgical treatment methods 💊 have failed ❌. Physicians 👨⚕️ and patients 🤕 usually prefer other medical approaches 🩺, such as chemical methods 💊.
B. Chemical Methods for Treating Pain 💊🧪
The field of medicine 🏥 has been much more concerned with developing methods for curing disease 🦠 than with reducing pain 🤕. Let's look at the use of chemical methods 💊 for treating acute ⚡ and chronic pain ⏳.
Using Chemicals for Acute Pain ⚡💊
Many pharmaceuticals 💊 are very effective ✅ for relieving acute pain ⚡, such as after surgery 🏥. Physicians 👨⚕️ choose the specific drug 💊 and dosage 📏 by considering many factors 📋, such as how intense the pain is 📊 and its location 📍 and cause 🔍.
Using Chemicals for Chronic Pain ⏳💊
When a patient is dying 💀, practitioners 👨⚕️ generally view options for pain relief 🤕 differently from those when a person has chronic pain ⏳ from a non-terminal illness 🏥. Many health care practitioners 👩⚕️ have long advocated using narcotics 💊 for the relief of severe pain 😣 in cancer patients 🎗️, and narcotic analgesics 💊 are commonly prescribed when these patients are dying 💀. In some cases of cancer 🎗️, severe pain 😖 becomes chronic ⏳ as the disease progresses 📈.
To summarize 📝, medical treatments of pain 🤕 focus mainly on using chemical approaches 💊 to reduce discomfort 😌. For chronic pain patients ⏳, these approaches can be enhanced ✨ when combined with pain control methods 🎯 that other health care professions 👨⚕️ provide. Physicians 👩⚕️ usually want to minimize the use of medication 💊📉 by their patients, especially when drugs would be taken on a long-term basis ⏳. Reducing the patient's drug consumption 📉 is one of the goals 🎯 in using other methods of pain control 🩺 with pain patients 🤕.
2. Psychological Methods for Treating Pain 🧠💭
In today's world 🌍, plentiful research evidence 📊 suggests that pain 🤕 can be controlled not only by biochemical methods 💊 that alter sensory input directly 🧬, but by modifying motivational 🎯 and cognitive processes 🧠, too. This more complex view 🔍 of pain provided the rationale 💡 for psychologists 👨🔬 to develop techniques to help patients (1) cope more effectively 💪 with the pain 🤕 and other stressors 😰 they experience and (2) reduce their reliance 📉 on drugs 💊 for pain control 🎯.
Psychologists 👨🔬 have developed approaches involving behavioral 🧍♂️ and cognitive methods 🧠, and we will examine some of these approaches here.
1. Behavioral Methods 🧍♂️🔄
The first approach focuses on changing patients' pain behavior 🔄 through techniques of operant conditioning 🔔.
A. The Operant Approach 🔔🎯
Consider the case of a 3-year-old girl 👧 whose pain behaviors 🤕 hampered her rehabilitation 🏥 after she suffered severe burns 🔥 months earlier ⏰. The help therapists provided was successful ✅. The approach the therapists 👨⚕️ used in changing this girl's behavior 🔄 involved extinction procedures 🚫 for her pain behavior 🤕 and reinforcement 🎁 for appropriate, or well, behavior ✅.
Observations 👀 of the child's social environment 🏡 revealed that the hospital staff 👨⚕️ reinforced her pain behaviors 🤕—crying 😭, complaining of pain 😣, resisting the nurse's efforts 🙅♀️ to put her splints on, and so forth—by giving attention 👀 to those behaviors and allowing her to avoid uncomfortable ❌ or disliked activities, such as physical therapy 💪. To change this situation 🔄, the therapists 👨⚕️ instructed the hospital staff 🏥 to:
- Ignore 🙈 the pain behaviors 🤕 they paid attention to 👀 in the past ⏮️.
- Provide rewards 🎁 for obedient behavior ✅—telling her, for instance, "If you don't cry 😭 while I put your splints on, you can have some cookies 🍪 when I'm finished, or, if you do this exercise 🏃♀️, we can play a game 🎮."
Changing the consequences 🔄 of her behavior in these ways had a dramatic effect 💥: her pain behaviors 🤕 decreased sharply 📉, and she began to comply ✅ with requests to do exercises 💪, make positive comments 😊 about her accomplishments 🎯, and assist in putting on her splints 🩹.
The operant approach 🔔 to treating pain 🤕 can be adapted for use with individuals of all ages 👶👴, in hospitals 🏥 and at home 🏡—and elements of the operant approach 🔔 can be introduced before pain behavior 🤕 becomes chronic ⏳. But treatment programs 🩺 using this approach are usually applied with patients whose chronic pain ⏳ has already produced serious difficulties 😔 in their lives 🌍. These programs typically have two main goals 🎯:
The first goal 1️⃣ is to reduce the patient's reliance 📉 on medication 💊. The second goal 2️⃣ of the operant approach 🔔 is to reduce the disability ♿ that generally accompanies chronic pain conditions ⏳.
The reinforcers 🎁 may be of any kind 🎨— attention 👀, praise 👏 and smiles 😊, candy 🍬, money 💵, or the opportunity to watch TV 📺, for example—and may be formalized within a behavioral contract 📝. The therapist 👨⚕️ periodically reviews 🔍 the record 📋 of pain behavior 🤕 to determine whether changes 🔄 in the program are needed ⚙️. Studies 📊 have shown that operant techniques 🔔 can successfully decrease 📉 patients' pain reports 📝 and medication use 💊 and increase 📈 their activity levels 💪.
B. Relaxation and Biofeedback 🧘♂️📊
Many people experience chronic episodes ⏳ of pain 🤕 that result from underlying physiological processes 🧬, and these processes are often triggered by stress 😰. If these patients could control 🎮 their stress 😰 or the physiological processes 🧬 that cause pain 🤕, they should be able to decrease 📉 the frequency 🔄 or intensity 📊 of discomfort 😣 they experience. Thus relaxation 🧘♂️ and biofeedback methods 📊 are effective ✅ in treating and reducing pain 🤕.
2. Cognitive Methods 🧠💭
To help people cope effectively 💪 with pain 🤕, medical 🏥 and psychological practitioners 👨🔬 need to assess and address their patients' beliefs 💭. Cognitive techniques 🧠 for treating pain involve active coping strategies 🎯, and many of these methods are, in fact, quite effective ✅ in helping people cope with pain 🤕. These techniques can be classified into three basic types 3️⃣: distraction 👀, imagery 🖼️, and redefinition 🔄. We will examine these methods and consider their usefulness for people with acute ⚡ and chronic pain ⏳.
A. Distraction 👀🎯
Distraction 👀 is the technique of focusing on a non-painful stimulus 🎨 in the immediate environment 🌍 to divert one's attention 🧠 from discomfort 🤕. We can be distracted from pain 🤕 in many ways 🎨, such as by looking at a picture 🖼️, listening to someone's voice 🗣️, singing a song 🎵, counting ceiling tiles 🔢, playing a video game 🎮, or doing mathematics problems ➕➖.
Distraction strategies 👀 are useful ✅ for reducing acute pain ⚡, such as that experienced in some medical 🏥 or dental 🦷 procedures, and they can also provide relief 😌 for chronic pain patients ⏳ in some circumstances 🔍. Singing a song 🎵 or staring intently 👁️ at a stimulus 🎨 can divert the person's attention 🧠 for a short while ⏱️—and this may be a great help 🙌, such as for an arthritis sufferer 🦴 who experiences heightened pain 📈 when climbing stairs 🪜. People who want to use distraction 👀 for moderate levels 📊 of continuous pain ⏳ may get longer-lasting relief 😌 by engaging in an extended engrossing activity 📚, such as watching a movie 🎬 or reading a book 📖.
B. Imagery 🖼️💭
Sometimes when children 👶 are about to receive injections 💉, their parents 👨👩👧 will say something like, "it'll be easier if you think about something nice 😊, like the fun things 🎉 we did at the park 🏞️." Non-pain imagery 🖼️—sometimes called guided imagery 🧭—is a strategy whereby the person tries to alleviate discomfort 😌 by conjuring up a mental scene 🧠 that is unrelated to or incompatible with the pain 🤕. The most common type of imagery 🖼️ people use involves scenes that are pleasant 😊 to them—they think of "something nice 🌈." This scene might involve being at the beach 🏖️ or in the country 🌾, for instance.
Therapists 👨⚕️ usually encourage 💪, or "guide 🧭," the person to include aspects of different senses 👁️👂👃: vision 👀, hearing 👂, taste 👅, smell 👃, and touch ✋. As an example, the scene at the beach 🏖️ could include the sight 👀 and smell 👃 of the ocean water 🌊, the sound 👂 of the waves 🌊, and the warm ☀️, grainy feel of the sand 🏖️. The person generally tries to keep the imagined event 💭 in mind as long as possible ⏳.
The imagery technique 🖼️ is in many ways like distraction 👀. The main difference ⚖️ is that imagery 🖼️ is based on the person's imagination 🧠 rather than on real objects 🎨 or events in the environment 🌍. As a result, individuals who use imagery 🖼️ do not have to depend 🔗 on the environment 🌍 to provide a suitably distracting stimulus 🎨. They can develop one or more scenes 🖼️ that work reliably ✅, which they "carry" around 🎒 in their heads 🧠.
Although imagery 🖼️ clearly helps ✅ in reducing acute pain ⚡, the extent of this technique's usefulness ❓ with longer-lasting pain episodes ⏳ is unclear 🤔. One limitation ❌ with using imagery 🖼️ in pain control 🎯 is that some individuals are less adept 📉 in imagining scenes 🖼️ than others 📈.
C. Redefinition 🔄💭
The third type 3️⃣ of cognitive strategy 🧠 for reducing discomfort 😌 is pain redefinition 🔄, in which the person substitutes constructive ✅ or realistic 💯 thoughts 💭 about the pain experience 🤕 for ones that arouse feelings of threat ⚠️ or harm 😨. Therapists 👨⚕️ can help people redefine 🔄 their pain experiences 🤕 in several ways. One approach involves teaching clients 👨🎓 to engage in an internal dialogue 💬, using positive self-statements ✅. There are basically two kinds 2️⃣ of self-statements for controlling pain 🤕:
- A. Coping statements 💪 emphasize the person's ability 🎯 to tolerate the discomfort 🤕, as when people say to themselves 💭, "It hurts 🤕, but you're in control 🎮," or, "Be brave 🦁— you can take it 💪."
- B. Re-interpretative statements 🔄 are designed to negate ❌ the unpleasant aspects 😣 of the discomfort 🤕, as when people think 💭, "it's not so bad 😐," "It's not the worst thing 📉 that could happen," or, "It hurts 🤕, but think of the benefits 🎁 of this experience 🌟." This last statement can be particularly appropriate ✅ when undergoing painful medical procedures 🏥.
Summary 📋
Dealing with pain 🤕 requires a multifaceted approach 🎯 that combines medical 💊, surgical 🔪, and psychological methods 🧠. Understanding the difference between acute ⚡ and chronic pain ⏳ is crucial for effective treatment 🩺. While medical interventions 🏥 provide essential relief, psychological techniques 🧠—including behavioral approaches 🔄 like the operant method 🔔 and relaxation 🧘♂️, as well as cognitive strategies 💭 like distraction 👀, imagery 🖼️, and redefinition 🔄—offer valuable tools 🛠️ for managing pain and improving quality of life 🌟.