Category: Chronic Pain

Discuss the relevance of psychological interventions in pain management.

In this essay, I am hoping to discuss the relevance of psychological interventions in pain management and how these interventions work and help in the management and treatment of chronic pain if they do at all. I will investigate the various types of psychological interventions and how they contribute to a patient’s physical and mental well-being and also if this psychological intervention can being used alongside healthcare and manual therapy. Chronic pain according to (Breivik, Collett, Ventafridda, Cohen & Gallacher, 2006) has been estimated in nineteen percent of adults in Europe, with reports of it affecting their daily activities as well as social life. One of the main causes of disabilities worldwide has shown to be chronic pain with conditions ranging from lower back pain to osteoarthritis (Vos et al., n.d.). Lower back pain is said to affect somewhere around one-third of the adults in the United Kingdom annually, with less than a quarter consulting a medical professional (Macfarlane, Jones & Hannaford, 2006). After the first incidence of Lower back pain, 62% are still suffering with pain and sixteen percent of these are unable to continue to work (Lise Hestbaek, 2019). Within the United Kingdom alone, just under nine million people suffer with osteoarthritis and seek treatment for this limiting disease. Although there is no cure for osteoarthritis, many people still seek treatment for help managing and making sure the symptomology do not worsen (‘Osteoarthritis’, 2019).

Pain is defined as “a highly unpleasant physical sensation caused by illness or injury” (‘the definition of pain’, 2019). As there are different ways of describing and feeling pain, the experience of pain varies with each person. Pain is usually short-term; however, for many people, the pain remains over a period of time and is then considered to be chronic (Otis, 2008). Chronic pain is defined as pain that lasts longer than twelve weeks despite medication or treatment (‘Chronic pain’, 2019). There are several types of chronic pain nociceptive, somatic, visceral, neuropathic, psychogenic, and idiopathic. All these types of chronic pain can cause a range of conditions from headaches to fibromyalgia (‘How We Experience Different Types of Chronic Pain’, 2019). (‘The silent epidemic – chronic pain in the UK | News | British Pain Society’, 2019) says that around twenty-eight million people within the United Kingdom suffer with pain that lasts over three months. They also say that fourteen percent live with chronic pain that is severely disabling (‘The silent epidemic – chronic pain in the UK | News | British Pain Society’, 2019). Patients who suffer with chronic pain are at an increased risk of further developing complications, including physical dysfunctions and altered mental states (Fine, 2011). When a patient suffers with chronic pain every aspect of their life is affected, including employment, relationships with others, and the ability to complete daily activities. Individuals who suffer with chronic pain tend to experience physiological and emotional consequences. The individuals tend to have a fear of being judged negatively and have a raised level of guilt and shame compared with a person perceived to be healthy (Turner-Cobb, Michalaki & Osborn, 2015). These physiological effects can spiral further and ultimately lead to further negative feelings, resulting in depression and anxiety. As chronic pain can further develop into a primarily biopsychosocial problem, treatment may diversify to include psychological interventions (Roditi & Roditi, 2011).

Due to the complexity of chronic pain and only the partial resolution of chronic pain by medical interventions, psychological interventions can be introduced to manage pain. Psychological interventions involve a conversation about your feelings in order to improve your thoughts and hopefully bring about a change in feelings and behavior. These interventions are said to work for a range of, behavioral, emotional, and mental problems and are effective in the treatment of people from all ages, races, genders, and cultures. Psychological treatments can treat a wide variety of conditions from depression, anxiety to stress and chronic pain (‘Psychological treatments’, 2019). Instead of solely focusing on fixing the pain, psychological interventions can be used to aid the emotional and psychological aspects of pain. These interventions are known as “operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy and acceptance, and commitment therapy” (Sturgeon, 2014). (Gatchel, Peng, Peters, Fuchs & Turk, 2007) states how Biopsychosocial factors like stress can affect a patient’s perception of pain and response to treatment. Hence the need for psychological interventions alongside medical interventions, in the treatment of chronic conditions, enables patients to live a functional and able life.

Skinner (1938), Operant conditioning uses rewards and punishments for behavior as a method of learning. Skinner proposed, “Behaviour which is reinforced tends to be repeated (i.e., strengthened); behavior which is not reinforced tends to die out or be extinguished (i.e., weakened)”. He identified three different types of responses that follow any behavior, a neutral operant; which neither decrease nor increase the tendency of behavior being repeated, reinforcers; which increase the tendency of behavior being repeated (can be positive or negative) and punishers; which decrease the tendency of behavior being repeated. From the basis of operant conditioning a theory named ‘behavior modification’ developed, which is mainly based on changing environmental events in relation to an individual’s behavior (Mcleod, 2019). Behavior modification is the basic of CBT.

Cognitive behavioral therapy or CBT is said to be a type of psychotherapeutic treatment, which allows the patient to gain an understanding in to the beliefs and feelings that are responsible for behaviors. A vast range of conditions can be treated using CBT, from anxieties, depression, phobias (agoraphobia and social phobias) as well as addictions. The effects of CBT are relatively short-term, but it helps patients deal with a problem unique to themselves (‘Cognitive Behavior Therapy and How It Works, 2019). Similar to this (‘Cognitive behavioral therapy (CBT)’, 2019) says that there is an interconnection between your feelings, physical sensations, thoughts, and actions and that negative feelings and thoughts can engulf you in a vicious cycle. By breaking down a problem into smaller parts, CBT can help a person deal with the problem in a more positive way. There are many advantages of using CBT therapy; it helps aid mental health disorders, where medication itself has not being successful. Compared to other talking therapies, CBT can also be completed in a shorter time frame. Also, skills learnt throughout the treatment can be integrated in everyday life to help with any other stresses. Although CBT is efficient in helping some conditions, it may not be the correct type of treatment for everyone. Unless a patient commits to the CBT treatment, the problems will not go away, regardless of the therapist’s advice and help. As well as commitment, patients with a more complex condition may not find the treatment useful, due to its structured nature. Another disadvantage of the intervention is that the confrontation of emotions and feelings can initially lead to an increase in anxieties and negative emotions (‘Pros & Cons of CBT Therapy | The CBT Therapy Clinic – Nottingham – West Bridgford’, 2019).

Acceptance and behavior therapy (ACT) is an “action-oriented approach to psychotherapy that stems from traditional behavior therapy and cognitive behavioral therapy”. ACT differs from CBT as instead of struggling, denying, and avoiding negative emotions, patients learn to accept their feelings (‘Acceptance and Commitment Therapy | Psychology Today, 2019). (‘How Does Acceptance And Commitment Therapy (ACT) Work?’, 2019) says there are six core mechanisms involved in ACT therapy that all contribute to a patient well being. Acceptance is the first method, although it is not an end goal, it is a way of promoting actions that will achieve positive results. ACT teaches patients to accept the existence of unpleasant feelings instead of avoiding them. The next core principle is cognitive defusion, which helps a patient react to negative experiences and come through the experience positively. Being present and self as context are the next two principles, but the most important principles are values and commitment to action, which work hand in hand. People abide by their own values, which influence their steps. In ACT patients are helped to commit to actions in order to pursue long-term goals in accordance with these values, without awareness of the affects of behavior a positive change can not be made. Similarly to this (Overview, Program & Motion, 2019) explains how ACT can help sufferers of chronic pain. Sufferers of chronic pain stop taking part in activities and hobbies they used to enjoy, as they associate these with pain, this is known as experiential avoidance. ACT helps enable patients to increase activity levels and enjoyment of life without the complete elimination of pain. Despite persistent pain, ACT hopes to help patients live life and enjoy, regardless of their pain. Practitioners of ACT doesn’t challenge a patient’s perspective about pain, but in turn teaches them to embrace and stop focusing on the pain, as negative experiences are a part of life.

From this essay, we can see that using psychological interventions in the treatment of chronic pain is an essential tool. These interventions vary widely in their techniques from breaking down problems to accepting them, but all of these interventions have the same goal in promoting a positive attitude and increasing patients’ mental state toward chronic pain. Psychological interventions and osteopathy can be used directly alongside one another in the management of a patient’s pain. We have seen how chronic pain can cause many biopsychosocial problems, but with the implementation of psychological interventions, we can nullify these before they lead to further negative thoughts. By breaking this cycle using psychological interventions as well as using manual therapy we can greatly improve not only a patient’s physical state but also mental state. As we know how complex pain is, the use of just manual therapy alone will not benefit all patients in their battle with chronic pain, therefore using a physiological intervention alongside it and teaching them to accept their pain can help a patient to live life and enjoy, regardless of their pain. As osteopaths are highly involved in the treatment of a wide range of chronic pain conditions, the implementation of these psychological interventions can be incorporated into treatment to lower negative feelings towards certain treatments like manipulation, which will benefit a patient greatly. As we further investigate the interconnection between a patient’s feelings, physical sensations, thoughts, and actions we can see the use of these intervention will be even more vital in attitudes toward chronic pain. Techniques used in physiological interventions can also help us deal with the stresses of daily life, not only in pain management. With this being said I feel that the need for psychological interventions in the management of pain, as well as chronic pain, is fundamental. The use of these interventions alongside manual therapy will not only

Improve a patient’s physical well-being dramatically but will improve their outlook and attitudes toward chronic pain, leading to a massive increase in a patient’s quality of life.

Bibliography

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Medicalization is the process in which a non-medical problem becomes defined and treated as a medical problem (Conrad, 1992). There are copious amounts of evidence suggesting that medicalization has increased and changed over the past couple decades with the emergence of new diagnoses, one being chronic pain (Møller & Gormsen, 2010). Chronic pain is defined as pain that persists for longer than three months and extends its expected healing process (Ling, 2017). When referring to the medicalization of chronic pain, it is the pain itself that is deemed a medical problem, not just a symptom, sign, or by-product of another diagnosis (Møller & Gormsen, 2010). As a result of recognizing chronic pain as a discrete medical condition, the focus has shifted from eliminating pain to managing it (Møller & Gormsen, 2010). One avenue for managing chronic pain that has gained popularity is the use of prescription opioids. Opioids are a class of medications that are known to help alleviate severe and/or chronic pain (Vowles et al., 2015). Today, opioid analgesics are widely being used to ease chronic pain in patients, however, heavy concerns have been raised in recent years regarding the addiction, abuse, and misuse of prescription opioids, particularly due to the opioid epidemic evident across the world (Vowles et al., 2015; see Figure 1). In the treatment of chronic pain, there may be no area of greater controversy than the use of opioids (Vowles et al., 2015).

Although there is much debate and conversation about the dangers of the illicit use of opioids, there is little about the dangers associated with use of prescription opioids. This paper is exploratory in nature, with the intent of exploring the relationship between chronic pain and prescription opioids, particularly opioid addiction, abuse, misuse, and overdose.

Scope Of The Problem

The rise of the global prescription opioid epidemic first began in the 1990s (“The Prescription Opioid,” 2015). During this time, pain specialists and advocacy organizations around the globe began to argue that the world faced an epidemic of untreated pain (“The Prescription Opioid,” 2015). As a result, an increasing number of professional and consumer groups pushed for the increased use of opioids for pain management (“The Prescription Opioid,” 2015). The shift towards opioids for pain management led to a dramatic upsurge in prescription opioid production, prescriptions written by medical professionals, sales, and consequently consumption (“The Prescription Opioid,” 2015; see Figure 2).

As a result of chronic opioid therapy increasing dramatically, there has been a parallel increase in the abuse, misuse, and addiction rates of prescribed opioids along with overdose rates (“The Prescription Opioid,” 2015). Although definitions vary, for the purpose of the paper, the terms are defined as following. Abuse refers to consumption of the drug in a way other than prescribed, usually by consuming more than directed or taking a higher dosage (Brady, McCauley, & Back, 2016). Misuse of opioids is a broad term including using the drug outside of prescription parameters, such as misunderstanding or ignoring instructions and using the medical for non-medical reasons (Brady et al., 2016). Addiction refers to a physiological dependence on the drug for purposes other than pain relief, using the drug despite it causing damage, inability to control drug intake, craving the drug for non-medical reasons, and deterioration in daily functioning due to obsessive preoccupation with the drug (Brady et al., 2016). And finally, overdose refers to death due to high levels of consumption of the drug (Brady et al., 2016).

The abuse, misuse, addiction, and overdose rates resulting from prescription opioids is vastly evident in society. For instance, in the documentary Understanding the Opioid Epidemic, several individuals spoke about personal encounters with prescription opioids, mainly about abusing such medication and overdosing on it due to its addictive nature (Grant, 2018). Recent data supports this statement. For example, one report estimated the rate of opioid abuse to be 26% amongst those taking chronic opioid therapy (Kata et al., 2018). Similarly, from 2015 to 2016, there was an increase of over 11,500 drug overdose deaths, and opioids accounted for 63.1% of these deaths, a number that has quadrupled since 1999 and made it more common than overdose from cocaine and heroin combined (Kata et al., 2018; see Figure 3). Contributing factors include more liberal prescribing methods, reports of undertreated pain, creation and availability of new opioids, and marketing techniques by drug manufacturers (Kata et al., 2018).

The Issue

This situation presents a conundrum. Opioid therapeutics are widely prescribed because they are the most effective analgesics in relieving many types of chronic pain, especially for those patients for whom no other treatment has been effective (Brady et al., 2016). However, with long-term use of prescription opioids, likelihoods of developing an addiction, abusing the medication, and/or misusing the medication are high and unfortunately not very uncommon (Vowles et al., 2015). The dilemma of treating chronic pain in patients by use of opioids versus the rising rates of opioid addiction, abuse, and misuse is an enduring and multifaceted issue that has no simple solution.

Prescribing Chronic Opioid Therapy

Why Are Opioid Analgesics Prescribed?

Opioid painkillers are prescribed by physicians to treat moderate to severe pain, be it the result of injury, surgery, a dental procedure, and/or a chronic health condition (Walwyn, Miotto, & Evans, 2010). They are prescribed due to their high effectiveness in relieving most types of pain and when used properly, opioids are successful in alleviating agony in both severe and long-term pain, making it a viable option for many (Walwyn et al., 2010).

After recognizing pain as a medical issue, physicians have been influenced and forced to put it into practice (Ling, 2017). Hospitals not following the mandate to address pain are in jeopardy of losing their accreditation (Ling, 2017). In fact, pain relief is viewed as a patient’s right, and under-treatment of pain is considered a form of malpractice (Ling, 2017). For instance, a California court awarded $1.5 million dollars to a family who sued their physician for failing to adequately treat their 85-year-old father’s pain (Bergman v Wing Chin, MD and Eden Medical Center, No. H205732-1 Cal App Dept Super Ct 1999).

Thus, due to the complex nature of understanding and treating pain, along with the vicious consequences of under-treating pain, prescribing opioids as painkillers, medication that has proven time and time to be effective, has become an increasingly popular choice made by many medical professionals.

Prescribing Patterns

Opioid prescriptions increased from 47 to 62 million from 2006 to 2012 and opioid sales quadrupled from 2000 to 2010 (Kata et al., 2018). Correspondingly, the medical use of opioids increased by 240% from 2004 to 2011 in the United States alone (Kata et al., 2018). Data indicates that the majority of opioid prescriptions are provided by family practice providers (Kata et al., 2018). The most common prescribers of opioids include family practice, internal medicine, nurse practitioners, physician assistants, orthopedic surgeons, physical medicine, rehabilitation, and anesthesiology subspecialties (Kata et al., 2018). Pharmaceutical industries also benefit from prescriptions and sales of opioids for chronic pain as it brings them lots of income (Ling, 2017). It is thus not surprising that such industries are not against the prescribing practices of opioids for chronic pain (Ling, 2017).

Moreover, there are differences in prescribing patterns based on patient-provider interactions. Differences are based on multiple factors such as race, socioeconomic status (SES), and gender. More specifically, those that are non-white are less likely to have a physician treat their pain with opioids than those that are white (Hausmann, Gao, Lee, & Kwoh, 2013), and those that are females are less likely to have their pain perceived as being real by the physician (Frantsve & Kerns, 2007) and thus are less likely to be treated with prescription opioids, and lastly, those from a higher SES are more likely to not only have access to a physician but to also get better treatment (Frantsve & Kerns, 2007) and thus be prescribed opioids by their doctor.

Furthermore, there have been reported concerns among physicians about their confidence in prescribing opioids safely, their ability to detect misuse, addiction, and abuse of prescription opioid use in their patients, and their ability to discuss these issues with their patients (Kata et al., 2018). Nonetheless, there is still a demand for prescription opioids amongst pain sufferers. For example, a recent news article outlines the case of a women searching for a doctor that is willing to prescribe her opioids for her chronic back pain (Proctor, 2018). She states that she has seen three family physicians who have refused to bow to her demands of continuing her prescriptions due to the high risk associated with them and that doctors are not willing to accept her as a patient when learning that she desires opioids (Proctor, 2018). There are two important concepts here. One is that people are increasingly using the internet to research the prescriptions they want along with seeking the doctors they would like to see. Individuals use the internet to make sense of their illness, to find a solution to their illness, and to look for doctors who will meet their needs. For instance, in my journey to treating my chronic pain, I have turned to the internet several times to find treatments and doctors that can help me. Second, the opioid epidemic cannot be attributed to doctors. As specified in another recent new article, doctors are clearly not over-prescribing and many of them are not willing to prescribe opioids at all (Payne, 2018). Relating back to my journey, it took six years of failed attempts before my doctor was willing to prescribe me opioid painkillers, and even when he did, I was given an extremely low dose.

Consequences Of Chronic Opioid Therapy

Chronic opioid therapy entails many prevalent adverse effects. The list of negative side effects is never ending, with the most common being gastrointestinal and central nervous system related, specifically, constipation, nausea, somnolence, and respiratory depression (Kata et al., 2018). Other users report side effects such as fatigue, cognitive dysfunction, sweating, weight gain, and dry mouth (Kata et al., 2018). Some of the more serious effects include endocrine dysfunction, inadequate production of sex hormones, sexual dysfunction, muscle rigidity, pruritus, delayed gastric emptying, hyperalgesia, and adverse drug interaction (Kata et al., 2018).

However, the most substantial effects are those that include tolerance, addiction, dependence, abuse, and death, which are major risks when prescribing opioids (Kata et al., 2018). Thus, although the increase in the number of prescriptions and use of opioids has significantly improved the treatment of pain, this has been accompanied by an increased incidence of opioid abuse, addiction, and death (Ling, 2017). Overdose can be accidental but also a result of long-acting opioids contributing to cardiac-related deaths (Kata et al., 2018). For example, one study found that prescribing long-acting opioids for chronic pain compared to anticonvulsants and antidepressants was associated with a significant increased risk of mortality (Kata et al., 2018).

Additionally, supporting these findings and arguments is a short podcast from Dr. Daniel Alford where he expresses his opinions on prescription opioids and argues that the benefits of it prominent, but so are the side effects and consequences, the risks are just as pronounced (2018). He argues that the need for safer opioid prescribing programs are required in order to counteract rates of abuse, addiction, and overdose deaths (Alford, 2018).

Furthermore, another consequence is the fear and stigma associated with chronic pain. As stated in one news article, because chronic pain is a contested and chronic illness, rates of stigma against the pain are high (Scanlon, 2019). In turn, these high rates of stigma against the pain may lead to high rates of stigma against using opioids for treating chronic pain which then leads to stigmatizing those individuals using prescribed opioids as contributing to the opioid epidemic (Scanlon, 2019).

Who Is At Risk For Prescription Opioid Abuse, Addiction, Misuse, And Overdose?

It is no secret that the dangers of prescription opioid abuse, addiction, misuse, and overdose are high. Thus, it is instrumental to recognize risk factors, in terms of those who are more vulnerable to these effects, so that society can collectively work towards safely decreasing the rates of prescription opioid abuse, addiction, and deaths. A wide range of variables, such as the user’s gender, age, race, SES, geographical area, and medical or clinical history all contribute to the progression of opioid abuse. However, it is vital to note that the risk factors are correlational, meaning they do not definitively predict that a person will develop an addiction, abuse, misuse, and/or overdose on opioids (Brande, 2018).

Gender

When it comes to gender, women are prescribed abuse-prone medications more often than men (Brande, 2018). It is thus not surprising that men are likely to die from a prescription drug overdose at higher rates than women and that men also report more problems associated with opioid use than women (Brande, 2018). Nonetheless, men and women are admitted to the emergency department at approximately equal rates for complications relating to opioid abuse (Brande, 2018).

Age

Moreover, younger individuals have a higher risk of abusing, misusing, overdosing, and becoming addicted to opioids (Brande, 2018). This is also reflected in a news article by the Vancouver Sun in which Dr. Gary Franklin highlights that prescription opioids are highly addictive, especially for teens (Harnett, 2018). However, rates among older users are on the rise with middle-aged users having the highest risk of overdose (Brande, 2018).

Race

Furthermore, there is a marked associated between race and prescription opioid problems with rates of opioid prescriptions being highest amongst White patients, followed by Black, Hispanic, Asian, and then other race patients, regardless of SES (Brande, 2018). Additionally, opioid overdose rates are nearly three times higher amongst American Indians/Alaska Natives and non-Hispanic Whites than among Blacks and Hispanic Whites (Brande, 2018). This may reflect larger societal issues regarding racial disparities and the effect of race in healthcare.

Socioeconomic Status

There is some preliminary evidence that SES may be related to prescription opioid problems (Brande, 2018). Specifically, people from high SES are prescribed more opioid medication than those from low SES neighborhoods (Brande, 2018). Also, those with higher education levels are three times more likely to be prescribed opioids than those with lower levels of education (Brande, 2018). SES can affect substance abuse by shaping drug use habits, influencing the availability of health resources, and affecting adherence to medication (Brande, 2018). Although the association is not yet complete, there is some evidence suggesting that SES and opioid medication prescribing and abuse are interwoven.

Geographical Area

Additionally, abuse of prescription opioids has been found to have a regional component, with rural regions having higher rates of prescriptions, abuse, misuse, addiction, and overdose than urban areas (Brande, 2018). Interestingly, these higher rates to do reflect higher incidences of injury, surgery, or chronic pain (Brande, 2018). Thus, this inconsistency may reflect a lack of consensus amongst healthcare professionals as to the appropriate guidelines of prescribing opioid medications.

Medical and Clinical History

Lastly, medical and clinical history are another risk factors. Those struggling with chronic pain along with coping with a substance use or mental health disorder simultaneously are at the highest risk for misusing prescription opioids (Brande, 2018). Also, long-term medical use of prescription opioids for chronic pain increases risk factors for overdose (Brande, 2018). Psychological disorders have shown to have a clear link with developing opioid abuse (Brande, 2018). Likewise, substance abuse of other substances is related to higher rates of abuse with opioid medication (Brande, 2018).

Reasons For Prescription Opioid Abuse, Addiction, Misuse, and Overdose

Prescription opioid abuse can result from a magnitude of different reasons. For instance, social acceptability may contribute towards structuring prescription opioid use norms and acceptability. Viewing prescription opioid use as a socially acceptable practice may have a potent impact on individuals as they will not only be more willing to try opioids but also consequently be at a higher risk of abusing and getting addicted to them (Brande, 2018). Additionally, social media has created a community connection in which individuals can engage and interact with other users, encouraging the use of opioids without properly assessing the risk factors (Brande, 2018). When individuals perceive others engaging in a particular behavior, such as opioid use, they come to normalize the behavior, which only serves to expand the problem (Brande, 2018). Therefore, rationalizing prescription opioids as socially acceptable has massive implications.

Moreover, because prescription opioids are prescribed by a physician, and because they are prescribed at higher rates today compared to the past (see Figure 4) many individuals view them as coming from a trusted authority source and thus believe that they are safe, overlooking the risks associated with them (Brande, 2018). Next, easy consumption, meaning that it is easy to take pills compared to smoking or injecting substances, and easy accessibility and availability, meaning that pills can easily be shared between individuals and that prescriptions can be obtained from a willing physician instead of a dealer, also contribute to the abuse of opioids (Brande, 2018). Furthermore, the staggering number of prescriptions being written sends the wrong message to consumers regarding the dangers of opioid abuse, a message that indicates that opioids are safe (Brande, 2018). Again, this leads to increased rates of opioid abuse, addiction, misuse, and overdose. Additionally, a major factor contributing to this issue is the aggressive marketing by major pharmaceutical companies. These companies have spent a lot of money creating and promoting prescription opioids and this direct marketing to consumers may communicate the message that opioid medications are good and safe to use (Brande, 2018). In turn, this may drive rates of demand for the medication from consumers, along with increase rates of abuse, addiction, misuse, and overdose (Brande, 2018).

Moreover, self-motivation to treat and manage pain may be a driver behind using opioids and ultimately contribute to the abuse and addiction to these medications to control pain (Brande, 2018). Also, there is a strong correlation found between prescription opioid abuse and mental health issues where those who struggle with mental health issues are more likely to underestimate the dangers of prescription opioid abuse, leading to higher rates of abuse amongst these individuals (Brande, 2018). Lastly, poly-substance abuse in association with the prescription opioids significantly increases the risk of overdose (Brande, 2018).

Alternative Pain Management Approaches

Given the severe consequences and risks of chronic opioid therapy, and because managing pain is still a necessary part of life, it is crucial to find alternative methods to cope with and treat chronic pain. There are many alternative methods that have been proposed recently. In a hearing held by the Senate Health Committee in the United States to examine pain management alternatives to opioids, alternatives presented include spinal cord stimulation, nerve blocks, injections, and non-opioid prescription drugs (Pain Management Alternatives, 2019). Other alternatives consist of acupuncture, stress reduction, exercise/physical therapy, psychological therapy, and hypnosis (Brande, 2018). Additionally, two alternatives that have received great news coverage recently include the use of medical marijuana and virtual reality in treating chronic pain (Bain, 2019; Desatoff, 2019). The next step is to test these alternatives and observe their effectiveness. Due to the nature of the high effectiveness of prescription opioids, and because there is no one size fits all, it will be hard to find alternatives with similar effects.

Conclusion

Opioid analgesics are considered to be the most effective pain relievers known to man (Walwyn et al., 2010). However, it is no longer feasible to simply continue previous practices of managing chronic pain with respect to opioids. The associated risks and rates of opioid abuse, addiction, misuse, and overdose demand change. Currently, society is facing the dilemma of treating chronic pain by use of opioids, a highly effective treatment, but also managing the high rates of abuse, addiction, misuse, and overdose in society. This issue is one that requires more attention because the treatment of chronic pain is vital for pain sufferers, yet society is still to develop a safe and effective treatment plan.

So how do we fix this? Future research needs to uncover precise ways to diagnose, prevent, and treat opioid abuse, addiction, misuse, and overdose. This is a multifaced issue that requires a comprehensive solution; the key is to focus on prevention, early intervention, and reversal of present cases. In turn, this will influence the rates of abuse, addiction, misuse, and overdose. Alternatively, substitute treatments with the same efficacy would also contribute to solve this issue and should be a primary concern for researchers. Although opioids may help us temporarily forget our troubles, they are in no way the solution to this problem in the long run. Continued determined efforts to find ways to treat chronic pain safely and effectively should be at the forefront of society’s future.

In the debate over opioid abuse, addiction, misuse, and overdose, many voices are being heard, including those of doctors, nurses, pain specialists, community workers, addiction support workers, government agencies, pharmaceutical industries, and even the voices of ordinary people in the society. However, there is one group whose voice is not being heard, the voice of those living with chronic pain who require opioids to manage their discomfort. As someone who has been living with chronic pain themselves for the past six years, I work hard to manage the pain and I want the medical system to be a respectful and cooperative partner, not a bully. I take opioids to treat my chronic pain and decisions about them will be decisions that harm me.

Chronic back pain is a common disease that affects many people, especially the ones aged 35 – 55. It is quite difficult to detect the causes of this pain, but it is usually considered to be related to the strain in one of the structural components of the back. A chronic back pain is the one that is lasting longer than a month.

It can be caused by many reasons, such as long period of standing or sitting, having a fall, lifting or carrying heavy objects, stress, overweight, etc. There are several ways of treatment of the chronic back pain, including tacking various medicines, physical therapies, surgery, psychological therapy, complementary therapy.

The Gate Control Theory provides the methods of the chronic back pain therapy based on the work of mind and brain regarding pain perception. In this paper, we are going to discuss the methods of pain control based on the Gate Control Theory and how the Gate Control Theory relates to cultural explanations regarding the sensation of pain. We will also consider a possibility to completely eliminate pain by applying the Gate Control Theory.

The Gate Control Theory was developed by Patrick Wall and Ronald Melzack in 1960s. The theory suggests that there are systems in the central nervous system responsible for the transmitting the “pain messages” through the brain. These systems can open or close “gates” that let in or block the pain.

This process can be explained by the work of neurotransmitters: “when a nerve impulse comes to the end of the axon and reaches a terminal button releases a chemical courier called a neurotransmitter” (Ryan, 2011). The Gate Control Theory describes the phenomena of the mental nature, but with regard to the processes that occur in the nervous system.

Although, there are no detailed explanation of how these processes occur and regulated, the Gate Control Theory help explain why different treatments might be effective to manage the chronic back pain, “The effectiveness of nonpharmacological pain-management strategies can be explained by the Gate Control Theory and the processes responsible for the transmission of pain” (Simpson and Creehan, 2007). Thus, acupuncture is one of the alternative medicines based on the Gate Control Theory. However, there are also:

“Opioid analgesics act on synaptic transmission in various parts of the central nervous system by binding to natural opioid receptors. They inhibit ascending pathways of pain perception and activate descending pathways” (Freudenrich, n. d.).

Thought, they can become addictive. The massage is another method of back pain relief. In order to prevent or reduce the back pain, one should combine these methods.

Our sensation of pain can be explained by the Gate Control Theory as it is related to the work of mind. Our cultural background plays an important role. Thus, our beliefs and values, memories of previous pain, upbringing, expectations of and attitudes towards pain affect how we interpret the pain. (“Pain and How You Sense It, n. d.).

Thus, the information mentioned earlier suggests that we can eliminate pain by applying the Gate Control Theory. However, in order to do this, a number of various methods based on the Gate Control Theory should be applied during course of treatment.

In conclusion, it should be said that the Gate Control Theory can provide a basis for the treatment of the chronic back pain. Moreover, with its help, we can explain how f cultural background can influence our sensation of pain. In addition, a balanced course of treatment based on the Gate Control Theory can help eliminate pain completely.

List of References

Freudenrich, C. (n. d.) How pain works. Discovery Health. Web.

Pain and how you sense it. (n. d.) For Healthy Australia. Web.

Ryan, M. (Ed.). (2011). Psychsmart. New York, NY: McGraw-Hill.

Simpson, K. R., and Creehan, P. A. (2007). Perinatal nursing. New York: Lippincott Williams & Wilkins.

Introduction

Applied kinesiology is now being increasingly applied in the field of alternative medicine for a variety of purposes. Among these is for the relief of chronic pain among patients. While this method is popular, debate about its efficacy continues. Up till now, there is significant literature and research that supports applied kinesiology as a good alternative treatment.

Brief History of Applied Kinesiology

Applied kinesiology was introduced Goodheart in 1964, which introduced the method of manual muscle testing or MMT to diagnostic procedures. However, in addition to identifying the “weak muscles”, it aimed to identify “the subtle shifts away from optimal neurologic status”. (Schmitt and Yanuck, nd, pp 1) While initially, this methodology was met by skepticism, it was with continuous application and refinement of the procedures that led to the development of this field. with the help of advancements in neurology and neuromuscular biology, applied kinesiology is able to increase its accuracy considerably to be applied in various medical fields.

Difference Between Applied Kinesiology and Kinesiology

Applied kinesiology is very different from kinesiology, which is the study of movements of the human body. Applied kinesiology is also known by the names muscle testing and manual testing. However, the technique aims to diagnose illnesses in patients by testing the level of strength of the various muscles of the body. (American Cancer Society, 2007, np) The field is also different from medical fields in that it aims to treat the patient as a whole and not just stick to relieving symptoms.

As it is a non invasive method, it is a very popular procedure among patients who suffer from chronic pain disorders or debilities. (AOL, 2007, np) Applied kinesiology is an unconventional form of medicine, which does not fall within the standards set by the medical fields. The use of unconventional forms of medicine is prevalent in all parts of the globe, including the United States of America.(Eisenberg et al, 1993, pp 246) In the past, unconventional medicine was considered to constitute a small fraction of the medical industry. However, researches have revealed that unconventional medicine is a very large proportion of the medical servicing. However, they remain one of the sideline treatments, being used as adjuvant to the medical treatments. (Eisenberg et al, 1993, pp 249)

Principles of Applied Kinesiology

Applied kinesiology works on the principle of cause and effect. It claims that any illness in a specific organ leads to a corresponding weakness or illness in the respective muscle. By identifying the muscles with illness, applied kinesiology helps in diagnosing the ailment of the patient. However, applied kinesiology approaches the body as a whole as well as individual part in its evaluation. Therefore, problems such as nerve damage, poor lymph draining system, poor blood supply, or chemical nutritional or hormonal balances can also be diagnosed with the help of applied kinesiology. (American Cancer Society, 2007, np)

The charm of this field is that it is applicable by all health personnel whether conventional medicine or alternative medicine. The key to the therapy is manual stimulation of key points of a muscle or body, which initiates changes in the disease process, and thereby helps restore the organ and the body to full health. This is in addition to the safe therapeutic procedure and the noninvasive nature of it. (American Cancer Society, 2007, np) Unlike acupuncture, there is no invasive modality involved, which helps in patient compliance. Patients with chronic pain especially claim a reduction in the intensity of pain after applied kinesiology sessions. However, it is mostly used as an adjuvant and not as single therapy alone.

Researchers now know that the Central Integrative State or anterior horn motoneurons is the location where changes occur, which then lead to various muscle responses. Applied kinesiology is particularly different as it aims to identify any changes in the functional neurology before the end stage of clinical disease. The method of this process is therefore to normalize the afferent capacity of the neurons. (Schmitt and Yanuck, nd,pp 2)

This process is achieved through various manipulations of the muscles, which include touch, pressure, vibration, and other physical agents. The response to the physical changes is then recorded, which identifies the muscle as being weak or strong. (Schmitt and Yanuck, nd,pp 3). The aim of applied kinesiology is therefore restoring the normal functions of the muscle, including autonomic and neuroendocrine balance, proper neuron immune function and reduction of pain. (Schmitt and Yanuck, nd,pp 3).

By identifying the strong or weak muscle areas, the kinesologist is able to affirm the disease and its progression level, thereby helping in quick diagnosis. The relation of mind and body, and taking the individual as a whole person rather than a mix of individual body parts is the key in the success of this technique. applied kinesiology is now increasing its knowledge by learning from neuroscience. Both neuroscience and applied kinesiology are now working together to improve their understanding about diagnosis in various medical conditions. (Schmitt and Yanuck, nd, pp 1)

Applications of Applied Kinesiology

Applied kinesiology is therefore, used for many conditions and includes pain of both chronic and acute type, arthritis and headaches, allergies, disorders of the muscles and joints, tiredness and injuries due to vigorous activities, digestive disturbances and other such related medical problems. (AOL, 2007, np)

Concepts and Misconcepts in Applied Kinesiology

There are many areas in unconventional medicine that utilize the use of muscle testing procedures in their diagnostics and treatments. Apart from applied kinesiology, chiropractice etc. were also considered areas where manual muscle testing or MMT was carried out. Applied kinesiology started gaining importance when the value of active and healthy living began to surface. There is now sufficient literature to prove that sedentary manner of living is the cause of most of the developed country illnesses. The need for physical activity increases in patients who are debilitated or who are severely ill. The treatment plan for today must include physical activity as a prescription rather than advice by the physicians. It is here that the role of applied kinesiology can be appreciated in those who are debilitated or cannot move due to illness.

However, the most common misconception about the field is that the muscle itself becomes weak due to illness. The real concept it is an inhibition of the motor neuron in the absence of end organ pathology. The sensory and the motor pathways of the nerves carrying stimuli to the muscle are influenced by many factors. These include chemo and nociceptors, mechanoreceptors and the various secretions and products of the body at different times. This theory is supported by the somatic function theory. It claims that if a somatic or visceral tissue dysfunction took place, the associated neuron reflexes will also be affected and in turn will affect the excitability and activity of the muscle. (Belli, 2003, pp 1)

The kinesiology experts believe that every point represents a specific attitude, and meridian is used to channel energy to specific areas and muscles of the body. The responses in this system are based on the mind body connection and by manipulating them, the attitudes and the medical conditions can be improved. There is a strong component of emotional and mental health with the health of the body. A healthy body will have positive attitudes and will respond positively, and vice versa for a negative person. (Goodheart, nd, np)

Current Applications of Applied Kinesiology

Applied kinesiology is now being considered as an important additional tool in the fields of functional neurology. With increased understanding of the neurological pathways and methods of conduction, applied kinesiology will be better able to diagnose various conditions within the human body. (Schmitt and Yanuck, nd, pp 2) Various neuromediators that affect the conduction capacity and activity of the muscle are also being learned to understand the complex integration between the nervous system as well as the muscles and their coordination.

Current medical use of applied kinesiology includes evaluating the gait patterns through the MMT, evaluating the spinal cord interneuron functions, utilizing mechanoreceptor and nociceptor stimulation for injured areas, and suprasegmental modulation of pain. (Schmitt and Yanuck, nd, pp 7)

Various applications of applied kinesiology include identification and correction of muscle problems, visceral problems, and correcting meridian imbalances. Identification of food sensitivities and metal toxicity, as well as various infections can also take place. Applied kinesiology can be used to detect nutritional deficiencies and any emotional issues contributing to the ill health of the patient. In many treatment procedures, applied kinesiology can be used as an adjunct to improve treatment outcomes such as acupuncture and laser acupuncture, nutritional medicine and homeopathy, application of herbal medicine, chiropractic medicine, as well as Ayurvedic medicine. (What is Applied Kinesiology, nd, para 12)

Conclusion

Applied kinesiology is now being considered as an important adjuvant to medical practice and its benefits are now visible. However, there is still lack of information about how effective this procedure actually is. There is still limited research conducted in the area, and the studies that have been carried out have not provided any significant findings. To properly understand the true role of applied kinesiology requires more research in this area.

Works Cited

American Cancer Society, 2007. Applied Kinesiology. Web.

AOL, 2007. Better Health with Applied Kinesiology. Web.

Belli, Richard, 2003. Applied Kinesiology and the Motor Neuron. Dynamic Chiropractic. Web.

David M Eisenberg, Ronald C Kessler, Cindy Foster, Frances E Norlock, David R Calkins and Thomas L Delbanco, 1993. Unconventional Medicine in the United States—Prevalence, Costs and Patterns of Use. The New England Journal of Medicine, Volume 328:246-252.

George Goodheart, nd. Applied Kinesiology. Web.

Walter H Schnitt and Samuel F Yanuck, nd. Expanding the Neurological Examination Using Functional Neurologic Assessment: Part II Neurologic Basis of Applied Kinesiology. The Elements of Health, Scottsdale, Arizone, USA. Web.

What is Applied Kinesiology? House of Natural Medicine. ND. Web.

Introduction

Chronic, or persistent, pain is a prevalent issue in clinical patients. It can stem from a multitude of causes, which range from consequences of trauma or surgery to particular diseases or being caused by treatment (Treede et. al., 2015). It is a significant reason for a reduced quality of life in patients (Edwards et al., 2016). Therefore, the management of chronic pain is a crucial element of patient care. Although a variety of treatments exist for this purpose, there is significant inter-patient variability in their outcomes (Edwards et al., 2016). Furthermore, “long-term administration of analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids involves risks of organ damage, overdose, and, in some cases, drug dependence and misuse syndromes” (Edwards et al., 2016). As a consequence of these factors, a large number of variables need to be considered for improving the management of chronic pain in patients.

Relevant Data

To implement a database management approach to investigating, recording, and, ultimately, treating pain, one needs a design that incorporates as many factors that affect pain and pain treatment. A patient’s history of diagnoses and pain prescriptions, and history of responses to such, is crucial for establishing a factual base for future decisions. A diagnosis history is relevant because different illnesses cause different types of pain that respond best to different treatments (Stanos et al., 2016). A history of previously used methods of pain treatment and the patient’s response to them can be used when assessing whether a method should be adjusted or a new one assigned (Centers for Disease Control, 2016). Furthermore, this information can be useful to assess possible drug-drug interactions that can affect the ultimate choice of medication (Moore, Pollack, & Butkerait, 2015). All of these data need to be assembled in a convenient, easily searchable, and sortable database structure to facilitate the visualization of their relationships and selection of the appropriate treatment.

Database Structure

A database approach to managing patients’ chronic pain would require accounting for several factors that fall into four general categories. The first includes the initial cause of pain, consisting of primarily structured data of diagnoses and dates. The second category is comprised of both structured and unstructured data describing the patient’s history of pain medication and treatment methods. The third category, primarily unstructured, includes factors that are not necessarily related to diagnosis or treatment history, but affect the patient’s individual indications or contraindications. Finally, a patient’s general biometrics, such as his or her age, weight, and sex, can all be relevant for prescribing treatment.

Figure 1 visualizes the four categories with one sample entity each. Elaborating on each entity and attribute:

• Biometrics is the biometric data from the patient’s EHR. As these data are pulled from the EHR, their operational definitions are determined by what is already present in the database, thus following existing standards and conventions.

• • The date of birth is used to calculate the patient’s age, an important factor for prescribing pain treatment.

• • Weight is important to determine the appropriate dosage when prescribing medication.
• Diagnosis contains the data on one of the patient’s diagnoses, pulled from his or her EHR. Of particular importance are:

• • The name refers to the diagnosis’ name and code, linking to the diagnosis database.

• • The date is the date when the diagnosis was given. In all tables, the date should inherit its format from the currently used EHR system; if that is impossible, a standard YYYY-MM-DD format should be used.
  • The prescription contains the name and ID of the specific treatment or medication prescribed for the diagnosis, linking to the treatment or medication database as appropriate.
• The Treatment entity refers to a particular treatment or medication prescribed to the patient as a means of managing his or her chronic pain.

• • The treatment’s name refers to its name and ID, linking to the medication or treatment database, as appropriate.

• • Start date and end date refer to the date range when the treatment or medication was active. This is relevant to estimate the development of a patient’s tolerance or possible drug interactions during that time.
  • Comment contains a physician’s note concerning the patient’s response to the treatment. This field is unstructured and can include information on tolerance, drug interactions, or other details of the patient’s response to the treatment.
• The miscellaneous factors table is less structured than the other three. It contains information on various factors that can affect what treatments or medications can be prescribed to manage a patient’s pain. These factors can include a developed tolerance, known allergies, known drug interactions, or behavioral factors such as dependence and misuse.
  • The name and date fields are necessary to identify each factor and the time when it was recorded. Since these factors are not necessarily diagnoses, the name field may not contain a linking ID.
  • The positive and negative indications are IDs and names linking to specific treatments and medications in the corresponding database. These fields are used by the health care provider when choosing an appropriate method for managing the patient’s pain.
  • The comment field contains the physician’s note on the factor in question. Any clarifications or comments that can further affect the should be recorded in this field.

Database Usage

This database approach should be whenever a patient suffering from chronic pain needs to have his or her methods of pain treatment updated. It can make use of cross-linking between its three tables (note that dates and medication/treatment IDs are present in all of them). This allows the specialist to easily visualize the relationships between past diagnoses, history of pain, and miscellaneous factors relevant to this choice. Furthermore, each table can be explored individually if more detailed evidence is necessary.

Conclusion

Chronic pain is a major clinical problem that affects a significant number of patients. A large selection of treatments exists to help manage it, and selecting one that is optimal for each individual patient is a complex task that requires considering a multitude of factors. These factors can include the patient’s diagnoses explaining the initial causes of pain, past and current methods of pain treatment and response to them, biometric data, and a large set of information classed as miscellaneous. In organizing and visualizing these factors and the relations between them, a database management approach may bring significant improvements. Therefore, a database can be designed, incorporating information related to a patient’s history of pain and pain treatment methods. Such a database would connect with the patient’s EHR to pull existing data and provide fields for the entry of new data. The usage of this database design should facilitate choosing an appropriate method of treating an individual patient’s chronic pain.

References

Centers for Disease Control and Prevention. (2016). Guideline for prescribing opioids for chronic pain. Journal of Pain & Palliative Care Pharmacotherapy, 30(2), 138-140. Web.

Edwards, R. R., Dworkin, R. H., Turk, D. C., Angst, M. S., Dionne, R., Freeman, R., … Yarnitsky, D. (2016). Patient phenotyping in clinical trials of chronic pain treatments. PAIN, 157(9), 1851-1871. Web.

Moore, N., Pollack, C., & Butkerait, P. (2015). Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs.Therapeutics and Clinical Risk Management, 11, 1061-1075. Web.

Stanos, S., Brodsky, M., Argoff, C., Clauw, D. J., D’Arcy, Y., Donevan, S., … Watt, S. (2016). Rethinking chronic pain in a primary care setting. Postgraduate Medicine, 128(5), 502-515. Web.

Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., … Wang, S. J. (2015). A classification of chronic pain for ICD-11.PAIN, 156(6), 1003-1007. Web.

Abstract

Pain is both an alarming and useful signal that demonstrates that certain malfunctions are occurring and serves as a call for action. However, the subjective sensations experienced by different patients may vary greatly – some easily endure pain, while others feel the same pain acutely. Chronic pain is a syndrome that significantly diminishes life quality and life satisfaction. Research has shown that the leading cause of chronic pain is pathological disturbances in perception and similar mental processes. They can be triggered by injuries and operations, heart attacks and strokes, or significant stressful situations. Nowadays, several treatment methods gain substantial recognition for chronic pain treatment – medical cannabis, hybrid emotion-focused treatment, and acetaminophen are among them. Each of the methods possesses qualities that the others may lack, but also certain drawbacks.

Introduction

Chronic pain syndrome is an independent disease that significantly deteriorates the quality of a patient’s life. The syndrome does not fulfill a protective function and does not bear any biological expediency. On the contrary, chronic pain leads to maladaptation, to an abnormal perception of pain and non-pain impulses, and is accompanied by various disorders of the central nervous system. It should be noted that chronic pain results in considerable discomfort, and often acute suffering for patients. Modern medical knowledge, seemingly, does not provide a clear understanding of the mechanisms of chronic pain, which leads to a lack of clear standards for the management of patients that suffer from it. Nevertheless, new treatment approaches emerge, promising to alleviate the suffering that chronic pain patients undergo.

Main body

The popularity of medical cannabis (MC) for chronic pain treatment is increasing progressively, and more and more researchers are involved in investigating its virtues. A study conducted by Bellnier et al. on efficacy, safety, and costs of treating chronic pain with MC aimed at comparing life quality and pain scores at the beginning and three-month after MC therapy (Bellnier et al., 2018). European Quality of Life 5 Dimension (EQ-5D) Questionnaire and Pain Quality Assessment Scale (PQAS) were used for the evaluation in which 29 subjects participated (Bellnier et al., 2018). The participants used only non-smokable dosage forms of MC (Bellnier et al., 2018). It should be noted that the number of participants, and thus sample size, seems to limit the potential for overarching judgment of the results and their universality.

The study showed positive effects that MC has in chronic pain treatment. Both EQ-5D and PQAS scores improved after the three-month therapy, demonstrating enhanced life quality, diminished pain, and even lesser opioid usage (Bellnier et al., 2018). In this regard, the researchers (Bellnier et al., 2018) state that “preclinical evidence suggests cannabinoids increase the analgesic effect of opioids, thus requiring a lower dose to achieve relief” (p. 113). Despite the study’s limitations, such as sample size, its retrospective nature, and the absence of full awareness of patients that leads to the lack of blinding, it demonstrates consistency with other investigations. On the whole, Bellnier et al. showed that MC is sufficiently effective in neuropathic pain alleviation.

Chronic pain often appears to result in depression and anxiety, making the necessity for a treatment that could aim these supplementary symptoms as well, especially poignant. Managing chronic pain using hybrid emotion-focused treatment is the center of the research in which 115 chronic patients participated during January 2016 and September 2018 in two cities in Sweden (Boersma et al., 2019). The study compares the efficacy of cognitive-behavioral therapy (CBT) and hybrid emotion-focused treatment with a greater focus on the latter. Boersma et al. (2019) state that “the hybrid treatment (n=58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy” (p. 1708). In this way, the treatment stems from the reasoning that chronic pain and emotional issues are both based on similar cognitive operations. The division between the two options was randomized, and the number of participants in each was almost equal.

The research shows that hybrid emotion-focused treatment could be considered an effective treatment option for chronic pain patients with psychological complications. The article dedicated to the study shows that it is extensive, prolonged in time, and, seemingly, has an adequate sample size. Regarding the limitations of the research described in the article, its authors note that, for instance, the methods used for patient selection limit its generalization potential (Boersma et al., 2019). Overall, the study revolves around the demonstration of how emotion regulation correlates with pain coping.

Acetaminophen is one of the most common recommendations for treating all types of pain. Moreover, the drug is advocated by WHO as the first-line pain treatment agent (Ennis et. al, 2015). “Acetaminophen for Chronic Pain: A Systematic Review on Efficacy ” is an article that systematically investigates acetaminophen’s effectiveness and reasons for its widespread usage based on already conducted researches. The article’s authors (Ennis et. al, 2015) notice that “the primary strength of this study is the multiple broad search strategies designed to include original data on either chronic pain or conditions associated with chronic pain” (p. 186). Hence, the conclusion that the authors draw on acetaminophen’s somewhat limited effectiveness and dubiousness of arguments for its use seem relatively reliable. The lack of research on acetaminophen’s long-term effects on chronic pain is another discouraging argument given by the authors (Ennis et al., 2015). Overall, the article in question represents a comprehensive analysis of the perceived effectiveness of acetaminophen and persuades against it.

Conclusion

The problem of chronic pain has become widely investigated because of the high prevalence and the variety of forms in which it manifests. Its significance is further emphasized by the creation of specialized pain centers and clinics in several countries to treat patients with chronic pain syndromes. Depending on the nature of the psychopathological symptoms, severity, and patients’ motivation, various techniques may be used to alleviate chronic pain, varying from MC to hybrid emotion-focused treatment.

References

1. Bellnier, T., Brown, G. W., & Ortega, T. R. (2018). Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis. Mental Health Clinician, 8(3), 110–115.
2. Boersma, K., Södermark, M., Hesser, H., Flink, I. K., Gerdle, B., & Linton, S. J. (2019). Efficacy of a transdiagnostic emotion–focused exposure treatment for chronic pain patients with comorbid anxiety and depression. PAIN, 160(8), 1708–1718.
3. Ennis, Z. N., Dideriksen, D., Vaegter, H. B., Handberg, G., & Pottegård, A. (2015). Acetaminophen for chronic pain: A systematic review on efficacy. Basic & Clinical Pharmacology & Toxicology, 118(3), 184–189.

Introduction

It is not a surprise to meet a person with chronic illness in the modern world. Bad nutrition, awful environment (air people breath and water drink), constant stresses, too hush life and other factors are the main reasons for the chronic illnesses occurrence. The pain any chronic illness causes may never be compared to anything except for the experience of grief and loss related to the feeling of the nearest bereavement induced by person’s dying. The main purpose of the literature review is to conduct a research on the chronic pain caused by illness and the experience of loss; great many of different sources are going to be considered which are aimed at evaluating the various opinions on the problem with the identification of the most crucial and influential aspects of the situation.

The main characteristic aspects of chronic pain and the feeling of loss

Sage, HELIN. Newton-John and Gedd (2008) define chronic pain as “any pain that has persisted on a more of less daily basis for more than 3 months, or for longer than the expected healing time for body tissues” (p. 199). The authors state that the persistent pain is not the only problem the chronic illnesses have and refer the readers to the emotional suffering, and social and occupational troubles.

MEDLINE, EBSCO. The loss connected to the chronic illness may be defined in a number of different ways. The loss may be identified as “a reduction in symbolic or physical resources in which a person is emotionally invested” (Gatchel, Adams, Polatin, & Kishino, 2002, p. 100). The loss may be also specified as the one that is “produced by an event that an individual perceives to be negative, and results in long-term changes to his/her cognitions, relationships, and social environment” (Gatchel et al, 2002, p. 101). Furthermore, some scholars identify the loss as a major “if it has a lingering impact on a person’s consciousness and continues to affect his/her life long after the initial occurrence” (Gatchel et al, 2002, p. 101).

Academic Search Complete, EBSCO. Gordon (2009) identifies one more type of grief related to the relative death, chronic sorrow and explains it “as a normal grief response associated with an ongoing living loss that is permanent, progressive, recurring, and cyclic in nature” (p.115). It is crucial to notice that such sorrow is mostly connected to the situations of children’s death when parents cannot face the reality and continue living in the past.

Feeling of loss in relation to relatives

Sage, HELIN. Demmer (2001) research the problem of AIDS treatment in the modern world. The main idea of the article is that modern achievements allow people live longer with the terrible disease. Still, it is rather hard to know about the problem and be able to do nothing. The mortality rate because of AIDS is rather low for now, still, those who know their relatives’ destiny cannot remain calm and enjoy life as before. Those who have lost loved people because of AIDS feel injustice and great disappointment mixed with grief. Demmer (2001) says that “there is the danger that, with AIDS becoming a chronic disease, individuals who have lost loved ones to AIDS could become a forgotten group with grief issues” (p. 35).

CINAHL, EBSCO. Roy (2001) examines the chronic disease and pain in older age. The research results in unexpected information. The spouses who performed the roles of the caregivers for their chronically ill beloved people almost find it stressful because of constant psychological pressure. This leads to the increase of mortality among caregivers without an apparent cause. Moreover, Roy (2001) manages to identify the main reasons for grief in case of relatives’ chronic illness, (1) “an inability to accept the death of a loved one”, (2) “persistence of intense grief attempts to communicate with the dead person”, (3) “persistence of physical symptoms such as loss of appetite, sleep disturbance, aches, and pain”, and (4) “severe depression with suicidal thoughts or actions” (p. 73). The level of the influence of one of those reasons may vary, depending on different factors that should still be researched.

EBSCO. Miyabayashi and Yasuda (2007) conduct a comparative research on the problem of relatives’ feelings concerning a number of situations, namely suicide, accident, acute illness, shorter and longer illnesses. The comparative analysis is conducted from the following perspectives, depressive mood, general health condition and grief. It is significant that the consideration of all those cases shows the same physical distress, while the emotional condition differs greatly. Being interested in people’s grief and experience of loss caused by chronic disease people suffer from, it is crucial to state that the outcome rates in the group with chronic illness patients are significantly lower than in those groups with unnatural and unexpected deaths. In conclusion, the authors of the article make a prediction that the low results in the chronic illness group are related to the relatives’ anticipation and expectation of the nearest death. The data is collected for the following symptoms, somatic, anxiety and insomnia, social dysfunction, severe depression, cherished reminiscences, alienated feeling, mood stability and adaptive effort (Miyabayashi & Yasuda, 2007).

Academic Search Complete database, EBSCO. Lewis (1983) defines the grief connected to the chronic illness as a “little dying” that is the repeated in a number of times on the way to the “final dying” (p. 8). The author also accentuates that the grieving losses are obligatory and people must come through the period of time they are present in. The pain and experience of loss helps people move to the other stage, the rehabilitation and acceptance, “grieving is necessary to relinquish one stage of live to move into the next” (Lewis, 1983, p. 10).

MEDLINE, EBSCO. Gilliland and Fleming (1998) conduct an interesting research comparing a number of situations. The focus of their exploration is considered to be on the group of spouses who experienced grief by “terminally-ill patients prior (anticipatory grief) and following the death (conventional grief)” (Gilliland & Fleming, 1998, p. 541). The results are also compared with those of the other two groups, the spouses with chronic disease and those with the satisfactory health. The factors that could influence the problem are contemplated and the conclusion appears to be unexpected. The anticipatory grief stirs up anger, atypical grief and the cases of loss of emotional control (Gilliland & Fleming, 1998).

MEDLINE, EBSCO. Boss and Couden (2002) explore the problem of the ambiguous loss. The term is rather specific and the authors define it as “a situation where a loved one is perceived as physically present while psychologically absent, or physically absent but kept psychologically present because their status as dead or alive, dying, or in remission, remains unclear” (Boss & Couden, 2002, p. 1352). People suffering from ambiguous loss because of relative’s chronic illness that is impossible to cure remain in constant stress as have to hold two ideas simultaneously, that the person has already died (there is no any possibility to prevent him/her from death) and that the person is still alive, still here. People experience the following feelings and reactions in the situation, confusion, freezing, the inability to prevent family roles from reorganization, the search for fair and justice, and physical and psychological exhausting (Boss & Couden, 2002).

ProQuest, EBSCO. Murray (2003) raises a problem that can be the basis for a thorough research. He is sure that cultural views and beliefs influence the level of grief and bereavement greatly. Thus, making an example of impoverished cultures where the death of children and infants is considered as something inevitable, the grief does not last long. Such attitude is not understood by most Western cultures, where the death of a child is the greatest loss even occurred. This difference also influences the stages people have to come through to the final one, acceptance.

Experience of loss and grief in the relation to dementia patients

Sage, HELIN. Lindgren, Connelly and Gaspar (1999) offer the examination of the feelings of grief and loss of the dementia patients’ relatives. The authors mostly examine the attitude to patients with Alzheimer. The focus of the research is the duration and the rating of distress at the situations when caregivers are informed about their relative death twice. The research shows that while being informed about the nearest death of the relative with Alzheimer for the first time the experience of loss and bereavement level is much higher than that on the news about the nearest death for the second time. Still, the second notice influences more caregivers’ understanding of the nearest changes related to the absence of the beloved person.

Sage, HELIN. The reaction of caregivers to Alzheimer disease in one of their relatives is also considered by Adams and Sanders (2004). They highlight that those who take care of the patients with progressive dementia are subjected to “depressive symptoms and other mental and physical health problems” (Adams & Sanders, 2004, p. 195). Adams and Sanders (2004) conduct a research to evaluate caregiver’s condition on the early, middle and late stages. It is concluded that dealing with dementia patients, caregivers are more depressed and experience more grief at the last stage of the patient’s illness. Furthermore, the caregivers at the last stage of the disease of their relatives mention the losses “related to the interpersonal relationship with the care recipient and how radically it had changed over the years of Alzheimer’s disease” (Adams & Sanders, 2004, p. 202).

Sage, HELIN. Ashton (2008) is sure that there is a great difference in the professional and home care of the patients with chronic illness. Ignoring the fact of the medical facilities and necessary skills, it is crucial to mention that bereavement and grief are the main feelings relatives experience in the relation to the sick person. In spite of the fact that grief has been usually rejected as the core feeling in the relation to the sick relative, Ashton (2008) made an attempt to identify five main human dimensions of grief patients and caregivers usually suffer from, namely cognitive, physical, socially, emotionally, and spiritually. Cognitively, people are unable to perceive the disease as it is and feel confused and disoriented. Physically, they may feel some complications in sleeping and eating abilities along with repetitive pains and aches. Socially, most patients withdraw from surrounding world and friends, and try to get ready to die. Shock and denial are the main emotional conditions both the patients and their relatives feel. The spiritual condition also lacks inspiration as most people suffer from the feeling of being abandoned by God (Ashton, 2008).

Sorrow and loss families experience when have a child with chronic disease

Sage, HELIN. It is a great sorrow to know about the nearest death of a child from the chronic disease. The problem is that parents have to make their child believe that nothing wrong is happening. Langridge (2002) makes an attempt to consider two types of parental grief, namely time-limited grief and chronic sorrow. The central characteristics of time-limited grief are that it is accomplished in five stages, “denial, anger, bargaining, depression and acceptance” (Langridge, 2002, p.159). Parents do not stop thinking about the problem and they still fell grief, but the pain is not so sharp as they accept the reality as it is. Chronic sorrow has four main characteristics, “a perception of sadness over time in a situation with no foreseeable end; the sadness has a cyclical nature; it is triggered either internally or externally bringing to mind the person’s losses or fears; it is progressive and can intensify” (Langridge, 2002, p. 159).

SocINDEX, EBSCO. Penzo & Harvey (2008) examines the feeling of loss and grief parents usually experience while raising children with different mental disorders. Continuing the research conducted by Langridge (2002) the authors deeply reflect each stage of parental grief and loss, coming to the conclusion that the level of sorrow parents experience of different stages, namely (1) denial, (2) anger, (3) bargaining, (4) depression, and (5) acceptance of the loss, is absolutely different. The final stage may never be reached if parents do not readjust the hopes they have and do not restructure the expectations they possess in the relation to their child.

The experience of loss and grief after consideration of personal chronic diagnosis

Sage, HELIN. Thannhauser (2009) tries to identify the personal feelings of adolescents who get to know about their diagnosis, multiple sclerosis. The scientist stresses that the adolescents’ experience is a “cyclical movement between grief and acceptance” (Thannhauser, 2009, p. 773) supported with numerous losses. The author is sure that a person chooses one of the schemes for behavior. On the one hand, sick adolescents may experience loss, grief, and then the acceptance. On the other hand, the way to acceptance may be longer and can be accomplished in a number of the following stages, “medication–peer tug-of-war”, “shifting friendships”, “finding supportive relationships”, “dealing with others’ worry”, “talking about multiple sclerosis”, and “acting normal” (Thannhauser, 2009, p. 772).

CINAHL, EBSCO. The other classification is offered by Ahlström (2007) who manage to identify, by means of inductive analysis, eight categories of people’s experience of loss, namely loss in bodily functions, relationships loss, autonomous life loss, loss of the life imagined, loss of roles, loss of activities, loss of identity, and the loss of uplifting emotions. Chronic/episodic sorrow was considered by means of deductive analysis. The experience of losses is provided in different frequency and of various power rates. Thus, the loss of identity is the most rarely met answer though being the most severe feeling. The results obtained while the examination are influenced by a number of facts, determined as the research limitations. The ethical issue is one of the main potential problems in the research as the emotional effect of the questions could cause pain (Ahlström, 2007).

Academic Search Complete, EBSCO. The loss may be related not only to the personal emotions but also to some material sides of life, such as the feeling of loss in relation to workplace or friends, as well as to the previous life that was painless. Sagula and Rice (2004) conduct a research using the mindfulness meditation program and prove that the program helps to cope with the difficulties created by the current condition, chronic illness. The grief and loss should be integrated, not defended. This will help pass the stage faster and with less mental anguish.

CINAHL, EBSCO. Richardson, Ong, and Sim (2006) conduct a research focused on the experience of those who live with chronic pain. The reaction of people to the fact that the disease they possess is chronic and may lead to death is different and may be divided into three groups. The first group gathers people who are optimists and still hope for something better. The second group combines those who think only about the worst outcome and do not want to continue normal life leading. The uncertainty and fear is the other feeling that is predominant in the third group. People are afraid of the future as they are not certain about the length of their tortures.

EBSCO. The problem of bereavement and loss in patients with intellectual disabilities is debated by Brickell & Munir (2008). The concept of traumatic grief is evaluated and the main conclusion of the research is that those patients with intellectual disabilities are more subjected to it on the basis of the experience of the secondary loss, the existence of some barriers that prevent those people from communicating their losses, and the inability to find the meaning of the loss.

CINAHL, EBSCO. Clements, Focht-New and Faulkner (2004) evaluate the importance of patients’ acceptance of their nearest death or constant pain. Having focused the research on people with developmental disabilities, the authors state that it is crucial for such patients to cope with the problem, to accept the grief they experience and do not react too emotionally on the diagnosis in future. The research shows that “disabled persons can articulate their perceptions and feelings about traumatic experiences, death, and the subsequent impact of the events that follow” (Clements, Focht-New & Faulkner, 2004, p. 799) and it positively affects their condition.

Conclusion

In conclusion, the literature review of a number of sources was conduced where different topics were considered. The research is focused on the problem of caregivers and family members’ experience of loss, grieve and bereavement connected to the chronic illnesses in relatives, children, people with dementia as well as the same feelings considered after the personal experience of inevitability. The level of grief and loss depends on different factors, but most scientists agree that to cope with the problem, people should accept it as inevitability and continue living, no matter how difficult and painful it is.

Reference List

Adams, K. B., & Sanders, S. (2004). Alzheimer’s caregiver differences in experience of loss, grief reactions and depressive symptoms across stage of disease. Dementia, 3(2), 195-210.

Ahlström, G. (2007). Experiences of loss and chronic sorrow in persons with severe chronic illness. Journal of Nursing & Healthcare of Chronic Illnesses, 16(3A), 76-83.

Ashton, J. M. (2008) Bereavement Care in Home Care and Hospice. Home Health Care Management & Practice, 20(5), 394-399.

Boss, P., & Couden, B. (2002). Ambiguous loss from chronic physical illness: clinical interventions with individuals, couples, and families. Journal of Clinical Psychology, 58(11), 1351-1360.

Brickell, C., & Munir, K. (2008). Grief and its Complications in Individuals with Intellectual Disability. Harvard Review of Psychiatry, 16(1), 1-12.

Clements, P., Focht-New, G., & Faulkner, M. (2004). Grief in the shadows: exploring loss and bereavement in people with developmental disabilities. Issues in Mental Health Nursing, 25(8), 799-808.

Demmer, C. (2001).Dealing with AIDS-related loss and grief in a time of treatment advances. American Journal of Hospice & Palliative Care, 18(1), 35-41.

Gatchel, R., Adams, L., Polatin, P., & Kishino, N. (2002). Secondary loss and pain-associated disability: theoretical overview and treatment implications. Journal of Occupational Rehabilitation, 12(2), 99-110.

Gilliland, G., & Fleming, S. (1998). A comparison of spousal anticipatory grief and conventional grief. Death Studies, 22(6), 541-569.

Gordon, J. (2009). An evidence-based approach for supporting parents experiencing chronic sorrow. Pediatric Nursing, 35(2), 115-119.

Langridge, P. (2002). Reduction of chronic sorrow: a health promotion role for children’s community nurses? Journal of Child Health Care, 6(3), 157-170.

Lewis, K. (1983). Grief in chronic illness and disability. Journal of Rehabilitation, 49(3), 8-11.

Lindgren, C. L., Connelly, C. T., & Gaspar, H. L. (1999). Grief in spouse and children caregivers of dementia patients. Western Journal of Nursing Research, 21(4), 521-537.

Miyabayashi, S., & Yasuda, J. (2007). Effects of loss from suicide, accidents, acute illness and chronic illness on bereaved spouses and parents in Japan: Their general health, depressive mood, and grief reaction. Psychiatry & Clinical Neurosciences, 61(5), 502-508.

Murray, C. I. (2003). Grief, Loss, and Bereavement. In J. J. Ponzetti (Ed.), International Encyclopedia of Marriage and Family (pp. 782-788). New York: Macmillan Reference USA.

Newton-John, T. R., & Geddes, J. (2008). The non-specific effects of group-based cognitive-behavioral treatment of chronic pain. Chronic illness, 4, 199-208.

Penzo, J., & Harvey, P. (2008). Understanding Parental Grief as a Response to Mental Illness: Implications for Practice. Journal of Family Social Work, 11(3), 323-338.

Richardson, J., Ong, B., & Sim, J. (2006). Remaking the future: contemplating a life with chronic widespread pain. Chronic Illness, 2(3), 209-218.

Roy, R. (2001). Old age, pain, and loss. Topics in Geriatric Rehabilitation, 16(3), 66-76.

Sagula, D., & Rice, K. (2004). The Effectiveness of mindfulness training on the grieving process and emotional well-being of chronic pain patients. Journal of Clinical Psychology in Medical Settings, 11(4), 333-342.

Thannhauser, J. E. (2009). Grief–peer dynamics: understanding experiences with pediatric multiple sclerosis. Qualitative Health Research, 19(6), 766-777.

One of the main concerns of the contemporary medical worker is the patient’s comfort and well-being during the period of their presence in the hospital. Medical facilities today offer a wide range of services directed at the improvement of the patient’s comfort. Medical treatment of various diseases is more likely to have a positive outcome if the patient was taken care of in calm and peaceful surroundings. One of the most effective ways to encourage relaxation and calmness in patients is through aromatherapy and gentle massage. This technique is highly effective for patients that suffer from chronic pains and anxieties.

Regular massage therapies showed strongly positive results in chronic pain alleviation and improvement of the overall physical and emotional condition of the patients. The researchers in this field were focused on measuring the pain using Iowa Pain Thermometer and Geriatric Multidimensional Pain and Illness Inventory before and after the several-week courses of massage and aromatherapy. The researchers documented a significant decrease in pain and the improvement of the quality of life of the participants of the studies. This means that this rather simple method of treatment is highly effective and should be considered by the contemporary therapeutic nursery.

The patients’ comfort and well-being are the main functions of contemporary nursery professionals (Kolcaba et al, 2006). People of different ages report having chronic pains which influence their quality of life in a negative way. Patients with chronic pains tend to have multiple comfort needs of psychological, physical, and environmental characters. The procedure of massage and aromatherapy is very helpful, not complex, it can be easily included in the process of patient care and the nurses and nursery assistants can be trained to perform the most useful and efficient massage techniques.

The experiments conducted by medical professionals all around the world were directed at measuring the levels of chronic pain the patients experienced. After the quantitative data was collected the course of aromatherapy and hand massage was practiced. The researchers worked with patients experiencing a variety of chronic non-malignant pains. The therapy course proved to have a significant analgesic effect on pain in the lower back area, neck and shoulder pain, and headaches. Massage and aromatherapy were recommended as auxiliary treatments for carpal tunnel syndrome and fibromyalgia and musculoskeletal pains (Tsao, 2007).

The research conducted by Cino included forty participants that took a four-week course of massage having sessions twice a week. To measure chronic pain Geriatric Multidimensional Pain and Illness Inventory points such as emotional distress, life interference, and suffering. Besides, Iowa Pain Thermometer, a pain scale, was employed. The course showed that hand massage with and without aromatherapy significantly reduced the scores showed by the measuring devices at the beginning of the experiment (Cino, 2014).

The research by Yip and Tse included a course consisting of eight sessions of manual acupressure therapy that was held within three weeks on adult patients with sub-acute non-specific neck pains. The researchers use the Visual Analogue Scale to measure pain intensity, stiffness and stress levels, lateral and forward neck flexions, and extensions in centimeters. The research results documented that massage therapy reduces stiffness by twenty-three percent, stress level by thirty-nine percent, improved lateral and forward neck flexions, and also showed a twenty-three percent pain level decrease (Yip & Tse, 2006).

To introduce changes to the practice it is recommended to add simple massage techniques on a group of patients suffering from knee pains and neck stiffness and flexions. The functional improvements of the limps can be measured with the help of a goniometer. Massage sessions should be provided within several phases. Each of the phases should last for at least three weeks. One week should include at least two massage sessions conducted with a break lasting one or two days. The sessions should not be scheduled for two days in a row as it is believed that muscles need time to recover from massage sessions so the therapy is more effective if it is properly combined with the periods of rest.

After each of the three-week phases, the measurement should be renewed and documented. This will help to follow the improvement tendency and speed. Through the course of the therapy, the staff included in the procedures will be able to learn and improve their insights on the techniques performed during the sessions and alter their approach to achieve better efficiency and more positive results.

The end of the trial session will be able to show the results of the patients’ improvements, the best techniques, and the best performers. Massage sessions for patients with various kinds of chronic pains should be tested. To make the practice regular, experienced nurses should be able to train and teach others. This way the procedure to aromatherapy, massage, and acupressure treatment will become available for any patient with chronic pains.

To conclude, massage and aromatherapy are practically useful, efficient easy, and safe methods of addressing such serious concerns of many patients as chronic pains. One of the main tasks of contemporary nursery professionals is to do everything to improve the quality of life of their patients. Aromatherapy, massage, and acupressure are fresh and innovative ways of improving the performance of nurses and nursing assistants, creating more comfortable and less stressful surroundings for the patients and alleviating their pain.

Reference List

Cino, K. (2014). Aromatherapy Hand Massage for Older Adults With Chronic Pain Living in Long-Term Care. Journal of Holistic Nursing 1(117).

Kolcaba, K., Schirm, V. & Steiner, R. (2006). Effects of Hand Massage on Comfort of Nursing Home Residents. Geriatric Nursing 27(2), 85-91.

Tsao, J. (2007). Effectiveness of Massage Therapy for Chronic, Non-malignant Pain: A Review. ECAM 4(2), 165-179.

Yip, Y. B., & Tam, A. C. Y. (2008). An Experimental Study on the Effectiveness of Massage with Aromatic Ginger and Orange Essential Oil for Moderate-to-severe Knee Pain Among the Elderly in Hong Kong. Complementary Therapies in Medicine: 131-138.

The causes of abdominal pain in young adults, as well as middle-aged and elderly persons, are often different. In addition, it is also possible to differentiate between the causes of the acute and chronic pain that can be typical of this or that age group. For male adults aged 20 years old, acute abdominal pain is most typical. However, there are also cases when chronic abdominal pain is observed, and it is caused by the prolonged unhealthy diet or consequences of the acute conditions (Marsicano, Vuong, & Prather, 2014). The possible differential diagnoses for young male adults suffering from acute abdominal pain include acute gastritis caused by problems in the gastrointestinal tract. The sudden inflammation can be caused by stress and unhealthy eating habits (Gans, Pols, Stoker, & Boermeester, 2015). The other possible diagnosis is acute pancreatitis. These diseases can become chronic if they are not treated effectively. In addition, acute appendicitis is also most often observed in young persons. Acute cholecystitis is rare in young people. The possible diagnosis associated with chronic abdominal pain is irritable bowel syndrome typical of young adults (Gans et al., 2015). The problem is in the fact that young people more often suffer from the consequences of unhealthy diets and the impact of psychological factors than middle-aged persons do.

While discussing the possible causes of chronic and acute abdominal pain in the 50-year-old man, it is important to note that chronic diseases more often cause pain in middle-aged and elderly patients. Furthermore, acute conditions are often associated with other chronic disorders that can lead to worsening. Middle-aged males often suffer from acute and chronic pancreatitis because it can be caused by the abuse of alcohol and unhealthy eating habits (Cartwright & Knudson, 2015). The cases of peptic ulcers associated with acute and chronic abdominal pain are also typical of this age group because middle-aged patients can have problems with stomach acid and prolonged courses of medications.

Chronic gastritis, chronic cholecystitis, inflammatory bowel disease, chronic peritonitis, and diverticulitis are the differential diagnoses that are usually mentioned while discussing the case of chronic pain in a middle-aged person. Inflammatory bowel disease is also diagnosed in addition to different types of colitis that cause chronic abdominal pain. The mentioned problems are usually associated with the chronic inflammation in organs of the gastrointestinal tract that are typical of middle-aged persons in contrast to young adults (Cartwright & Knudson, 2015). In addition, chronic pain can also be associated with gallbladder diseases and the biliary disease gallstones that are often observed in middle-aged and elderly males. Moreover, this group of diseases and the observed chronic pain can also be related to a large group of liver disorders.

While discussing the causes of chronic and acute abdominal pain in patients belonging to two different age groups, it is important to note that acute conditions are more typical of young patients. In spite of the fact that gastritis, pancreatitis, and colitis can be observed in both patients, the characters of diseases are different. Furthermore, some conditions can be mainly typical of this or that group, as it is in a case of irritable bowel syndrome observed in young patients or diverticulitis observed in older males.

References

Cartwright, S. L., & Knudson, M. P. (2015). Diagnostic imaging of acute abdominal pain in adults. American Family Physician, 91(7), 452-459.

Gans, S. L., Pols, M. A., Stoker, J., & Boermeester, M. A. (2015). Guideline for the diagnostic pathway in patients with acute abdominal pain. Digestive Surgery, 32(1), 23-31.

Marsicano, E., Vuong, G. M., & Prather, C. M. (2014). Gastrointestinal causes of abdominal pain. Obstetrics and Gynecology Clinics of North America, 41(3), 465-489.

The human body weakens and deteriorates as a person advances in age beyond adulthood. One of the consequences of this deterioration is pain. Chronic pain differs from acute pain mainly by duration. There is no consensus regarding the duration but it generally falls somewhere between one and six months (Better Health Channel, 2011). Below this duration, the pain is acute, but beyond this duration, it becomes chronic. Some scholars classify pain between the first and sixth month as sub-acute. Chronic pain tends to last for more than a year especially among the older generation.

Age is one of the factors that increase the propensity of an individual to suffer from chronic pain. There is some sort of plateau phase observed among the older people in Victoria above the age of seventy, who do not seem to have any major difference with those slightly younger in their pain profiles. Research reports show that between 27% and 61% of people aged over 65 have chronic pains in Australia (Dewar, 2007). This variance in numbers is because of the difficulty in diagnosis of pain due to its subjective nature (Virir, 2009). Chronic burden also contributes up to 80% of the disease burden in Australia (National Health Priority Action Council, 2006).

Normally, as the human body ages, its capacity to deal with infection and to recover from injury diminishes. Certain conditions such as heart disease, kidney failure, liver problems, and other organ failures increase. In addition, old people tend to take a disproportionately longer time to recover from physical injury due to accidents. Chronic pain in the elderly in Victoria take the form of persistent headaches and migraines, back pains, limn and joint pains and gastrointestinal problems. However, older people above the age of seventy tend to have fewer cases of headaches as compared to younger age groups. Some also develop conditions causing them chronic pain in the ENT system. While these pains mainly affect to the elderly, they tend to be more concentrated among them.

The effects of chronic pain vary from person to person and take different forms. In a general sense, people show two main reactions to chronic pain. The first type of effect that chronic pain has on people is that it reduced the range of options they have relating to physical activities. In this sense, chronic pain limits their participation in physical activities such as sports, manual work and can significantly reduce their mobility. These activities tend to increase the awareness of the pain because of the increased potential for spikes in level of pain when people engage in physical activity. The second effect is psychological. Pain can result in social withdrawal and in some cases can lead to significant stress, paving way for depression. The continued presence of pain makes an elderly person more aware of the physical limitation they experience because of age and serves to limit them even further.

There are two general approaches to pain management available in Victoria. They include the use of drug based therapies (pharmacological) and secondly, the use of non-drug interventions (non-pharmacological) (Better Health Channel, 2011). Drug based therapies generally involve the use of painkillers such as Paracetamol, aspirin, Opioid drugs and local anesthetics (Kumar, 2007). The option used depends on the facts of the case, and the severity of the pain as shown in figure 1.

Non-drug interventions include the use of physical therapy such as exercise, massage, and acupuncture, among many others. These options work for patients who cannot use drugs or are not responding to drugs. It may also be a choice as an alternative to drug based therapies.

References

Better Health Channel. (2011). Pain Management – Adults. Web.

Dewar, A. (2007). Assessment and Management of Chronic pain in the Older Person Living in the Community. Australian Journal of Advanced Nursing , 24 (1).

Kumar, N. (2007). WHO Normative Guidelines on Pain Management: Report of a Delphi Study to Determine the Need for the Guidelines and to Identify the Number and topics of Guidelines that Should be Developed by WHO. Gevena: World health organization (WHO).

National Health Priority Action Council (2006). National Chronic Disease Strategy. Canberra: Australian Government Department of Health and Ageing.

Virir. (2009). Pain Assessment and Management in Residential Aged Care. Victoria: Vivir Healthcare Pty Ltd.