Pain Management Through Psychology

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Table of Contents

Sickle Cell Pain Management
Dental Surgery Pain Management
Back Pain Management
Preoperative Pain Management
References

Pain is the unpleasant feeling experienced by an individual’s emotions or senses as a result of tissue damage. Pain is experienced in either acute form which is commonly encountered by most patients who seek help or chronic form which persists for a longer period of time despite being treated. Pain can be managed through a number of ways among them being psychological means. Pain management through psychology can further be divided in the various fields of psychology namely educational, social and health where each field has its own technique of dealing with pain management. Among the variety of pain experiences encountered by human beings include pain from the disease of sickle cell, pain encountered after and before receiving surgery and back pain. (Kaslow, 2000)

Sickle Cell Pain Management

The management of pain experienced by patients of sickle cell has received extensive contributions from behavioral scientists. Management of pain from sickle cell gives best results when undertaken through a psychological approach, where various interventions are combined among them being relaxation therapy, cognitive interventions, biofeedback and behavioral interventions. A study was carried out to test the effectiveness of these interventions with the study population comprised of both adults and children although there are differences in the level of pain encountered by the two types of patients.

Subjective findings argued that, the process of pain management should be initiated by an accurate assessment of the both adult and children. Adult patients were assessed using a different pain questionnaire from the one administered during children patients’ assessment. The pain questionnaires measured various levels of pain among them being chronic, recurrent and acute pain. Other pain measurements covered by the specific pain questionnaires were pain intensity and pain perception in terms of sensory as well as affective qualities. Subjective findings also recommended that, assessments of pain from sickle cell should be carried out through diagnostic interviews where a patient’s family history is provided.

The diagnostic interview also addressed disease symptoms, previous pain treatments that have been given to the patient and situations of social environment which are likely to influence perception of pain. Other than subjective findings, there were objective ones suggesting that, pain from sickle cell is managed through a medical diagnosis which should be performed thoroughly including both laboratory and physical examinations.

Treatment of both children as well as adult patients of pain from sickle cell involved biobehavioral and cognitive techniques. The first technique that was used included regulation of pain perception, where self regulation was utilized during relaxation of muscles, guided imagery, biofeedback, and meditation. Biofeedback was particularly applied in the management of pain in those patients that were experiencing acute pain in their tissues.

During biofeedback, the electrical activity experienced by a patient’s body undergoes amplification which is then translated into visual signals. Biofeedback results gave information through which patients’ emotional changes were associated with physiological changes. This technique of biofeedback was incorporated in cognitive strategies like imagery, attention diversion, adaptation body operations and relaxation training.

Application of cognitive strategies in the management of pain resulting from sickle cell involved rhythmic deep breathing and exercises aimed at providing relaxation which were accompanied by dialogues concerning pain reduction. Those patients who were put under muscle relaxation exercises were taught how to tighten their muscles, which was followed by relaxation in order to relax their minds and physical body. These exercises necessitated an overall body relaxation, since physiological change of patients were made to correlate with anxiety that reduced pain caused by sickle cell. (Kaslow, 2000)

The second technique used in the treatment of pain resulting from sickle cell was regulation of pain behavior. During this particular intervention, patients were made to disconnect from activities that provided opportunities for their significant others to reinforce pain behavior. This was based on the premise that, when a patient who is in pain receives so much attention from people around him/her, the patient tends to increase pain sensitivity. Regulation of pain behavior was carried out by engaging the patients in daily routines in order for them to be active and reduce the perceived difference between them and those who are not suffering from sickle cell related pain.

Children as well as adults on whom these interventions were carried out registered positive responses but further recommendations were given where they were required to receive educational information concerning management of pain from sickle cell to enable them perform the same therapies on their own. Parents of children suffering from attacks of pain from sickle cell were also recommended to receive education on this kind of pain management in order to assist their children when infected. (Kaslow, 2000)

Dental Surgery Pain Management

This is the management of pain conducted to patients who experience episodes of pain after dental surgery. A study was carried out to test the effectiveness of techniques used in the management of pain experienced by these category of patients. A diagnosis was applied in order to measure the level of chronic pain being experienced. The main aim of applying this diagnosis was to recognize the causal mechanism which later assisted in treatment process of the chronic pain. Pain experienced by the patients of dental surgery was found to result from nerve injury, which directed treatment to the mechanism that caused chronic pain.

Patients of dental surgery were then asked to give descriptions of pain they were experiencing and measurement was applied on the words they used. Those who said that they were experiencing itching and shooting pain, it was interpreted that their nerves had been injured while those who had sharp pains were said to suffer from inflammations. Further questioning was carried out where patients were asked the period of time during which pain had persisted which occurred to be from the exact time dental surgery was undertaken.

Listening to patients of dental surgery stories was taken to form part of pain management, since a clinician is able to recognize the cause of pain from those stories, after which explanation is provided to concerned patients. This was reported to give positive results after their understanding of the main cause of pain and symptoms which had been previously neglected by dental surgeons. Since most of the patients expected some pain to occur after surgery, part of that pain was predicted to be psychological.

Pain killers of anticonvulsant category were given to reduce the intensive pain which was to prepare them psychologically that, some medication had been given and pain should seize immediately. For most of them, pain ended after they had taken pain killers. However, the actual pain management occurred during story telling which gave patients an assurance that the cause had been recognized and was under control. Surgeons were recommended to be preparing their patients psychologically of the aftermath of dental surgery to reduce resultant pain. (Macrae, 2001)

Back Pain Management

This is management that was undertaken to patients who were experiencing pain from the lower part of their backs with the actual study population being comprised of elderly women. This was explained as threatening pain which was being stimulated by direction of excessive attention to their backs as well as existing potential for them to escape back pain. In cases where back pain was recurrent, the individuals under study developed extra caution to painful experiences. The number of times during which these patients went for treatment were counted in order to help with pain management process.

It occurred that those patients who had sought medical treatment for a large number of times had higher intensities of pain as well as emotional distress. The high level of caution to back pain was taken to be a predictor of agony and disability. Patients suffering from back pain were found to suffer from excessive caution to threat which resulted to high levels of anxiety. Laboratory findings showed that those patients who had habitual bodily sensation experienced more attacks of back pain. It was realized that the best treatment for these patients was the integration of physical fitness with cognitive reframing.

This was to reduce their physical disuse which causes inflexibility and eventually results to back pain. Systematic general fitness was applied to them which reduced fatigue as well as back pain symptoms. This was aimed at providing self and positive reinforcement which prepared the minds of back pain patients that they were getting healed. Cognitive reframing involved the integration of massage with conversations where patients were made to think of pain reduction which challenged the sources of pain and eventually reduced back pain. This study resulted to recommendation that back pain patients should try to make use of practical methods like this one rather than using medicine to manage their pain. (Nierkerk, 2001)

Preoperative Pain Management

This involved management of pain that is normally experienced by patients prior to surgical operations. The study population for this particular study was adolescents who had been accompanied by their parents to operation rooms. The main objective was to explore the existing correlation between preoperative pain, anxiety, coping styles and analgesia that is patient controlled otherwise known as PCA. PCA involves a situation where patients administer pain medication on their own when needed by pressing a button.

This mechanism is programmed in such a way that a patient cannot overdose him/her self since a certain period of time must elapse before the next medication is provided, regardless of the number of medication demands made by patients. PCA was used to complement injections provided to patients before surgery to ease their pain. An assessment of coping styles was conducted two days before surgery where pain scores were recorded in accordance with PCA use on the adolescent patients. It was noticed that before the performance of surgery, those adolescents registered anticipated pain and curiosity as preoperative characteristics.

Anticipated pain experienced by adolescent patients had a close connection with the outcome of preoperative pain. However, the anxiety experienced by these adolescents’ parents had minimal prediction of preoperative pain which was to be encountered by adolescent patients. It was assumed that the larger the number of demands for PCA by adolescent patients the much the preoperative pain experienced. However, it was found out that those adolescents who were over anxious made lesser PCA demands since they were equally afraid of overusing medication for pain. The final results revealed that there was a high correlation between patients anticipated pain and actual pain experienced.

It was therefore necessary to first reduce anxiety which would then minimize the preoperative pain levels. The most effective solution to this problem of anticipated pain was found to be an establishment of adolescent patients’ self worth which should then regulate pain perception. Coping styles were implemented in order to increase adolescents’ self worth that reduced their fear towards use of medication to reduce pain which was the main predictor of preoperative pain.

PCA was used as the main coping style as it helped reduce levels of anxiety in the adolescents under study by preparing them psychologically. Anxiety reduction was achieved through an increased level of control administered to the expected painful situation. PCA usage is associated with exposure of patients to expected experiences of surgery, a positive state of emotional preparation to pain as well as reduced conflicting instances of hospital staff and their patients. Using the findings of this particular study, it was recommended that clinicians should have an increased usage of PCA in order to prepare patients psychologically that they have ultimate control of the situation which helps in the reduction of preoperative pain. (Logan, 2005)

From the different research studies performed in order to test effectiveness of psychological methods of pain management, it is clear that, these particular methods are highly effective and can be used to supplement tablets and injections. Pain from sickle cell was managed through regulation of pain behavior as well as perception, which contributed to overall reduction of pain from the disease. In the second study, health psychologists managed pain experienced from dental surgery by listening to explanations given by patients concerning extent of pain.

The main cause of pain was explained to this category of patients, which was followed by administration of pain killers’ though the understanding of the causes of pain and assurance that pain killers would ease the pain was the main application of pain management. The third study involved management of back pain which was carried out through administration of cognitive framing in conjunction with physical fitness to reduce instances of pain. Lastly, preoperative pain was managed through the use of PCA and anxiety reduction which resulted to a reduction of preoperative pain. A closer evaluation of all the four studies shows the effectiveness of psychological methods in pain management. (Logan, 2005)

References

Kaslow N. (2000): Coping with sickle cell disease pain; Journal of Consulting and Clinical psychology, New York: Guilford press pp 35-41.

Logan D. (2005): Expectancy effects on preoperative pain and PCA usage among adolescent surgical patients; Journal of pediatric Psychology, Pennsylvania: Pennsylvania University Press pp 34-40.

Macrae W. (2001): Chronic pain after surgery; British Journal of Anesthesia, New York: Elsevier pp 88-98.

Nierkerk V. (2001): Knowledge of back pain management; journal of nursing studies, California: SAGE Publishers pp 78-82.

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