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INTRODUCTION

Everyone experiences pain at some time in life but althoughthis is likely a universal experience, it is also a complex and private one. It is a personal experience because it is very difficultto describe or to explain to others. It is the most common reasonfor seeking health care. It occurs with many disorders, diagnostictests, and treatments. It disables and distresses more people thanany single disease. Since nurses spend more time with the patientin pain than do other health care providers, nurses need tounderstand the pathophysiology of pain, the physiologic and psychological consequences of acute and chronic pain, and themethods used to treat pain. Nurses encounter patients in pain in avariety of settings, including acute care, outpatient, and long-termcare settings, as well as in the home. Thus, they must have theknowledge and skills to assess pain, to implement pain relief strategies, and to evaluate the effectiveness of these strategies,regardless of setting.

DEFINITION

The International Association for the Study of Pain defines pain as “an unpleasant sensory emotional experience associatedwith actual or potential tissue damage”A definition by Margo McCaffery, widely used in nursingsince 1968, reflects pain’s subjective nature. “Pain is whatever theexperiencing person says it is, existing whenever he says it does”.

TYPES OF PAIN

Pain is categorized according to its duration, location, andetiology. Three basic categories of pain are generally recognized:acute pain, chronic (nonmalignant) pain, and cancer-related pain.

ACUTE PAIN

Usually of recent onset and commonly associated with aspecific injury, acute pain indicates that damage or injury hasoccurred.

Pain is significant in that it draws attention to its existence andteaches the person to avoid similar potentially painful situations. If no lasting damage occurs and no systemic disease exists, acute pain usually decreases along with healing. For purposes of definition, acute pain can be described as lasting from seconds to 6months. However, the 6-month time frame has been criticized asinaccurate since many acute injuries heal within a few weeks andmost heal by 6 weeks. In a situation where healing is expected in 3weeks and the patient continues to suffer pain, it should beconsidered chronic and treated with interventions used for chronic pain. Waiting for the full 6-month time frame in this examplecould cause needless suffering.

CHRONIC (NONMALIGNANT) PAIN

Chronic pain is constant or intermittent pain that persists beyond the expected healing time and that can seldom be attributedto a specific cause or injury. It may have a poorly defined onset,and it is often difficult to treat because the cause or origin may beunclear.Although acute pain may be a useful signal that something iswrong, chronic pain usually becomes a problem in its own right.Chronic pain may be defined as pain that lasts for 6 months or longer, although 6 months is an arbitrary period for differentiating between acute and chronic pain. An episode of pain may assumethe characteristics of chronic pain before 6 months have elapsed, or some types of pain may remain primarily acute in nature for longer than 6 months. Nevertheless, after 6 months, most pain experiencesare accompanied by problems related to the pain itself. Chronic pain serves no useful purpose. If it persists, it may become the patient’s primary disorder. The nurse may come in contact with patients with chronic pain when they are admitted to the hospitalfor treatment or when they are seen out of the hospital for homecare. Frequently the nurse is called on in community-based settingsto assist patients in managing pain

CANCER-RELATED PAIN

Pain associated with cancer may be acute or chronic. Painresulting from cancer is so ubiquitous that after fear of dying, it isthe second most common fear of newly diagnosed cancer patients(Lema, 1997). More than half of the 1,308 cancer patients includedin a study conducted by Foley (1999) reported being in moderateto severe pain 50% of the time. Pain in the patient suffering fromcancer can be directly associated with the cancer (eg, bonyinfiltration with tumor cells or nerve compression), a result of cancer treatment (eg, surgery or radiation), or not associated withthe cancer (eg, trauma). Most pain associated with cancer,however, is a direct result of tumor involvement.

PAIN CLASSIFIED BY LOCATION

The previous discussion of acute and chronic pain is an example of the categorization of pain according to duration. Pain is sometimescategorized according to location, such as pelvic pain, headache, and chest pain. This type of categorization is helpful in communicating and treating pain. For example, chest pain suggests angina or a myocardial infarction andindicates the need for treatment according to cardiac care standards

PAIN CLASSIFIED BY ETIOLOGY

Categorizing pain according to etiology is another way to think about pain and its management. Burn pain and postherpetic neuralgia are examplesof pain described by their etiology. Clinicians often can predict the course of pain and plan effective treatment using this categorization

PATHOPHYSIOLOGY OF PAIN

The sensory experience of pain depends on the interaction betweenthe nervous system and the environment. The processing of noxious stimuliand the resulting perception of pain involve the peripheral and centralnervous systems.

PAIN TRANSMISSION

Among the nerve mechanisms and structures involved in thetransmission of pain perceptions to and from the area of the brain thatinterprets pain are nociceptors, or pain receptors, and chemical mediators. Nociceptors