Concept Analysis of Pain, Thesis Paper Example

The seminal importance of pain management is central to so many ailments. Pain is defined in terms of sensations of hurt, distress, and unpleasantness. Though these concepts are not quite the same as pain, they are often synonymous and/or symptomatic of it. Pain exerts a deleterious influence on the wellbeing of patients, dramatically affecting quality of life. In light of the considerable importance of pain management, a conceptual analysis of pain is vital for nursing practice.

Clinical Significance

Pain remains the most commonly-reported patient complaint, and is a major factor in undermining patients’ sense of wellbeing (Cheng, Foster, & Huang, 2003, p. 20). Nurses commonly encounter a plethora of different kinds of pain, posing considerable challenges for nursing practice (Montes-Sandoval, 1999, p. 935). In particular, nurses have encountered many difficulties attendant on the alleviation of pain, particularly because it is so widely variant across patients and ailments (p. 935). Chronic pain, for example, is the cause of tremendous suffering for those afflicted, and the economic impact in lost productivity and financial compensation is measured in millions of dollars (Martorella, Côté, & Choiniére, 2008, p. 417). The alleviation of pain, with all of the discomfort, unpleasantness, and suffering that it inflicts on patients, is therefore a major concern for nursing practice (Montes-Sandoval, 1999, p. 935).

Defining the Concept

According to the Online Etymology Dictionary (OED), the word ‘pain’ dates back to c. 1300, and had two usages: “’punishment,’ especially for a crime; also ‘condition one feels when hurt, opposite of pleasure’” (OED, 2012). The first usage is now obsolete, leaving only the second. The phrase ‘to give (someone) a pain’ means that one is being annoying and irritating; this usage dates to 1908 (OED). From 1924 on, a popular variant has been ‘pain in the neck’, which means the same thing. But pain is also a verb, i.e. ‘it pains me’: in this usage, the literal meaning is ‘to inflict pain’ (OED). Similarly, Merriam-Webster.com’s dictionary (2012) defines pain in terms of physical suffering; in terms of the sensation of pain itself as transmitted by the nerves, and in terms of grief or other emotional distress.

Pain has been conceptualized in a number of distinct and different ways throughout history, and across the disciplines. Hippocrates believed that pain was caused by an imbalance in the bodily ‘humors’; it was therefore the aim of medicine to ameliorate pain by righting the balance of the humors (Santoro & Savica, 2011, p. S134). For Plato, pain was emotional and soul-derived, as well as physical, and relieving it was necessary in order to experience pleasure (Cheng, Foster, & Huang, 2003, 21). From Late Antiquity through the Middle Ages, the regnant theories of pain included the idea that pain enabled its sufferers to experience Christ’s passion, as well as the idea that the contemplation of God was the surest remedy for pain (Santoro & Savica, 2011, p. S134).

In Western art, pain has been an important subject since Classical times. The Laocoon Group, which was discovered in 1506 in Rome, depicts the scene from the Iliad where the Trojan priest Laocoon and his three sons were attacked by great serpents after warning the Trojans not to bring the wooden horse into the city (Spivey, 2001, p. 21). Frozen in stone, this Laocoon seems to writhe and scream in agony (p. 25). And from the late sixth century on, Christendom began to depict Christ crucified (p. 48). Down the ages, the cross, a symbol of pain, death, and sacrifice, has remained an enduring symbol of the Christian faith (p. 48). The Isenheim Altarpiece, painted by Würzburg-born Renaissance artist Matthias Grünewald, depicts the suffering of Christ in graphic detail: the savior’s limbs are twisted, and his body’s many wounds pour out rivulets of blood (Janson & Janson, 2004, p. 535). In art, then, pain is depicted with wounds, with facial expressions that scream of agony, with twisted or writhing limbs.

The Gate Control Theory of pain, developed by Melzack and Wall (1965), proposes a view of pain that goes beyond sensory experience to encompass psychological aspects and effects of pain (Hadjistavropoulos et al., 2011, p. 911). As such, this perspective enjoins an analysis of pain not only through the biomedical lens, as a biophysical phenomenon, but also through the lens of psychology, as a psychosocial phenomenon (p. 911). This biopsychosocial approach has gained a great deal of acceptance, resulting in a much more complex understanding of pain (p. 911).

The psychological approach to pain delineates emotional pain from physical pain: emotional pain might be defined in terms of emotional or psychological distress, anguish, heartache, and the like (Snooks, 2009, p. 237). Pain may be emotional, but even physical pain can exert biopsychosocial effects (Barlow & Durand, 2012, p. 328). However, some individuals are capable of tolerating such pain, and even continuing to be productive and maintain their social lives, and this too is an important point: the psychology of pain is different for different patients (pp. 328-329).

In addition to psychology, then, one must also consider the influence of culture and society (Main & Spanswick, 2000, p. 44). In fact, different cultures define and experience pain in different terms. In one study, a comparison of individuals afflicted with back pain found that the degree to which the patients reported a deleterious impact varied internationally: the Americans, for example, reported the highest levels of impairment in the psychosocial and vocational domains, while New Zealanders and Italians fared much better (Sanders et al., 1992, ctd. in Main & Spanswick, 2000, p. 44). Cultural values and perceptions with regards to pain vary: for example, in a study of lower back pain amongst Southeast European immigrants to Switzerland, Scheermesser, Bachmann, Schamann, Oesch, and Kool (2012) found that they preferred passive approaches to treatment, relying heavily on medication and rest (pp. 5-6). The problem was that the patients were going against sound medical advice, which counsels increased activity (p. 6).

Antecedents and Consequences

In the simplest biomedical terms, pain is caused by a stimulus, which typically damages cells. The stimulus causes the release of pain-bearing substances, which affix themselves to the nociceptors, causing a transmission to the brain that is perceived as pain (Clancy & McVicar, 1992, p. 8). Pain, then, is an unpleasant sensation in the brain correlated with suffering. This is the simplest and most accurate way to define it from a biomedical and neurological perspective. However, pain is mediated and contextualized by a whole host of individual, psychological, social, and cultural factors: different individuals perceive pain differently. The emotional and psychological state of the individual exerts a significant influence on pain. Even in the case of chronic pain, individual factors such as physical and mental health and quality of life matter a great deal in determining how central the pain is to the patient (Nicolaidis, Chianello, & Gerrity, 2011, p. 615).

What is clear is that pain is an unpleasant, distressing experience which entails suffering (Merriam-Webster.com, 2012). It may also, as seen, entail emotional distress. Suffering and emotional distress may be concomitant with pain, causes of pain, or even consequences of pain, but they are not pain itself, at least not in all cases: suffering, for example, is an experience that may be precipitated by pain, but it is concerned more specifically with negative affect (Cheng, Foster, & Huang, 2003, p. 23). Of course, in common usage, much suffering is pain; thus, these concepts are often quite synonymous. Discomfort may describe mild pain, but it may also be distinguishable from pain, in that pain is generally experienced and defined as much sharper and more intense; moreover, pain often has psychological ramifications well beyond those of discomfort (p. 23). Depression may be thought of as a kind of mental pain; certainly it afflicts those who suffer from it (Main & Spanswick, 2000, p. 22). However, depression is not pain, strictly speaking: it is a state of mind characterized by negative affect, and it can reduce the sufferer’s ability to tolerate pain (p. 22).

Model Case: Having defined pain, it now remains to construct a model case exemplifying salient features of the concept. Mr. George Robinson is a 72-year-old man who has been suffering from terrible headaches, localized in the occipital region of the skull, as well as attendant pains around the ear, and in the neck, shoulder, and upper right arm. He has difficulty carrying things in his right hand, and his handwriting has deteriorated. He is diagnosed with neurogenic thoracic outlet syndrome (TOC). He confides in Jake, the 34-year-old nurse responsible for his care: “I can’t do half the things I used to do,” he says in disgust, explaining that he once served in the army, and later had a highly successful career building homes. “I knew getting old would be rough, but lately I feel like less than a man.” Mr. Robinson’s case exemplifies all the aspects of pain: the neurogenic TOC has not only detracted from his physical comfort, but also dramatically impeded his quality of life. Moreover, because of his individual experiences and cultural values, Mr. Robinson values hard work and physical activity: he interprets his condition as an affront to his sense of manhood.

Other Cases: The borderline case does not include all of the elements of the model case. Rebecca is a 22-year-old woman who enjoys kayaking, mountain-climbing, and hiking. After taking a fall while on a hike with friends, she is taken to the hospital and treated for assorted minor abrasions and a few lacerations, as well as a broken radius. Despite her injuries, Rebecca is remarkably cheerful. She tells Jake, the nurse on duty, that her parents “brought me up to be tough. It’s only a few scratches.” Rebecca may be experiencing some discomfort, but she is upbeat and gives no indication of being in pain. Thus, this is a borderline case.

The related case is similar, but not quite the same. Frank is 55, a lifelong smoker who has been diagnosed with lung cancer. He is married, with two young children. He has begun chemotherapy, but his prognosis is not good. The chemotherapy has taken a tremendous toll on his body, weakening him. He tells the nurse on duty: “Every day is agony. I look at my wife and kids and I say, ‘How could I be so stupid as to do this to myself? To them?” Frank is experiencing anguish and remorse: he is suffering, but not because of his own pain. The contrary case differs again: it is not the concept. Katie is a 8-year-old girl who hates going to the doctor. A bad case of appendicitis lands her in the hospital, and she remains there for a day to recover. Tearfully, she asks her parents to take her home: “I don’t like it here,” she says. Katie’s complaint has nothing to do with her own condition, and everything to do with her situation.

Conclusion: This concept analysis demonstrates the considerable importance of pain to nursing practice. Pain is the most common complaint, and it is associated with many disorders and ailments. It is essential for nurses to understand how different individuals process pain, due to their own psychological and mental makeup, as well as the cultural and social influences that affect them. Pain management, the alleviation and amelioration of pain, is central to the nursing practice precisely because pain is so disruptive and unpleasant, and exerts so many unfortunate effects on patients’ lives.

References

Barlow, D. H., & Durand, V. M. (2012). Abnormal psychology: An integrative approach (6^th ed.). Belmont, CA: Wadsworth.

Cheng, S., Foster, R. L., & Huang, C. (2003). Concept analysis of pain. Tzu Chi Nursing Journal, 2(3), pp. 20-30.

Clancy, J., & McVicar, A. (1992). Subjectivity of pain. British Journal of Nursing, 1(1), pp. 8-10. Retrieved from http://www.search.ebscohost.com/

Hadjistavropoulos, T., et al. (2011). A biopsychosocial formulation of pain communication. Psychological Bulletin, 137(6), pp. 910-939. DOI: 10.1037/a0023876

Janson, H. W., & Janson, A. F. (2004). History of art: The Western tradition. Upper Saddle River, NJ: Pearson Education.

Main, C. J., & Spanswick, C. C. (2000). Pain management: An interdisciplinary approach. London, UK: Harcourt Publishers, Ltd.

Martorella, G., Côté, J., & Choiniére, M. (2008). Pain catastrophizing: A dimensional concept analysis. Journal of Advanced Nursing, 63(4), pp. 417-426. DOI: 10.1111/j.1365-2648.2008.04699.x

pain. Merriam-Webster.com. (2012). Retrieved from http://www.merriam-webster.com/

Montes-Sandoval, L. (1999). An analysis of the concept of pain. Journal of Advanced Nursing, 29(4), pp. 935-941. Retrieved from http://www.search.ebscohost.com/

Nicolaidis, C., Chianello, T., & Gerrity, M. (2011). Development and preliminary psychometric testing of the centrality of pain scale. Pain Medicine, 12(4), pp. 612-617. Retrieved from http://www.search.ebscohost.com/

Online Etymology Dictionary. (2012). “Pain.” Online Etymology Dictionary. Retrieved from http://www.etymonline.com/

Santoro, D., & Savica, V. (2011). Development of the concept of pain in history. Journal of Nephrology, 24(17), pp. S133-6. DOI: 10.5301/JN.2011.6481

Scheermesser, M., Bachmann, S., Schamann, A., Oesch, P., & Kool, J. (2012). A qualitative study on the role of cultural background in patients’ perspectives on rehabilitation. BMC Musculoskeletal Disorders, 13(1), pp. 5-17. DOI: 10.1186/1471-2474-13-5

Snooks, M. S. (2009). Health psychology: Biological, psychological, and sociocultural perspectives. Sudbury, MA: Jones and Bartlett Publishers.

Spivey, N. J. (2001). Enduring creation: Art, pain, and fortitude. Berkeley and Los Angeles, CA: University of California Press.