Pain Management and Quality of Life, Research Paper Example

Patients with a variety of disorders suffer from chronic pain, but there is no scientific consensus as to what constitutes effective pain management. However, many studies have been enacted to determine the relationship between pain management techniques and patient quality of life. Quality of life surveys serve as an ideal way to measure the efficacy of chronic pain treatment and can be used as a tool in evidence based practice to add to the knowledge base of the nursing field. Thus, this experimental strategy can be used to deduce whether ineffective pain management affects the quality of life of patients who suffer from chronic pain. Two theories that can be used to explain how patients with chronic pain exhibit their symptoms include the gate control theory and the cancer theory. Briefly, the gate control theory states that thoughts and emotions influence pain perception via a gating mechanism of the dorsal horn of the spinal cord (Melzak, 1996). The cancer theory states that patients have unique pain experiences based on the specifics on each individual situation (Im, 2006). Therefore, the degree of a pain management techniques impact on patient quality of life can be assessed using principles from either method.

The gate control theory is a middle range theory that resulted from many studies initiated by Ronald Melzack and Patrick Wall in an attempt to gain a greater understanding of the causes of pain. This work was built primarily upon the specificity theory and the pattern theory, which were developed in 1894 and were considered to be mutually exclusive concepts. Ultimately, the gate control theory was developed through Melzack and Wall’s ability to accept and refute various aspects of both concepts into one term that would have greater scientific acceptance.

The specificity theory states that pain receptors contained within the body’s tissues connect to a pain center in the brain. Nerve endings are therefore defined as pain receptors, while the pain center exists in the thalamus. This is somewhat reasonable and agrees with our modern understanding of physiology, but deviates from this knowledge by assuming a variety of psychological factors as explanation for this process. Frey and Goldscheider had proposed that the pain receptors found in the skin responded only to “intense, noxious stimulation”, which “implies a direct connection from the receptor to a brain center where pain in felt”. Furthermore, this theory stated that activation of these receptors would always lead to pain. However, modern science has indicated that nerves are essentially these pain receptors and that they may not necessarily interact directly with the brain, nor exclusively lead to pain symptoms. Rather, nerves are a complex network that ultimately resolve in the brain to confer a variety of sensations to an individual. Meanwhile, the pattern theory states that “stimulus intensity and central summation are the critical determinants of pain”. Stimulus intensity can be seen to be synonymous with the concept of pain input, which is necessary for people to feel pain. However, a major flaw in this principle is that it ignores the physiological specialization of pain. Since the intensity of pain received is not the only factor that impacts its perception, it was necessary to build upon these two theories in the 1960’s, when more knowledge had been acquired concerning human physiology.

The gate control theory of pain is comprehensive and provides gaps in the information presented by the specificity theory and the pattern theory. It attempts to understand the connection between the spinal cord and the physiological sensation of pain, which modern scientists have confirmed to share a relationship. Essentially, the theory states that “stimulation of the skin evokes impulses that are transmitted to three spinal cord systems: the cells of the substantia gelatinosa in the dorsal horn, the dorsal-column fibers that project toward the brain, and the first central transmission (T) cells in the dorsal horn”. The authors ultimately proposed that the substantia gelatinosa functions as a gate control system that monitors afferent patterns before the transmission cells are influenced, that these patterns activate selective brain processes, and that the transmission cells are responsible for activating neural mechanisms that define response to the stimuli. Although little was known about the complexities of neuroscience during the time in which this theory was postulated compared to modern science, the basis of the theory accurately describes how people feel pain. In short, people sense stimuli because of the nerve network that exists in our skin and organs, and this stimuli is converted into pain that can be perceived in the brain.

Since the original research paper introducing gate control theory was published in 1965, healthcare professionals have been able expand their knowledge of the pain detection and perception process. Today, we refer to pain receptors as nociceptors, which are capable of detecting signals from damaged tissue and respond to chemicals that they release to notify the body of damage (Byrne, 2014). Several different types of nociceptors exist and different types typically exist in different forms of tissue. A variety of biology factors, such as enzymes, hormones, and neurotransmitters are capable of activating these receptors in response to damage. This response typically creates an action potential on the nerve that allows a message to be sent to the brain when a chemical is present at its appropriate dose.

An alternative theory that is used to describe pain is the cancer theory. Research that supports this concept states that it is important to consider each individual’s pain experiences and to treat them based on these differentials. Many researchers therefore believe that a reasonable solution to treating pain is based on the ability of healthcare practitioners to determine the physiological needs of patients based on their biological factors. A recent example of this was the exploration of pain needs according to the individual’s ethnicities of patients (Im, 2006). This concept assumes that individuals that share the same ethnicity share the same biological characteristics and would therefore benefit from similar pain treatment methods.

The cancer theory states that patients have unique pain experiences based on the specifics on each individual situation (Im, 2006).

Many previous studies have indicated that race acts as a confounding factor in understanding the relationship between disease risk and disease prevalence. Therefore, it is important to consider demographic characteristics while treating patients for pain related symptoms as well, according to evidence-based practice. However, it is important to understand while the cancer theory is beneficial because it educates researchers as to the biological basis of all disease, it is not always feasible to diversify treatment on this basis. A common example of the need to patients based on their individual biology is within the realm of cancer research. Recently, many healthcare professionals have been studying cell surface receptor proteins to determine their relationship with specific cancers (Kong et al., 2009). The ultimate goal of this research is to produce pharmaceuticals that target cell receptors that are specific to certain cancers, thereby allowing targeted therapy. This process is beneficial because it will allow physicians to target these tumors more directly with a smaller change of poisoning healthy cells. On the other hand, this process would be ineffective if the tumor biomarkers that are targeted have a low representation in the overall population. A similar situation would arise in the treatment of pain on the basis of patient ethnicity. Although these patients have a similar genetic predisposition to certain pain symptoms, it is unscientific to assume that the cause of their pain is similar, even among those that share the same condition. Therefore, it is expected that treating patients in this manner would result in a lesser quality of life for the patients.

Gate control theory is a more appropriate method to use in the assessment of pain management and chronic pain. Currently, a majority of the pharmaceuticals that are used to prevent are reduce pain target the nervous system. By competitively blocking or altering the nociceptors in the body, we can prevent the pain of individuals. Doing so blocks the signal transduction process on the nerve, therefore preventing the pain message from being sent to the brain. Although the underlying medical reason for the pain is not treated during this process, it is occasionally warranted for patients who have severe cases of pain. In other situations, it would be reasonable to block the production of the ligand to the nociceptors altogether, which would also prevent the nerve from signaling the pain message to the brain. The gate control theory is therefore an effective model for rational drug design for these patients. Since it explains how pain is sensed and then perceived, pharmacologists can use the understanding of this process to design drugs that will block a patient’s pain at several steps of this process.

Using the gate control theory, the relationship between ineffective pain management and the quality of life of patients can be studied on the basis of pharmaceuticals that are used for a variety of pain management processes. For example, cancer patients are typically provided with pain medication depending on the severity of their pain. For mild to moderate pain, pain relievers such as acetominophen and NSAIDs, are given. For moderate to severe pain, narcotic pain relievers, such as codeine, morphine, and hydrocodone, are given. An additional pain class experiences by cancer patients, including tingling and burning pain, are typically treated using antidepressants, anticonvulsants, and steroids. Thus, gate control theory can be used to understand how each of these drugs work for each patient, which will allow researchers to conclude whether or not treatment constitutes effective pain management and contributes to an improved quality of life.

A major concern in chronic pain treatment is often the determination of which treatment methods are most effective. Although the drugs that are currently used for this purpose are well-documented, little is known about combination therapy. Furthermore, it is difficult for healthcare professionals to fully understand the certain combination theories that will be most effective in particular situations. Therefore, in order to truly understand the relationship between pain management and patient quality of life, it is necessary to study a variety of medical scenarios. For this purpose, both literature and databases should be searched in an effort to determine situations in which combination pain treatment has been effective and when it has been ineffective. It is then essential to note the specific treatment method used in addition to the demographics of the patient. In this way, a comprehensive retrospective study can be completed that studies the relationships of these drugs with patient quality of life.

To effectively use our modern understanding of the gate control theory in pain management, it would be ideal to begin the study of the relationship by considering the treatment of chronic pain in only one disease. Furthermore, the efficacy of treatment in retrospective studies using only one treatment method should be compared to the efficacy of studies that use combination therapy. Thus, the treatment method used to manage pain will represent the independent variable, while patient quality of life will be the measured outcome, or the dependent variable. This search should be limited to studies that have been conducted since the year 2000 and should include a variety of medical databases. It will not be necessary to gain IRB approval for this particular study, as patient identifiers will not be used during the research process. Only studies that consider patient quality of life as an outcome will be utilized for this purpose.

It is necessary for me to narrow down my clinical research question in order to avoid a variety of confounding variables that would alter the validity of my results. Therefore, I propose studying the relationship between pain management and patient quality of life within the scope of elderly patients who have suffered from fractured hips. The inclusion criteria will therefore be both male and female patients over the age of 65, who suffered from their first hip fracture. To ensure that the information retrieved is targeted, primarily orthopedic databases and journals will be searched. Exclusion criteria for this study will be patients who use pain medication illegally or those who are on pain medication for severe symptoms for other illnesses in order to reduce the amount of confounding variables observed. The goal of this study will be to determine the efficacy of a variety of pain treatment methods, including those that block the nerves from transmitting pain signals to the brain, those that utilize spinal analgesia, and those that utilize systemic analgesia. Studies that utilize combination therapy and alternative medicine as treatment methods will also be addressed. The gate theory of pain will be utilized in order to gain a scientific understanding of why the most effective pain management methods work, the results of which can be applied to other patient groups with other pain related symptoms in future studies. If this study finds that there is a strong relationship between pain management modality and improved patient quality of life, it may be necessary to perform a prospective study to validate these findings. Ultimately, studies of this kind are valuable because they contribute to evidence-based practice. Since little studies have demonstrated an ideal pain management system in patients with a variety of pain symptoms, it is essential to contribute to the existing literature on this topic.

References

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