Pain: an account of nurses' talk

This paper examines how nurses refer to pain and pam management in their talk The documentation of talk was established after engaging a group of five nurses in a series of in-depth unstructured interviews lastmg approximately 1 hour, in which they were encouraged to discuss their ideas regarding how postoperative pain should be managed, to render it more effective as an aspect of patient care However, the talk revealed that nurses tended to categorize patients according to symptoms or overt pain behaviours This essentially resulted in patients not being believed when they signalled that pam was becoming a distressing symptom The paper also discusses how nurses' knowledge regarding pain and pain management influences the way in which they manage postoperative pain     

Assessment of neuropathic pain in the community

The purpose of this paper is to provide the reader with evidence basedclinical guidance regarding assessing neuropathic pain. Persistent pain is a huge burden on health-care provision and the prevalence of persistent neuropathic pain is likely to increase owing to the ageing population. The provision of appropriate relieving interventions depends on accurate assessment. This paper sets out to provide the reader with simple neuropathic assessment tools that can be applied to community care. This will allow the community nurse to identify patients who have neuropathic pain and will therefore enable appropriate management.     

Exploring the nursing role in pain management from a post-structuralist perspective

The way in which discourses influence understandings of pain and the management of pain by nurses has received little attention in the nursing literature This is particularly apparent with the taken-for-granted practice of using self-reports of pain as the basis for the development of treatment regimes designed to manage that pain This paper uses a post-structural frame to analyse the way in which pain itself, and the management of that pain, are texts which are discursively constructed In so doing it opens up possibilities for a 'different' nursing role in the management of pain     

Update in cancer pain syndromes

Cancer pain assessment and management are integral to palliative medicine. This paper reviews recent publications in the period 1999-2004 in the broad categories of epidemiology, pain assessment, nonpharmacologic approaches to cancer pain (radiation therapy, anesthetic blocks, palliative surgery and chemotherapy, complementary and alternative medicine), and in nociceptive pain, neuropathic pain, visceral pain, and bone pain.     

Psychological approaches to chronic pain management: part 1

Aims and objectives. The aim of this paper is to provide an overview of the theoretical basis and application of psychological interventions used in the management of chronic pain. In doing this, psychological factors mediating pain and disability will also be reviewed. Background. A biopsychosocial model of chronic pain is widely purported and pain management is often based upon cognitive–behavioural principles as psychological factors meditating pain and disability have been found to include emotional, cognitive and behavioural components. Conclusions. This paper provides support for a biopsychosocial model of and for the effectiveness and efficacy of psychological interventions for the management of chronic pain conditions. Relevance to clinical practice. The application of psychological approaches to chronic pain management is reviewed and discussed. The way in which psychological approaches may be integrated specifically into nursing management of chronic pain is discussed in a later paper.     

Pain and families. I. Etiology, maintenance, and psychosocial impact

This is the first part of a two-part extended review on the interdependency between chronic pain and families. This paper will address the role of the family in the etiology and maintenance of chronic pain and will describe the reciprocal impact of chronic pain on families. Different conceptualizations of the role of the family and the available empirical evidence related to 3 central questions, namely, 'do families play an etiological role in chronic pain?,' 'does the family maintain the chronic pain problem?,' and 'is there a negative impact of chronic pain on the family?' will be critically examined. The second, companion paper will address the issue of the inclusion of family members in the assessment and treatment of chronic pain. Finally, recommendations for future research will be made.     

Deafferentation and chronic pain in animals: an evaluation of evidence suggesting autotomy is related to pain

This paper examines evidence which suggests that the self-mutilation of deafferented limbs exhibited by laboratory animals is a response to pain or dysesthesia and is therefore an adequate model of chronic pain. Evidence from studies using physiological, pharmacological and behavioral methods provides strong support that autotomy reflects chronic pain. New evidence presented in this paper demonstrates that specific treatments can be used to manipulate the extent of autotomy, causing increases or decreases, as well as restricting it to specific parts of a denervated foot. This evidence argues that autotomy scores are an appropriate measure of the degree of pain or dysesthesia which results from the deafferentation of a limb.     

分娩疼痛的护理干预

分娩疼痛是一种生理反应，其影响因素较多。本文系统地论述了分娩疼痛的来源及护理干预措施的进展，旨在说明可通过护理干预提高产妇的痛阈，降低其对疼痛的感受，增强其乐观面对分娩过程及从容应对分娩疼痛的能力，从而缓解分娩疼痛，减少催产药物和麻醉药物的使用。     

When morphine does not work

Up to 70% of patients with cancer should be expected to experience pain during the cancer illness. This is clearly more likely as disease progresses. The World Health Organisation (WHO) cancer pain guidelines remain the key to following a simple and systematic approach to cancer pain control in approximately 80% of patients. This approach was never intended to be used in isolation of various non-pharmacological approaches, including tumouricidal therapies. However, lateral thought when managing challenging cancer-related pain becomes even more critical. This paper reviews the approach to the approximately 20% of patients who do not respond to the standard WHO three-step analgesic ladder approach and of course, by definition this means in practice those patients with severe pain which is not controlled by morphine or alternative strong opioids. Such cancer pain can be broadly categorised as opioid irrelevant pain, opioid partially responsive pain, opioid unresponsive pain or pain resulting from excess opioid.     

Current status and future direction of pain behavior observation

Individuals who have pain engage in certain pain-related behaviors that tend to communicate their pain to others. There is growing recognition that the careful observation of such pain behaviors is an important component of a comprehensive pain assessment.This paper provides an overview of the current status of behavioral observation methods used to assess pain behavior.The first half of this paper describes and evaluates the most commonly used pain behavior observation methods.These include selfobservation methods such as activity diaries, and direct observation methods such as the use of standard behavior sampling methods and naturalistic observation methods. The second half of the paper discusses several important future clinical and research applications of pain behavior observation methods.The need to develop practical, clinical methods for incorporating pain behavior observation methods into practice settings is emphasized. Important future research topics include studying the social context of pain behavior (eg, by examining how spouses respond to displays of pain behavior), examining the predictive validity of pain behavior (ie, how observed pain behaviors predict future disability and impairment), and identifying pain behavior subgroups within heterogeneous chronic pain populations. Further development and refinement of pain behavior observation methods is likely to increase our understanding of the varied ways that patients adapt to persistent pain.     

国内外疼痛的管理现状

疼痛作为一种常见的临床症状，已成为护理工作的重要内容。文章综述了疼痛的定义、分级、管理标准，重点介绍了疼痛的评估方法和缓解措施，为临床护理人员进行有效的疼痛管理提供依据，以提高疼痛的管理水平和患者的生活质量。     

疼痛护理质量评价体系的研究进展

本文通过查阅文献,了解国外先进疼痛管理指南及疼痛管理质量评价体系,总结了疼痛护理质量管理评价体系的研究进展。为我国建立规范的疼痛护理质量评价体系,完善疼痛护理相关制度,培养疼痛护理专业人才,促进最佳疼痛护理实践提供参考。     

The value of thorough assessment in the management of cancer pain

The number of patients likely to require management of cancer pain is increasing. However, although modern analgesia can help most patients achieve complete pain relief, some studies report widespread under-treatment of all types of pain. This paper describes approaches that health professionals can employ to ensure optimum pain management.     

Swearing as a Response to Pain—Effect of Daily Swearing Frequency

Previously we showed that swearing produces a pain lessening (hypoalgesic) effect for many people.²⁰ This paper assesses whether habituation to swearing occurs such that people who swear more frequently in daily life show a lesser pain tolerance effect of swearing, compared with people who swear less frequently. Pain outcomes were assessed in participants asked to repeat a swear word versus a nonswear word. Additionally, sex differences and the roles of pain catastrophizing, fear of pain, and daily swearing frequency were explored. Swearing increased pain tolerance and heart rate compared with not swearing. Moreover, the higher the daily swearing frequency, the less was the benefit for pain tolerance when swearing, compared with when not swearing. This paper shows apparent habituation related to daily swearing frequency, consistent with our theory that the underlying mechanism by which swearing increases pain tolerance is the provocation of an emotional response.

Perspective

This article presents further evidence that, for many people, swearing (cursing) provides readily available and effective relief from pain. However, overuse of swearing in everyday situations lessens its effectiveness as a short-term intervention to reduce pain.     

癌症患者及家属对癌性疼痛药物治疗认知的研究进展

综述了癌症患者及家属对止痛药物错误的认知及信念,家属错误的认知及信念对疼痛控制的影响,以及疼痛教育对改正错误认知的效果.以期为癌性疼痛的有效控制及针对患者、家属的疼痛教育提供有力参考.     

Multimodale Schmerztherapie für die Behandlung chronischer Schmerzsyndrome

Multimodal pain management is a comprehensive treatment of complex chronic pain syndromes. In addition to medical therapy various other specialized therapeutic interventions based on the biopsychosocial model of pain origin and chronic pain development, are added. During the last few years treatment centers for chronic pain have been established throughout Germany. Multimodal pain management has been included in the official catalogue of the recognized medical procedures for day clinic units as well as for inpatient pain management. In daily practice there is, however, still a lack of clarity and of consistency about the components that multimodal pain management should contain. This is the reason for the ad hoc commission on multimodal interdisciplinary pain management of the German Pain Society to propose the following position paper that has been worked out in a multilevel and interdisciplinary consensus process. The paper describes the mandatory treatment measures in the four core disciplines of multimodal pain management, pain medicine, psychotherapy, exercise therapy including physiotherapy and assistant medical professions including nurses.     

Pain and families. II. Assessment and treatment

This is the second part of an extended review on pain and families. The first paper dealt with the role of the family in the etiology and maintenance of chronic pain and discussed the impact of chronic pain on families. The paper will examine the role of the family in the assessment and treatment of chronic pain. Finally, problems of the theoretical models and empirical studies reviewed will be discussed and suggestions for future research will be presented.     

Pain, anxiety and powerlessness

This paper explores the subject of postoperative pain, touching on the theories of the physiological mechanisms by which pain is perceived and exploring in some detail the literature on those factors which affect the pain experience. The need for a detailed assessment of the pain which an individual experiences is suggested by this study of the literature. This concept is explored in some detail. The author explores the relationship between pain and anxiety, commenting on that which affects patients undergoing surgery. The relationship between anxiety and perceived helplessness or powerlessness is also discussed. The paper concludes by drawing together the information from the literature reviewed and the author suggests a hypothesis that pain, anxiety and perceived powerlessness have an effect on each other. There is a suggestion that decreasing perception of powerlessness may decrease the intensity of the pain experience for the individual. It is suggested that this is an area for future research into postoperative pain management.     

The muscle pain of conflict,submissiveness and grief

Physiotherapists use electromyographic (EMG) techniques to look at muscle strength, and can also examine muscle behaviour. This paper examines the manner in which pain appears to result from the sustained muscle contraction that expresses unresolved emotion that may, indeed, be reactive to pain, thus forming a pain-perpetuating factor. This theory of pain perpetuation by the muscle activity of emotion is presented, and is illustrated by case examples. A discussion follows in which the literature pertaining to the muscle activity of emotion, and pain philosophy relevant to this situation, are introduced.