Pain is a commonly experienced phenomenon among patients. Despite the commonality of the phenomenon of pain, it is a complex concept to describe and explain. There are different types of pain that are diagnosed using different metrics in primary care –somatic, neuropathic, and visceral pain, depending on the location of the pain on the body. Pain can also be acute or chronic, based on the length of time that a patient has experienced the pain. Due to the complexity of the phenomenon of pain, it is poorly understood in the nursing practice. Performing a concept analysis of pain is imperative in understanding the phenomenon, in addition to allowing critical thinking about the concept. Understanding the concept will contribute to significant knowledge about the concept and its management. The purpose of this paper, therefore, is to perform a concept analysis of pain, with the aim of gaining deeper understanding about the phenomenon and how it can be effectively managed in practice.
Definition
The complexity of the concept of pain makes its definition difficult, as Nottingham University Hospital NHS (2016) posits that two individuals may experience similar situations causing pain, but the description always differs. The fact that pain cannot be directly measured is another complication, and it makes the definition elusive. However, the concept has been defined by various people, and a comparison of the different definitions helps in identification of its common characteristics. Johns Hopkins (2016) defines pain as an uncomfortable sensation such as a throbbing, stabbing, or pinching. Pain in itself is a symptom, and identifying the underlying condition or cause of the pain is critical in treating it. Pain decreases the quality of life of a person and may even cause other outcomes like irritability, depression and anger (IASP, 2014).
Cheng, Foster and Huang (2003) define pain as “a complex and multidimensional phenomenon that is subjective and unique to each individual”. Pain is not only difficult to describe, but it is also hard to measure, as a nurse largely depends on the individual descriptions of patients to define it. Pain is an uncomfortable, distressful and unpleasant feeling or sensation that affects the quality of life of an individual if left untreated. The medical dictionary defines pain as an unpleasant sensation that the sensory neurons convey to the brain to signal potential injury to the body. The International Association for the Study or Pain, IASP (2014), defines pain as the “unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.
The above definitions of pain elucidate some common characteristics of pain, irrespective of the location, onset, and progression of the concept. It is clear that pain is a subjective sensation that causes discomfort and displeasure to the affected person. The definitions also indicate that the subjectivity of the concept of pain makes it difficult to describe and explain which consequently makes it challenging to diagnose and manage. Each individual explains the feeling of pain based on his/her experience, which also varies depending on the stimuli. IASP posits that pain is not only physical, but also an emotional experience as it is an unpleasant sensation. The working definition of pain that will be used in this paper is “A subjective unpleasant discomfort resulting from nerve stimulation’
Model Case
Junior is a 7 year old boy who hurt his leg in school while playing football. He presents to the office for dressing, and when the doctor starts to remove the dressing, the boy starts to cry uncontrollably. He is also heavily heaving and closes his eyes when the nurse touches the bandages. The boy’s blood pressure and heart rate are elevated, and he grimaces and guardedly tries to prevent the nurse from accessing the hurt area. The boy admits that he is in pain, but he can’t point out the particular area in pain. The nurse gives the boy pain relief medications, but the rest of the procedure to remove the bandage is characterized by wailing from the boy. The area seems to be healing well, and after the removal of the bandage smiles at the nurse satisfactorily.
This model case indicates the critical characteristics of pain, including the unpleasant discomfort emanating from nerve stimulation. The damage to the tissues in the arm stimulates the painful sensation. Also, the case reveals that pain is subjective. While the pain should be localized on the injured area, the boy says that he feels pain all over his body. It is also evident from the case that pain is very subjective, as the boy initially cries of pain, but upon removal of the bandage, smiles at the nurse. Junior may have had a perception of the pain he would feel during the bandage change, hence the wailing, whereas in the real sense, the wound was healing well and therefore, pain should have been minimal. His initial vague description of pain is another critical characteristic of pain.
Contrary Case
Bree is a 16 year old white female who presents to the office with superficial injuries to her wrists and the back of her hands. The wounds seem to be self-inflicted, and her medical history indicates that she has tried to commit suicide before, as evidenced by darker scars on the same places. The investigation of the wounds doesn’t agitate Bree, and she doesn’t seem to be in pain. Touching of the wounds doesn’t produce any discomfort for the patient. The patient remains non-partisan to what is going around during the assessment.
This model case indicates the absence of the key attributes of pain. The patient doesn’t respond appropriately, and shows no indication of discomfort or distress during the assessment of the wound. She also seems remotely unaware that her wounds are stimuli for pain, and remains non-participative to the fact that her behavior is potentially fatal. Her noxious behavior doesn’t prompt protective mechanism reactions. This case is contrary, as it lacks all the critical characteristics of the concept of pain.
Related Case
Jake is a five year old boy who is suffering from kidney failure and requires dialysis twice in a week. When his parents bring him to the hospital, he starts to cry, saying he wants to go home. The parents are clearly frustrated, as the dialysis is the only way of survival for their son until he gets a donor. Jake is clearly irritated by the fact that he has to come to the hospital so often, in addition to the fact that his condition limits him from engaging in activities that kids his age enjoy. Jake’s parents are more concerned about the lack of a donor, as the delay worsens Jake’s prognosis. The comfort each other as they try to calm Jake down for his dialysis appointment. Jake’s are in anguish due to the unstable and unpromising condition of their son. They indicate that it is painful that there is nothing they can do for their son, other than watch his suffer.
The above case is an indication of key characteristics of pain that are present in another concept similar to pain. Grief and anguish are phenomena that cause pain and sadness in a person. Jake’s parents are in anguish due to the imminent threat on their son’s life. These phenomena are similar to pain in that they cause distress and discomfort, just like pain. Anguish and grief are also subjective, as different people describe the feelings differently. However, unlike pain, grief and anguish aren’t the result of mental misconceptions about a situation. It is categorical that prognosis of Jake worsens by the day if a donor is not found soon.
Antecedents and Consequences
Antecedents refer to certain events of circumstances that must be present before a concept occurs. Understanding the antecedents of a concept is vital in the effective management of the concept. The antecedents of pain include internal or external noxious stimuli that cause discomfort, physical and psychological awareness of the stimuli by the patient, and the perception of the stimuli as pain. Consequences refer to the outcomes of the occurrence of a concept. The consequence of pain include; verbal or non-verbal response to the stimuli being perceived as pain, use of protective mechanism to shield oneself from the perceived pain, and the response of others to the pain in an effort to reduce the uncomfortable sensations.
References
Cheng, S. F., Foster, R. L., & Huang, C. Y. (2003). Concept analysis of pain. Tzu Chi
Nursing Journal, 2, 20-30.
IASP. (2014). IASP taxonomy. Retrieved from http://www.iasp-pain.org/Taxonomy#Pain
Johns Hopkins Medicine. (2016). What is pain/types of pain treated? Retrieved from
http://www.hopkinsmedicine.org/pain/blaustein_pain_center/patient_care/what_is_pain.html
Nottingham University Hospitals NHS. (2016). What is pain. Retrieved from
http://www.nuh.nhs.uk/our-services/services/nottingham-back-and-pain-team/what-is-pain/
