Pain: A Concept Analysis
Purdue University Northwest
Pain: A Concept Analysis
Pain is at once quantifiable and unknowable. The peculiar nature of the perception of pain makes it both perplexing difficult to grasp. How the human body can either heighten or lessen the sensation of pain depending on circumstance is still not completely understood by modern science. One of the greatest mysteries concerning pain is the subjective nature of it. Individual sensitivities to pain continue to pose a challenge in the healthcare setting (Coghill, 2010).
Pain can create in an otherwise calm and rational person a sensation of anxiety and fear. This can drastically alter both the physical and emotional behaviors in an individual, causing him or her to act in a way contrary to the norm. In a healthcare setting, this can transform a patient who was once compliant into one that is at risk of causing harm to his or her self or others. To be better equipped to deal with pain, it’s necessary to define it or at least to define its major attributes.
Despite being highly variable depending on the individual experiencer, one commonality exists when referring to pain: according to the individual, it is present. Pain is described by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (Merskey and Bogduk, 1994). Interestingly, pain is referred to here as being associated with “actual or potential damage”, suggesting that even when no actual damage to tissue exists, the sensation of pain is still present for the individual. This can pose a challenge when interacting with a patient who claims to be experiencing pain when the healthcare professional cannot immediately observe any reason for such pain to exist. The perception of pain is also dependent on variables such as tolerance, sensitivity, and past experience.
It’s been long theorized that pain tolerances (at least the reporting of such tolerances) are largely influenced by cultural and religious backgrounds. For example, certain cultures such as Australian aborigines or rural Nepalese maintain abject stoicism regarding pain, even if such pain is chronic (Peacock and Patel, 2008).
In line with such an observation, Dr. Mary Moore Free posed the following question:
“Why do Asian patients rarely ask for pain medication while patients from regions on the Mediterranean coast prefer pain medication for the slightest discomfort?” (2002).
Studies have also shown that pain tolerance can be influenced by religion. To illustrate, during a study in Canada of patients who suffered from at least some form of chronic pain, it was discovered that those who claimed to be religious tended to be less afflicted with chronic pain and fatigue than those who were either spiritual (though not affiliated with regular religious worship) or not spiritual at all (Baetz and Bowen, 2008). This was found to be due to the religious individuals feeling depressed less frequently than the spiritual or completely non-religious patients. This lack of depression contributed to positive coping strategies and better psychological well-being, thus reducing the perception of pain and increasing the tolerance of it. The varying degree of sensitivity to pain can influence an individual’s perception of it.
Sensitivity to pain is often a misunderstood factor in the clinical determination or in many instances, validation of a patient’s level of pain. Certain individuals are highly sensitive to painful stimuli whereas others are not. For example, a family was discovered in Italy with six members ranging in age and spread throughout three generations who can suffer bone fractures, burns, and cutaneous cuts without feeling any sort of pain sensation (Habib et al, 2017). On the other hand, the following describes the increased sensitivity to pain experienced by some with an Autistic Spectrum Disorder:
“Clothing might feel like sandpaper, or fingers shampooing a scalp might feel like sharp metal” (Allely, 2013).
Clearly, pain sensitivity can vary greatly among patients. This variance can not only make it difficult to predict a patient’s pain response, but also to alleviate it effectively. A person’s previous exposure to painful stimuli can ultimately shape the future perception of it.
Even though the sensation of pain is one that most would rather not experience, it cannot be avoided entirely. The expectation of just how painful an experience will be can drastically influence the perception of pain. This can be illustrated by the common experience of receiving a flu shot. For an individual that has no fear of the localized, minor pain of a needle-stick, receiving an annual vaccination against the influenza virus is as simple a task as drawing a breath of fresh air. The perception of pain is minimal. The perception is diminished further by the individual’s expectation of a minimally painful experience, likely because the previously administered flu shots elicited very little (if any) pain. Conversely, for an individual that has a fear of needles and by extension, the localized pain of a needle-stick, receiving a flu shot can begin with a large amount of anxiety. This can lead to a heightened pain sensation once the vaccine is delivered and a lingering perception of pain lasting for several hours or even days. Perhaps the individual has associated needles with an exaggerated pain sensation due to a negative experience in early childhood. Thus, past experience would be a great influencer on current and future perceptions of pain. Similarly, a study conducted on a group of ten healthy individuals showed “that expectations for decreased pain produced reductions in pain ranging from 10–48%” (Coghill, 2010). Such a dramatic decrease in the perception of pain based on expectations molded by past experiences is of great importance when considering the effective treatment of pain.
Pain itself is commonly described conceptually as being located in a particular area or being a penalty for an action. For example, the phrases ‘pain in the neck’ or ‘pain in the rear’ are often heard to describe something undesirable. The phrase ‘on pain of death’ however, is utilized in a contractual sense, implying that the person will fulfill an obligation or complete a task or otherwise receive the punishment of death.
Analyzing the concept of pain within a nursing context (including the previously discussed factors of tolerance, sensitivity and past experience) yields some interesting insights.
After extensively researching the oft-misunderstood phenomenon of pain, I noticed some defining attributes:
It is both a physical and psychological sensation
Its perception varies depending on the individual and other factors
Its perception can be influenced
An adolescent male Asian patient is scheduled for a surgical procedure to debride and close an infected open skin lesion on his upper torso. The patient states that the lesion has been irritating him when he participates in his school’s swim meets (physical pain). The patient also asks repeatedly about the possible size of the scar caused by the procedure as he’s concerned that his “beach body” may be ruined (psychological pain). The pain is described as slightly irritating even though the patient guards the area when examined. This leads the nurse to ask multiple times about the patient’s current pain level, especially given the state of the lesion. The patient consistently describes his pain as “minor” and “no big deal” (varied perception of pain). The nurse asks the patient if there is anything else the patient would like, to which the patient responds, “Do you mind putting on some Beach Boys’ Greatest Hits? I never swim without listening to them.” The nurse complies and after playing the requested music, the patient mentions how he feels better and is visibly more relaxed (perception of pain has been positively influenced).
An older woman who’s previously suffered a stroke and currently has type two diabetes is walking with her husband on a winter’s day after there has been significant snowfall. At one point during the walk, the woman loses one of her boots along with the sock underneath. Upon completing their walk and returning home, the husband immediately notices the missing boot and exclaims “Honey! Your boot’s been off this whole time! Your foot’s been in the snow this whole walk!” As she looks down at the snow-covered, bluish foot, she flatly replies, “Interesting” (neither physical nor psychological sensation of pain). The husband brushes off the snow and fills a shallow basin with warm water. Upon submerging the foot in the warm water, the husband asks, “Seriously, this isn’t hurting you? I’d sure be hollering by now!” The wife simply shakes her head (unvaried perception of pain). The husband then goes on to tell the wife how she needs to be more careful and that maybe it’s best to postpone their walks until the weather gets better. He also expresses to her how much he cares for her and how he would be lost without her. The wife shrugs her shoulders, gets up and walks away (neither the psychological nor the physical perception of pain has been influenced).
A middle-aged man dining with his family in a restaurant suddenly backs away from the table and clutches his chest. “It feels like my chest is on fire! I’m freaking out!” (both physical and psychological pain). The man’s wife quickly grabs an aspirin from her purse and gives it to him while their adolescent daughter dials 9-1-1. “You sure it doesn’t feel like an elephant is sitting on your chest? That’s usually how heart attacks feel to everybody” (varied perception of pain). The man takes the aspirin, waits roughly 30 seconds and shouts “I feel the same! It didn’t work! I’m going to die!” (the perception of pain has not been influenced).
Concepts related to pain:
Two marine iguanas named Tim and Terri decide to go for a swim. They both take a running start and leap off the nearest Cliffside. Terri points her front legs forward and gracefully slips into the ocean with but a tiny splash. Tim screams “Cowabunga!”, spreads out all four of his limbs and crashes into the surface of the ocean with a loud splash, completing an epic belly-flop. When both come back up for air, Tim exclaims “Oh my god! My belly is sore! And my so-called ‘epic’ dive was an epic fail!” (physical and psychological pain). Terri giggles and says “Oh c’mon! Belly-flops aren’t that bad!” (varied perception of pain). Tim smiles and says, “You’re right, it’s not that bad. And, you know what? I’m still epic!” (perception of pain has been influenced).
Pain is defined as general or localized discomfort caused by a stimulus. Therefore, an illegitimate use of the term “pain” would be the following:
Although it pains us to say this, we’re terminating your employment here at S and S Machine Works.
Consequences of Pain
Diminished cognitive function
After an in-depth scrutiny of the concept of pain, it is clear that it is an ever present phenomenon in daily life. The perception of pain is not only highly subjective, but also extremely susceptible to external influences. Although it can be difficult to interpret and treat effectively due to it’s mysterious nature, pain must be recognized as legitimate and treated impartially no matter how the individual seems on the surface. Only in this way can pain be successfully coped with and understood by both the patient and the healthcare professional.