This paper will talk about a very important and complex concept, this concept is pain. Pain is a universal concept and common human experience in most of the disciplines especially, nursing discipline. In nursing life and practice, pain one of the most experienced and expressed phenomena by patients. This paper aims to extend the understanding of the concept of pain, to clarify pain concept from its different aspects and to determine its uses, attributes, antecedents, consequences, and finally introduces a real case that represents a model of this concept. This paper follows Walker and Avant criteria (2010) and based on literature from many nursing and other resources. The conclusion as a result for this paper, pain has been identified as a serious problem by both patients and health care providers especially nurses, also nursing studies and literature identified and mentioned the consequences of unrelieved pain, so it’s important to understand the concept of pain in its all aspects and to know that learning about how to relief pain is very important and seems to be an ongoing and multidimensional process, in the way of improving the physical, emotional, and psychological health for patients.
“From the brain alone arise our pleasures, laughter, and jests, as well as our sorrows, pain, and grief”.(“Hippocrates quote: Men ought to know that from the brain and from…,” n.d.). The term “pain” as mentioned by Hippocrates perceived by brain, its complex sensorineural concept, has many definitions, and has been widely used in nursing and other human disciplines for many years.
Pain is multidimensional concept, it’s important to be addressed and analyzed, also its important to put in mind that the pain experience is so individualized and highly variable from person to another, so the aim of this concept analysis to understand the pain concept in its all aspects to be all nurses and healthcare providers able to face the challenges during treating the patients pain, so to identify the major characteristics, and attributes of pain.
This analysis will be based on Walker and Avant criteria (2010) and also based on looking thoroughly in the literature, talking about definitions, attributes, antecedents, and consequences, all of that will be explained in details. Finally a model case will mentioned to reflect the term on the real world to articulate and recognize a complete understanding of the concept.
The concept “Pain” definitions and uses
According to the International Association for the Study of Pain (IASP) in 1979, it put a clear definition of pain “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in term of such damage”.(“IASP’s Proposed New Definition of Pain Released for Comment – IASP,” n.d.; Treede, 2018). Also, in 1996 the American Pain Society (APS) defined pain as “Pain as the 5th vital sign”.(Levy, Sturgess, & Mills, 2018).
According to the Medical Dictionary, pain is an uncomfortable feeling occurring as a result of disease or injury usually it’s localized in some parts of body.(“Pain | definition of pain by Medical dictionary,” n.d.). Pain is translated to the brain by sensory neurons system, and is not just a sensation or physical awareness, but it also includes the perception and the subjective interpretation of discomfort, the perception give the information and the characteristics of the pain; location, intensity, nature, and etc…(“Pain | Definition of Pain by Merriam-Webster,” n.d.).
Oxford English Dictionary defined pain as, one when he or she feels hurt in body or mind, suffering that the opposite of pleasure; bodily suffering, mental suffering, and grief.(“Definition The Oxford English Dictionary defines pain in several different ways | Course Hero,” n.d.).
Pain maybe localized or generalized, its complex sensation that causes mild to severe physical discomfort or emotional distress, also pain can be helpful in diagnosing a problem that needs treatment.(“Pain | MedlinePlus,” n.d.).
The world pain is derived from the Latin “Poena” meaning a penalty or punishment, it’s an abstract concept, which refers to a personal, individualized sensation of hurt, also pain acts as an important biological safety and defensive mechanism that warns people when something is wrong. It’s a private, personal, subjective, and multidimensional experience, pain intensity varies according and based on various psychological, physiological, social and cultural factors, and because pain is a private experience, it’s impossible to know accurately and precisely what someone else’s pain feels like.(“Pain management – foundation | Nursing Times,” n.d.).
According to McCaffery`s (1968) pain definition, “Pain is whatever the experiencing person says of is and occurs whenever the experiencing person says if does”.(McCaffery, 1968; “Remembering Margo McCaffery’s Contributions to Pain Management | ONS Voice,” n.d.). The North American Nursing Diagnosis Association (NANDA) defined pain in which an individual experiences discomfort or an uncomfortable sensation, the documenting and reporting of pain can be by verbal communication or by encoded features.(Hanoch Kumar & Elavarasi, 2016; “Welcome to NANDA International | Defining the Knowledge of Nursing,” n.d.).
According to psychology, pain is not just on physical aspect, it also can be emotional, emotional pain result because of disappointment in expectations or relationships, needs to be acknowledged and to deal with it, failure to do that can result in emotional problems and serious mental issues and consequences.(“Pain definition | Psychology Glossary | alleydog.com,” n.d.). Pain identifies who the people are, explains how life is really work, is always a precursor to significant change and to bring maturity and responsibility, athletes and mature persons believe that when no pain, there is no gain. Pain is Gods instrument to produce strength, to learn, grow, and improve, pain is essential to avoid any bad behaviors, and of course pain reminds persons that they need help and need a team, brings all people together because it is main part of everyone story, that is no one is immune.(“15 Benefits Of Pain | Brian Dodd on Leadership,” n.d.).
Pain could be a gift from the universe, it is a massage that there is something wrong, that change some habits, thoughts, emotions, and actions must be done and it’s time to take action, and make lives more and more valuable, pain prepare people for something better in the future and trach them to appreciate anything in the past.(“6 Reasons Why Pain From The Past Is A Gift For You Today,” n.d.).
According to Christian, pain is experience that all people live it, and the natural reaction to pain is to avoid it, or get rid of it, and the importance of the need to realize that God allows pain,. In fact, suffering and pain is a sign of Gods love. Dr. Brand said, “I can tell the health of a human body by its reaction to pain, if body doesn’t react to pain, I know that something there is dreadfully wrong”.(“Pain—- a Christian Perspective | Ben Witherington,” n.d.).
The body is a healthy body when it responds to pain, on another hand if pain persist and not treated related to specific injury, illness, or something else; emotionally reasons for example, it will be hurt, and lead to serious consequences. From the perspective of Islam, “Allah has a purpose for your pain, a reason for your struggles, and a reward for your faithfulness, don’t give up”.(“Even body pain has a divine purpose,” n.d.). So finally, pain is struggler of positive and negative change, is one of the most prevalent motivator of human change and is a provoker of human deterioration.
The philosophical perspective of pain; pain and related perception is influenced by several factors, these factors are; cognitive awareness, interpretation, behavioral dispositions, as well as cultural and educational factors, pain has bodily, psychological, and sociocultural dimensions, pain has been defined as a process as a result of somatosensory perception, later on present in the brain as a mental image and followed by unpleasant feeling as well as changes in the body. Cassell defines pain not just only as a sensation but also “As an experience embedded in beliefs about causes and diseases and their consequences.”(Bueno-Gómez, 2017; Cassell, 2011).
The theoretical perspective of pain, there are four major theories talked about pain, these major theories are; specificity theory, pattern theory, psychological behavioral theory, and gate control theory, the recent one is the gate control theory.
In 1965, Ronald Melzack and Partrick Wall published this scientific theory; the Gate Control Theory; which identified that pain signals can’t reach the brain as soon as the brain generated from injured sites, they need to catch, manage, and be faced with some certain neurological gates at the spinal cord. Therefore, these gates determine if the pain signals should reach the brain or not. So if pain gates give permission to pain signals to go away, pain will perceived. Gating mechanisms can be stimulated by three techniques: cutaneous stimulation, distraction, and anxiety reduction.(Melzack, 1996).
Attributes of pain
Defining attributes is a group of characteristics that are associated with a concept, any concept analysis will contain more than one attribute.(“Walker and Avant offer seven steps for conducting a concept analysis they are,” n.d.).
There are several critical attributes associated with the concept of pain, as identified by Montes-Sandoval (1999), these attributes are:
- An unpleasant, distressful, unwanted, and uncomfortable experience.
- A neurophysiological, socio-cultural, and psychological response to a painful stimulus.
- Subjective and difficult to describe feelings that can’t truly and clearly be measured or accurately perceived by others.
- Individual, unique, and private experience serves as a protective mechanism for self-preservation.
- An adverse sensation to an actual or potential threat of physical or emotional injury or damage.
- Verbal and non-verbal communication.
- Disturbing thoughts resulting from a mental misperception.(Montes-Sandoval, 1999).
Antecedents of pain
Antecedent are the events or incidents that occur before the identify concept, these antecedents help to know further and more and more about the critical attributes of the concept of pain. (Walker & Avant, 2010).
There is many antecedents related to pain such as environmental, personal, and cultural values. Environment is related to the event that arouses pain, these events such as venipuncture, painful stimulus or hospitalization, when they occur, the individual’s body, mind, or both may be affected by these events, which causes actual or potential tissue damage. Also, the individual’s knowledge and attitude related to specific event play an important role, this knowledge and attitude such as past pain experience, may affect the expectations and acceptance of pain on individuals, and later it will affect how the individual copes with pain. (“How to Cope With Chronic Pain by Nelson Hendler M.D. (1993, Paperback, Revised) | eBay,” n.d.).
The personal components consist of, the individual current physical and emotional condition, personality, gender, and socio-economic status.
Firstly, the physical condition contain sleeping pattern, degree of muscle tension, and if the individual is capable of feeling the stimuli. Secondly, emotional condition contain stress and anxiety level, if the individual has increased stress and anxiety, the individual will feel pain more easily. According to personality, when person has a good and positive attitude toward pain he or she will tend to use good and positive methods and techniques to deal with this pain. Regarding to gender, females tend to be more sensitive toward pain and are allowed to express their pain more often than males.(“Pleasure And Pain 7 Inch UK East West 1992: So Damn Tuff: Amazon.fr: Musique,” n.d.).
From a socio-economic perspectives, individuals from different socio-economic classes, may interpret pain differently and in many ways. East (1992) notes that people who have higher socio-economic class tend to express more pain and be more aware of their pain than ones in lower socio-economic classes.
Finally, the cultural aspect of pain, according to Sheridan (1992), culture specify how people and individuals interpret, express, and live with their pain, and how to react to this pain. Therefore, pain and its perception are always culturally shaped.(Sheridan, 1992).
While understanding pf pain is influenced by culture, Zborowski (1969) confirms pain expectancy and pain acceptance to express and discuss the person`s attitude toward pain.(Zborowski, 1969).
Also, according to Montes-Sandoval, the antecedents of pain are:
- Internal or external factors appear, creating harmful and painful stimuli to the nociceptors.
- The individual physical or psychological awareness of the stimuli or discomfort.
- The harmful stimulation or aversive sensation is perceived as pain.(Montes-Sandoval, 1999).
Consequences of pain
Consequences are the events or incidents that happen as results of the concept. (Walker & Avant, 2010). These consequences of pain are; pain reaction and the person`s own interpretation of the meaning of pain.
Firstly, pain reaction is interpreted and viewed as pain behavior, pain behavior is contained two categories; voluntary and involuntary responses.(Swanson, Maruta, & Wolff, 1986). Another consequence of pain is that the individuals have their own interpretation of pain and the meaning of it, this interpretation may be in the positive or negative aspects.(“Nursing Care of the General Pediatric Surgical Patient – Google Books,” n.d.).
Ferrell (1995) described three process for obtaining the meaning of pain, including immediate causes, immediate effects, and ultimate causes.(Ferrell, 1995).
The individuals may or may not aware about the meaning of the pain experience. However, the meaning of pain experience will affect how individual interact with the environment and their relationship with others.(“Pleasure And Pain 7 Inch UK East West 1992: So Damn Tuff: Amazon.fr: Musique,” n.d.).
According to Montes-Sandoval, the consequences are:
- Person with verbal and non-verbal communication, apply neurophysical, psychological and socio-cultural responses to the perception of pain.
- Individual’s responses to the pain may or may not provide relief.
- The pain will remain the same, decrease, or increase.
- Other people will respond to the individual and provide multiple interventions in relieving or coping with the pain.(Montes-Sandoval, 1999).
Modal case of pain
A model case is an example of real life case, which reflects the use of concept critical attributes in the real world. (Walker& Avant, 2010).
Mrs. Sara, 45 years old, married, Sara has been suffering of breast cancer diagnosed three years ago and has undergo chemotherapy and radiation in that period. She is now during recovery period, three days postoperative from a mastectomy. The nurse enters the room to change her dressing, the nurse finds Sara silently crying, nurse started to console her gently, during dressing, Sara avoids eye contact, closes her eyes, turns her head away. The nurse notices that Sara is tense, grimaces, and sweating, her blood pressure and heart rate is elevated. Sara says “I’m not good, I’m very tired, I don’t know exactly what I feel, I’m worrying about what my husband is going to think, and maybe he will not want me anymore, also I’m in pain, I’m in pain”, the nurse provides pain medication, and acknowledges her loss, feelings, fear, and as well as discomfort that related of postoperative pain.
In summary, the concept of pain has been chosen because pain has been recognized as a serious problem for patients and health care provider, it’s helpful and beneficial to nurses and other health care provider in gaining a better understanding of the concept of pain and implementing and providing appropriate nursing interventions to relieve pain.