Treatment Options Pain Treatment Options Clinical Pain

Treatment Options

Pain Treatment

Treatment Options Clinical Pain

Chronic pain is an issue that all healthcare providers have to deal with at one time or another. The mitigation of pain is a major factor in whether an individual will be able to heal properly and in an appropriate length of time (text, 320). The three cases offered -- various types of pain from a below-the-knee amputation resulting from a diabetic neuropathy, acute pain from an abdominal hysterectomy, and chronic, non-migraine headaches -- have different levels and sources of pain which need to be addressed in different ways. Helping to eliminate the pain can come through the use of surgical, pharmaceutical, behavioral, and cognitive methods, and the proper use of these methods is decided by the type of pain, its acuteness, and where it is.

Case One

Originally, this problem was caused because the patient experienced diabetic neuropathy which, in itself, can cause acute pain (WebMD, 2010). The pain that the patient felt was real when they still had their foot and can be very real now that they have had the foot amputated also. There can be issues at the surgical site which could cause the person to be feeling pain. This could be as a result of scarring that is restricting movement of the area, it could be from decreased blood flow to the area due to a cut blood vessel, or any of a number of reasons brought on by the seriousness of the surgery itself. Of course there could be other issues which have caused the pain, but the main issue that any pain management professional would have to look at is pain of the phantom variety.

Many times a patient who has experienced the loss of a limb will have symptoms that are not actually a part of any actual physical issue. The brain is the provider of pain cues via neural pathways, an sometimes the brain can send these cues even if there is no real pain. Many amputees experience phantom pain from a limb that has been amputated and this can be treated using techniques in the psychological realm. The treatment for this type of pain is a significant issue because as many as 70% of amputees will have some degree of this pain (Jeffries, 2008). This type of pain is very resistant to treatment, according to Jeffries (2008), and it can become more acute. The preferred method may be to use cognitive methods which help the patient deal with the psychological issues of the pain. This can be as simple as relaxation techniques which can mitigate immediate pain or other, more behavioral, treatment methods which can help the patient reduce the issue over time.

The fact that the pain is actually not real can also be treated with chemicals. The placebo effect is a powerful phenomena which was early discovered by physicians. It is the brain convincing he person that the medication they are taking is helping them to defeat the pain. Since much of the pain from a severed limb comes as a result of the psychological trauma incurred, it is possible to use a placebo to help the patient. This is both a cognitive and a chemical means of treating the problem. Also, there may be some actual pain from the area of removal, and this could need some actual pain management via pharmaceuticals. It actually depends on where the patient says the pain is and how long it occurs. If the site of the supposed pain is healing well and there is no surgical issue, then it could very well be phantom. If, however, there appears to be infection at the site where the pain is being experienced, then different chemical or surgical methods can be employed to help the patient manage the pain.

Case Two

Any form of pain can be a serious problem that the body is trying to inform the patient of. However, there are those instances of pain that can be much more dangerous than others. This case deals with acute pain from an abdominal hysterectomy. This is a majorly invasive surgery from which there can be many complications that involve more than one of the major organs in the body. Far from the phantom pain of the amputation patient, this pain suggests some very serious problems.

The first thing that has to be considered is whether there is a need to reopen the patient to treat the pain via surgery. this is not a surgical method of pain control because it is a reinvestigation of the original surgery not an alleviation of the nerves causing the pain (text, 322). Actual surgery to reduce the pain is probably not warranted in this instance.

The problem can most likely be fixed with chemical methods of pain control. Acute pain in the abdominal region after this surgery is normal because of the surgeons need to move the bowel and organs, and he or she would have had to cut through many layers of soft tissue. The pain caused by this would be acute, but it would also decrease naturally. This means that a regimen of pain medications (probably very strong at first and decreasing in strength as the patient recovers) would be needed. If the pain continues, it may be an infection which is not uncommon in this case. Therefore the patient would need some form of antibiotics to help get rid of the pain and the infection.

Case Three

When a person is having chronic headaches that are determined not to be the result of migraines, there can be many causes that need to be investigated. The four different methods of pain relief may all be needed in this case because it is very difficult to tell where the pain is coming from sometimes. There could be an issue where a surgery involving actual nerve, or nerve tissue, removal is needed to alleviate the pain (text, 322). The patient may just need some type of pain medication, stronger than the over-the-counter medications available, to combat the pain. However, the patient could be going through a stressful event that has caused them to tense, and this could be causing the pain. If this is the case they may need either cognitive (operant or relaxation) or behavioral (distraction, redefinition, etc.) to alleviate the pain. There may also be a need to use several different forms of pain management to combat the pain.