This is because every person has a different pain management need. Therefore, there is a need to have a bio-psycho-social-spiritual approach to the management of chronic pain. The four components of the experience of pain by the patient are as follows. The first component is the physical sensation that is felt. Second are the automatic thoughts that come as a result of the gross pain being experienced. Third are the uncomfortable emotional reactions that the patient has to deal with from the pain. Fourth are the self-defeating behaviors that are as a result of the thinking and the feelings of the patient. This is the approach that is in use in Sierra Tucson Hospital in Tucson, Arizona Merskey, 1994() Studies have indicated that as the patient continues to experience the pain and as the pain becomes chronic, the mood of the patient is grossly affected and their motivation toward the management of pain is also grossly affected. Therefore, it is important to learn to teach the patients to separate these four components of the pain they are experiencing. The physical sensations need to be separated from the psycho-emotional responses. In so doing, the stress levels experienced by the patient as a result of the pain being endured will be reduced Crombie, Davies, & Macrae, 1994()

There is also a fair amount of evidence that is present in the case studies. These case studies are on the psychometric properties of different intensity measures of pain in the outpatient, palliative and postsurgical care settings. However, these case studies may not be applicable to the inpatient setting Dusek, Finch, Plotnikoff, & Knutson, 2009()

Implications for practice

Quality improvement, especially in the field of pain management is extremely important. Therefore, an individualized approach should be undertaken to the management of pain as shown in the available evidence from the review of literature. In a study conducted at the Penny George Institute for Health and Healing, Allina Hospitals & Clinics and Abbott Northwestern...

This was on a scale of 0-10. Although we can see that the decrease in the pain score is quite significant, it is important to also remember that the initial levels of pain vary from one patient to another. Therefore, the percentage reduction in pain level is more important. The average percentage reduction for the patients in this study was 55.8% which goes to show that quality improvement in pain management is extremely important for all institutions Dusek et al., 2009()
Conclusion

Looking at the evidence provided by the literature and the studies analyzed, we can see that pain management is quite complex and it is multidimensional. Additionally, it is important for pain management to be done on an individual basis whereby each case or patient is looked at differently. It can also be seen that quality improvement in pain management brought a significant reduction in the pain levels of patients. Therefore, it is important that quality improvement measures should be undertaken for pain management.