Chronic pain

When chronic pain lasts for six months or longer, it can occasionally be traumatic. The intensity of the pain can range from light to agonizing; it can be constant or sporadic; and the victim may just experience minor annoyance or complete incapacitation. The victim's nervous system may continue to be active with persistent pain signals for months or even years. In other words, the patient experiences both physical and mental suffering, which is why doctors should diagnose and treat patients using biopsychosocial approaches.
Joint pain, backaches, headaches, and pain following an injury are the main concern areas for chronic patients. The tendinitis, carpal tunnel syndrome, sinus pain, and specific body parts pains including the shoulder, the neck and pelvis are other forms of chronic pain. It is important while some people may develop chronic pain from an infection or injury others suffer chronic pain even in the absence of injury or any notable body damage. With chronic pain, there are primary and secondary complications that can develop with time. Some of these complications include sleeping problems, job loss, and missing out of family among many others. The following paper focuses on procedural of chronic pain assessment using the case study of one Robert who sustained a compound fracture of tibia and fibula during a rugby match.

Initial Pain Assessment Considerations

The process of assessing the pain on Robert is multi-dimensional due to implications that the pain may have on the patients. The development of the comprehensive biopsychosocial approach in has led to facing out of the old biomedical reductionism model. The biopsychosocial model outlines exclusive connections among the biological, psychological as well as social factors pertinent to a deeper understanding of health and illness. The perspective of this approach is very crucial in assessing the comorbidity of both physical and mental health problems (Gatchel et al., 2007). A biopsychosocial model outlines level of biological complexity that is arranged in a range from the somatic then to intrapsychic and finally to the interpersonal level. The particular distinctive element of the approach can be seen when these levels are arranged in a vertical manner where one level seems embedded in those above it and constituting those below it. In simpler terms, it from the degree of the molecule, a cell and organ system to entire body system, dyad, family, society, nation, culture and the biosphere. The events of any particular level in this arrangement are influenced by events in other levels.

From the preceding outline of the biopsychosocial approach, it is a pain assessment on Robert a patient suffering from a compound fracture of fibula and tibia requires a consideration of an array of factors including those related to physical, psychological and social interactions. The three type factors are inherent in determining the nociception neurophysiology, perception of pain, pain modulation, and pain behaviour. As medical assessor, it is important to note the attitudinal state, expectations, and social support can have a direct bearing on how the Robert will report the pain or responds to the treatment. Biological/physical factors that determine the outcome entails those that takes toll of physical, such frequent twisting of the leg or sitting position, the strain of the back muscle and the number of surgeries performed as a result of pain. These factors are usually the precipitating biological factors.

Psychosocial factors (psychological and social factors) are imperative in assessing chronic pain mainly because they are related to patient behaviours ((Nicholas and Blyth, 2016). Psychosocial factors include (1) catastrophizing cognitions which entails a patient focusing much on pain and developing pessimism on their ability to deal with pain. (2) Coping responses includes those attempts that the patient like Robert will make to reduce the pain or its adverse effect on functionality. (3) Beliefs and attributions related to pain that entails the patient understanding of the reason for the pain and the bearing it has on their future life. (4) Social factors include the general social support and pain-contingent social response.

Pain Assessment Tool and Its Rationale

Pain Assessment Tool

It is important to note different instruments and methods of pain assessment are specific to certain types of pains (Williams, 2013). The choice of the method is particularly determined by the dimensionality of the pain. Mostly pains are characterized by biological, physiological and social dimensionalities. It is important to note that chronic pain cannot be diagnosed directly by observing the patient. The pain only presented through psychosocial and biomedical tendencies. A suitable assessment tool should include the three domains into consideration for a comprehensive understanding of the chronic pain experience with any particular patients. Some assessment fails terribly for assuming that patient suffering from chronic pain have similar experiences. Assessment of chronic pain is complex since each case is unique and therefore, no universal diagnostic test exists for assessment chronic pain (Clark and Galati, 2012). There is a myriad of chronic pain disorders, and that explains the complexity of the process.

The chronic pain assessment tool on Robert entails a 10-step approach that includes a thorough initial evaluation, establishment of diagnosis; identify medical necessity, risk-benefit ratio assessment, treatment goals establishment, informed consent and agreement, initial phase of dose adjustment, stable phase, monitor adherence and finally the outcomes. This approach is critical, especially when dealing with a long-term assessment of chronic pain.

Rationale of the Assessment Tool

With a compound fracture of the fibula and tibia, Robert’s case can qualify as a long-term case that suits the 10-step approach. The initial step of the process involves thorough initial assessment that will help in identifying biological, psychological, and social domains of the patient. The assessment will capture the history of pain, medicine (analgesia) and psychosocial living of Robert. After establishing the diagnosis by examining x-rays and psychological evaluation, the 10-item tools will establish grounds for medications (Clark and Galati, 2012). In other words, the tool will evaluate whether Robert should continue taking the analgesia or other physical modalities. The assessment will determine whether the treatment benefits outweigh the cost. Robert is a family man, and while her wife is on maternity leave, the family needs to spend on necessary treatment to avoid medical expenses risking finances budgeted for other family needs. The assessment tool will identify the goal for the treatments and any necessities for a new diagnostic test to alleviate the psychosocial elements of the chronic pain in the family.

Potential Problems When Assessing Robert’s Pain

The first step in treating pain is determining whether researcher or scientist is accurately the pain. The process can some prove challenging, especially when the patients are psychological disturbed, have absconded the first medication and sometimes those related does not want to respond to the questions. Pain causes stress and sometimes anxiety and depression. The Robert’s is apparently suffering some psychological disturbances given that he wants to go back to work to support the family. The paternal instincts may domineer during the assessment process, and most likely Robert may underestimate the pain in the interview scale than the actual situation. Provision of an incorrect scale of pain will present problems during the treatment phase, that is, the clinician may end establish the wrong treatment objective.

In other cases, Robert may altogether opt from answering some questions that relate psychosocial elements of the chronic pain. Having her wife Becky to take care of him and seven-month son is painful to him, and somehow he may fail to participate in social factors assessment to avoid creating more stress in the family. Non-response is a challenge when it comes to assessing none-quantifiable characteristics such as social factors. Robert’s failure to respond to some of the questions is likely to create a bias in the results that may lead to skewed outcomes that do not guarantee quality to give a final assessment report. The variation in pain tolerance when with family and when alone can challenge the reliability of the results obtained from the collected data.

Another challenging element that may present itself during Robert chronic pain assessment is patient and clinician perspective differences. Due to the cultural or ethnic differences, the perspective of the pain may vary from one person to other (Fosam, 2016). Scaling pain from mild to severe may vary depending on the experiences of suffering. Men are likely to acts unyielding even when undergoing excruciating pain. In some cultures, men are not supposed to feel pain and it shameful to show pain amidst of other people. Clinicians or researchers dealing with such patients are likely to make a misleading assessment. In other cases, the variability of analgesics in treating pain may cause challenges when assessing the precision of the treatment.

References

Clark, M. and Galati, S. (2012). Guide to chronic pain assessment tools. [online] Available at:https://www.practicalpainmanagement.com/resources/diagnostic-tests/guide-chronic-pain-assessment-tools [Accessed 24 Mar. 2017].

Gatchel, R., Peng, Y., Peters, M., Fuchs, P. and Turk, D. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, 133(4): 581-624.

Fosam, H. (2016). Systematic assessment of chronic pain domains as a way to improve diagnosis and treatment. [online] Available at: http://www.clinicalpainadvisor.com/news/systematic-assessment-of-chronic-pain-domains/article/526009/ [Accessed 24 Mar. 2017]

Nicholas, M., and Blyth, F. (2016). Are self-management strategies effective in chronic pain treatment? Pain Management, 6(1): 75-88.

Williams, D. (2013). The importance of psychological assessment in chronic pain. Current Opinion in Urology, 23(6): 554-559.