Week 5 – Discussion: Writing a Pain Assessment Diary

My thoughts regarding pain and my experience with it have changed over the past seven days. I had previously regarded pain as simply a phenomenon that was a result of some direct action such as when you stub your toe or hit your head. I was aware that pain also happened when experiencing a significant loss or disappointment, but I never really connected those two types of pain. This week’s reading has taught me that pain is not a simple matter of cause and effect. It is a complex neurobiological and psychosocial process which is experienced uniquely by each person. Extensive research continues to be done regarding pain and how to manage it. Since before the 20th century, the primary belief was that the mind and body processed pain separate. This concept was put forth by Descartes in the 1600’s and continued until the mid 1900’s, when Melzack & Wall theorized that the mind, through the perceptual interpretation of neurochemical stimulation of areas in the brain, would cause the person to experience pain (Brannon, et al., 2018, p154).

Their initial theory proposed that stimulation from the periphery of the body sent centrally had to pass through a juncture in the spinal cord to gain access to the brain. When allowed to pass through to the brain, the person would experience a pain response. If this passage were denied, the pain excitation would not be activated. The theory also describes an area of the brain that controls how much stimulation from the periphery will be allowed access. A region of the mid-brain can stop signals from entering and therefore the individual will not experience a consciousness of pain. This gate theory, as it has come to be known, was expanded further by one of its authors, Ronald Melzack, into what is called the neuro-matrix theory (LeFort, et al., 2014, p.7). This theory proposes that the brain maps the body using the thalamus, cortex, and limbic system such that neurons stimulate sensations relative to various body parts that are perceptually interpreted by the experiencer. Both theories have been validated repeatedly over the years and have promoted more research, particularly in the psychosocial fields.

My experience of pain involves a recent injury that has transformed into a chronic problem. It started as a severe sharp pain in my foot that occurred nine months ago and continues to give me grief every day. According to the podiatrist, it is osteoarthritis, described as an inflammation of the joint which causes a dull achy pain that worsens with movement and the resulting lack of movement causes worsening joint problems and pain (Brannon, p. 159). The knowledge I have gained from this week of study enables me to do a better job of alleviating the pain and distress this problem has caused. According to the research I have done, my attitude and historical experience of pain are affecting how I am experiencing the sensation of pain. As postulated in the pain theories described above, pain is modulated by the brain. It is heightened by emotions like anxiety, worry, fear, or depression, and can be lessened by behaviors such as distraction, relaxation, and a positive or optimistic attitude (Brannon, 2018, pp. 148-9,156)

My pain journal indicates that I experience the worst pain upon arising from sleep. Putting weight down on my foot is very scarry and it is made worse by anxiety I have about my knee. I experienced severe pain in the opposite knee a few years back, resulting in a very painful knee replacement surgery. I have thoughts about wanting to avoid the same thing happening to this knee. Irritation in the foot, weakness from not walking on it properly, and my apprehensions, are all affecting my experience of pain. I noticed that I hold my breath and frequently do not breathe rhythmically. I have an antalgic gait that I find myself doing when getting up from a prolonged sitting position. All these behaviors can be self-managed as suggested by researchers and there are many alternative and complementary medical practices available from which I can choose (Dartmouth-Hitchcock [Video file]).

There is so much more to this complex contemporary problem, and I hope to continue incorporating what I have learned into personal success as well as helping someone else experience relief from their suffering. An example of what I gleaned from reading about phantom limb sufferers is that the pain sensations they experience are like what I imagine happens when our computers shut off unexpectedly. When we restart them, the computer asks if we want the pages restored as they were prior to the disconnection. If we input yes, the computer re-establishes the connection that had existed. Research has indicated that most amputees experience sensations of the no longer existing body part. It is reported initially as a tingling sensation immediately after surgery followed by years of various intensities of pain and even with such descriptors as the position and size of the missing part.

The more severe the pain experienced prior to amputation, the more likely the symptoms of pain persist after the surgery. These descriptions fit my understanding of how our brain maps our body according to the neuro-matrix theory and as established biomedical evidence shows, brain neurons react to our thoughts and emotions. When adding neuropathic pain into my analogy, the burning and tingling sensations like that reported post amputation surgery, can be caused by such mechanisms as when spinal cord pain neurons spontaneously come alive once severed from their normal input transmission route and when there are sensitized or damaged primary afferent nociceptors. Both these and other mechanisms can cause the central nervous system and the peripheral nervous system to become hyperactive (Harrison’s, 18th ed., p. 96). The amputees’ perception of the phantom limb could be from the brain trying to “restore the pages” of the limb that was removed. The person is revisiting memories of the experiences that occurred when the limb was present.

Lastly, my thoughts of the two types of pain scales that I reviewed. The Mcgill questionnaire is agreeable to me in that it allows me to express details of my experience, but I would want to include a written subjective statement to capture more of how pain prevents me from doing things. The visual assessment scales are good to communicate whether pain is experienced or not. The facial expressions pictured are easy to relate to and mirror back, but the scale alone does not transmit any information useful to address relief efforts. I have attached my own completed Mcgill pain questionnaire form. Throughout the journaling process, I rated my pain level between 1 and 6. What was notable to me is that the pain was not at the worst level very often or for any length of time. Prior to now I thought the pain was much worse most days. This exercise has been quite helpful.

References

Brannon, L., Updegraff, J. A., & Feist, J., (2018). Health Psychology: An Introduction to Behavior and Health (9th ed.). Cengage Learning, www.cengage.com.

LeFort, S. M., Webster, L., Lorig, K., et al., (2015). Living a Healthy Life with Chronic Pain. Bull Publishing Company, www.bullpub.com

Dartmouth-Hitchcock Medical Center (Producer). (1995). Alternative Medicine: An Overview [Video file]

Harrison’s, (2012). Principles of Internal Medicine (18th ed., vol 1). McGraw-Hill Companies, Inc.

Pain, although define by many as something that is abnormal, hurtful, and causes discomfort is also subjected to ones own private and personal experience. Pain can be categorized by mental, emotional or physical but measured by numbers as well as visually. The most common tools for pain assessment are The McGill Pain Questionnaire and The Visual Analog Pain Scale. The McGill Questionnaire asks one to describe the pain they are feeling whether sharp, throbbing, stabbing or shooting. The Visual Scale, if you remember your last doctors visits do seeing the picture with different faces on the wall with ranges from happy to sad, 0-10. Everyone experience and describes pain differently which highlight the use of these tool to give providers a basis understanding of what one is feeling, allowing physicians to provide the best care.

Accessing my pain experience for the last week has been quiet eventful. It’s started in the week prior where I started to experience sharp abdominal pain along with a burning sensation around my navel area ranking from 4-5 on the pain scale. I attributed the discomfort to maybe bumping into a doorknob or something of the sort that I did not remember . The pain worsen whenever I walked or if there was any friction to the area. However the pain intensified to a 7 on the pain scale throughout the weekend, but I convinced myself that I was too busy to spend hours in an emergency room and could not spear a hour or two for urgent care. I resorted to over the counter pain management medications such as Advil, Tylenol and/or ibuprofen.

By Monday morning, I found fluid gather in my navel and I was unable to walk. With every step, it felt as if my intestines were hitting the floor. With all confidence I can say I have reached level 10 on the pain scale. I visited to ER, received a CATSCAN and learned that I had an incarcerated umbilical hernia requiring surgery the following day. I was given IV pain medication, which lower my pain rating to 6-7 on the pain scale. After surgery, I was discharged home with instructions for wound and pain management. I choose not to take anymore medication for the pain, because although it was at a level 5, I believe that alternative means could be explored. I practiced meditation, as well as explored herbal treatments and teas from my country.

While exploring the resources for the week, I took an interest in the Alternative approach to treatment. Many cultures such as china and India have practiced alternative medicines including herbs and different kinds of massages. They have also explored hands on approach like reflexology and acupuncture to target pain at the sights or intercept pain signals from the brain to the nerve system. The pain tolerance for one differs from that of another which results in the appropriate choice for treatment and pain management.