Treatment Options for Clinical Pain Essay
The type of clinical treatment methods used on patients depends on the kind of disease and pain they are suffering from - Treatment Options for Clinical Pain Essay introduction. These treatments can be surgical, pharmaceutical, behavioural or cognitive. This paper seeks to identify the most appropriate pain treatment for each of the following cases.
Various types of pain from a below-the-knee amputation resulting from diabetic neuropathy
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Diabetic neuropathy is a complicated form of diabetes in which the nerves of an individual are damaged. This damage is attributed to high blood sugar levels in the body. The nerves are damaged in such way that the patient is sometimes not able to feel pain. The most affected body parts are those below the knees (the feet and legs). It is characterised by wounds developing in this parts of the body which do not heal. In the event they became infected leading to vascular inefficiency which results to poor blood circulation in the feet, the feet have to be amputated. One of the most common kinds of pain that results after this kind of surgery is phantom pain. Phantom and other kinds of pans are usually characterised by feelings of itchiness, burning sensations, numbness and pain at the point that the amputated limb was connected to the body. This kind of pain has been treated using surgical treatments such as spinal surgery and re-amputation. Pharmaceutical treatment has also been applied such as use of analgesics and injection of the stump with anesthetics, behavioural and cognitive treatments have also been used to aid the patient in relaxation (Thorn, 2004). While some have been successful, others have not. The best treatment methods are behavioural cognitive as research has shown that stress contributes most to phantom pain and magnifies it. These treatments involve the patients being educated prior to the amputation procedure on what to expect and how to manage the situation. They are also taught how to control stress and acquire patience during the healing process. Relaxation training is also offered and methods such as mirror treatments taught to the patients.
Use of analgesics and anesthetics for example morphine though only effective for the time the medication is active is a good treatment for this pain. This method is however not very effective as the pain comes after they stop being active in the body. Surgical procedures such as re-amputation could result to more phantom pain after the procedure due to wrong position of the stump. Unless advanced procedures and technology are developed.
The best recommendation would be to combine pharmaceutical, cognitive and behavioural treatments. Cognitive treatment would involve making the patient understand their situation and what to expect both before and after the amputation procedures. It also involves training the patients on how to manage stress and exercise patience during this difficult period. Behavioural treatment on the hand would involve teaching the patients practices and exercises that will enable them to relax (relaxation training) (Thorn, 2004). This treatment also assists the patients to adhere to habits will keep the sugar level low in the body. The pharmaceutical treatment is used in administering rugs that help heal the wounds, avoid infection and relieve the pain.
Case 2: Acute pain from an abdominal hysterectomy
Abdominal hysterectomy is a procedure in which the uterus is removed via an incision through the abdominal wall surgically. The pain can be significant during recovery after the surgical procedure. This pain is usually treated pharmaceutical using analgesics and anaesthetics in the form of morphine and codeines (Winfield et al., 2008). Surgical treatment can not be used to treat this pain as it is irrelevant especially since it causes more pain to the already healing incision.
The best recommendation is to use pharmaceutical and behavioural treatments. This treatment plan involves using anaesthetics and analgesics to relieve the pain which usually is very extreme. Behavioural treatment involves training the patient to avoid practices that will worsen the situation such as taking alcohol and taking dairy foods that makes them constipated. The patients are encouraged to take a lot of clean water, use all the prescribed pain relievers, eating healthily especially foods that are rich in minerals and vitamins as they aid in hastening recovery.
Case 3: Chronic headaches (non-migraine)
Head aches that are non-migraine and not symptoms of diseases such as malaria or typhoid are usually associated with distress and depression. Chronic headaches are argued to be an implication that the underlying issue is more psychological than medical. In most cases, chronic headaches are not just caused by stress alone; stress however has the potential of significantly increasing the magnitude of the headaches. Approaches that reduce stress can therefore help control and treat the occurrence of the headaches themselves. The pain that is associated with chronic headaches is a physical and mental stressor in itself (Feldman & Christensen, 2007). It makes the normal stresses that individuals have to undergo in their daily lives worse.
Chronic headaches are usually treated using pharmaceutical methods mainly analgesics. This method of treatment is however not effective as it does not completely keep the pain away. The body system also has a way of becoming immune to certain drugs if exposed for a long period of time such that the drug is not effective in its system. Surgical methods can also not be used in this case as it is more psychological than medical. The cause of the pain is usually not clear making surgery irrelevant. Daily use of analgesics and painkillers can also result to the patient developing drug rebound pains/headaches that always emerge as each dose declines or wears off (Winfield et al., 2008).
The best recommendation would be to use treatment methods that control stress. These are the cognitive and behavioural treatments. Cognitive treatment enables individuals to identify hence change thoughts that contribute to feelings of helplessness, panic and enhance headache susceptibility. This treatment involves arming he patients with problem solving skills that can be used to deal with situations that could cause chronic headaches (Thorn, 2004). Behavioural treatment guides stressed individual not to turn to undesirable behaviours such as alcohol and drugs as they usually are prone to such temptations. Behavioral treatment helps individuals identity practices they can engage in that are helpful in keeping stress at bay such as exercising, enough regular sleep and rest and eating healthy balanced meals (Feldman & Christensen, 2007).
Benefits of having all the four (surgical, pharmaceutical, behavioral, and cognitive) pain treatment methods available to chronic pain patients in a traditional hospital.
Each one of the above methods has advantages that are not present in the other methods of treatment surgical treatment for example enables the physicians to identify the real cause of the problem and remove it so that the patient is completely freed of the pain after they heal from the surgery procedure. It is hence a permanent treatment if well managed. Behavioural treatment finales patients to acquire skills that help them avoid practices that cause chronic pain. It also is a treatment that has long term effects. Cognitive treatment enables patients to understand their situation and causes of the pain. They get to understand how they can manage the pain so that its magnitude is reduced. Cognitive treatment helps reduce stress that could worsen chronic pain. Pharmaceutical treatment though temporary as it usually has no lasting effects where chronic pain is concerned. It however helps relieve pain hence reduces its magnitude even for a short while. None of these methods can effectively function alone. In order to completely deal with chronic pain such that patients are completely healed of it, it is important to combine all the four treatments as this has effects that are long term as compared to using a single method.
Doherty, G .M. & Way, L. W., (2005). Current Surgical Diagnosis & Treatment. New York, NY: London: McGraw-Hill Professional.
Feldman, M & Christensen, F., (2007). Behavioral Medicine: A Guide for Clinical Practice. Third ed. London: McGraw-Hill Professional.
Thorn, B. E. (2004). Cognitive Therapy for Chronic Pain: a step-by-step Guide. New York, NY: Guilford Press, 2004
Winfield et al., (2008). Pharmaceutical Practice Philadelphia, PA: Churchill Livingstone.