Transcript No Slide Title

FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment
Arber, A.1
Pain assessment
Slide One
• Why is a bio-cultural approach to
pain recommended?
• What is meant by an embodied
approach to pain?
• How does new thinking about pain
affect assessment?
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May 2006
Re-thinking pain assessment (continued)
Slide Two
Why a bio-cultural
approach to pain?
• We need a theory of pain that
involves changes in culture rather
than biology alone
• Cartesian models of pain, which
split the mind from the body are
inadequate to explain the
complexity of pain
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May 2006
Re-thinking pain assessment (continued)
Body – mind split
Slide Three
• Descartes explained pain through
the bodily mechanisms called
nociceptors
• Human pain is not a sensation but a
perception dependent upon the
mind’s active power to make sense
of experience
• The mind’s power to alter
nociception makes pain far more
complex than a Cartesian alarm bell
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May 2006
Re-thinking pain assessment (continued)
Defining pain
Pain is an unpleasant sensory and
emotional experience associated with
Slide Four
actual or potential tissue damage, or
described in terms of such damage
International Association for the Study of Pain
1986
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FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment (continued)
Slide Five
Embodied experience of
pain
• Discourses related to pain as
organic/mental/emotional versus
that of psychogenic concerned with
causes rather than the experience
itself
• Knowing the cause of the pain is
distinct from the embodied
experience of pain
• The experience of pain concerns
feelings and emotions
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FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment (continued)
Criticisms of current
approaches
Slide Six
• Pain has become medicalised
• The person’s experience of pain
is neglected
• There is lack of a framework that
links pain with its social and
cultural context (Bendelow &
Williams 1995)
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FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment (continued)
A new model of pain
In other words, a far more
Slide Seven
sophisticated model of pain is needed
one which locates individuals within
their social and cultural contexts,
which allows for the inclusion of
feelings and emotions
(Bendelow & Williams 1995)
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FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment (continued)
Total pain
This concept expands the medical
Slide Eight
definition of pain into the emotional,
spiritual, social as well as physical
aspects of pain
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May 2006
Re-thinking pain assessment (continued)
Pain story
• Narrative is basic to any account
Slide Nine
of pain
• These narratives may not
separate the physical and
psychosocial aspects of the pain
experience
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FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment (continued)
Talking about pain
• If patients believe that the
physical causes constitute the
Slide Ten
meaning of the pain this makes it
risky to talk about emotional and
cognitive aspects
• Pain has an ‘acultural’ dimension
• Pain is both a medical entity and
a lived experience
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May 2006
Re-thinking pain assessment (continued)
Implications for
practice
Slide Eleven
• Pain autobiography
• Patient identity
• Pain diary
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May 2006
Re-thinking pain assessment (continued)
Reflecting on difficult
cases
Slide Twelve
• Negotiate with patients
• Learn from difficult cases
• Patient reputation
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May 2006
Re-thinking pain assessment (continued)
Support for staff
Slide Thirteen
• Unrelieved pain may be difficult
for health care professionals
• Good support of staff is
necessary when pain is difficult
to relieve
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May 2006
Re-thinking pain assessment (continued)
References and further
reading
Slide Fourteen
• Arber A (2004) Is pain what the patient says it is?
Interpreting an account of pain. International Journal of
Palliative Nursing. 10, 491-496.
• Beck SL (2000) An ethnographic study of factors
influencing cancer pain management in South Africa.
Cancer Nursing. 23, 91-9.
• Bendelow G & Williams SJ (1995) Transcending the
dualisms: towards a sociology of pain. Sociology of
Health & Illness. 17, 139-165.
• Benoliel JQ (1995) Multiple Meanings of pain and
Complexities of Pain Management. Nursing Clinics of
North America. 30, 584-596.
• Brockopp DY Downey E Powers P Vanderveer B
Warden S Ryan P & Saleh U (2004) Nurses’ clinical
decision-making regarding the management of pain.
International Journal of Nursing Studies. 41, 613-636.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment (continued)
References and further
reading
Slide Fifteen
• Clark D (1999) Total Pain, disciplinary power and the
body in the work of Cicely Saunders, 1958-1967.
Social Science and Medicine 49, 727-736
• Coward DD and Wilkie DJ (2002) Metastatic bone
pain. Cancer Nursing 23, 101-108.
• Fagherhaugh SY and Strauss A (1977) Politics of Pain
Management: Staff-Patient Interaction. London,
Routledge, London.
• Frank A (1995) The Wounded Storyteller. The University
of Chicago, London.
• Hilbert RA (1984) The acultural dimension of chronic
pain. Social Problems 31, 365-378.
• Hunt M (1989) Dying at home: its basic “ordinariness”
displayed in patients’, relatives’ and nurses’ talk
Unpublished Phd Thesis, Goldsmiths College,
University of London.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment (continued)
References and further
reading (continued)
Slide Sixteen
• Illich I (1976) The Killing of Pain. In: Limits to Medicine.
(ed. Illich I.) pp.133-154. Marion Boyers. London.
• Jackson J (1994) Chronic pain and the tension
between the body as subject and object. In:
Embodiment and Experience. (ed. Csordas TJ), pp. 210228. Cambridge University Press, Cambridge.
• Kuglemann R (1999) Complaining about Chronic Pain.
Social Science and Medicine 49, 1663-76.
• Melzack R and Wall P (1965) Pain Mechanisms: A New
Theory. Science 150, 971-979.
• Merleau-Ponty M (1962) The Phenomenology of
Perception. Routledge and Kegan Paul, London.
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slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment (continued)
Slide Seventeen
References and further
reading (continued)
• Merskey H. & International Association for the Study of
Pain (Subcommittee on Taxonomy) (1979) Pain terms:
a list with definitions and notes on usage. Pain 6, 249252.
• Murray SA Grant E Grant A Kendall M (2003) Dying
from cancer in developed and developing countries:
lessons from two qualitative interview studies of
patients and their carers. British Medical Journal
326,368-371.
• Patiraki-Kourbani E, Tafas CA, McDonald DD,
Papathanassoglou EDE (2004) Personal and
professional pain experiences and pain management
knowledge among Greek nurses. International Journal of
Nursing Studies 41, 345-354.
• Rogers MS & Todd CJ (2000) The ‘Right Kind of Pain’;
talking about symptoms in outpatient oncology
consultations. Palliative Medicine 14, 299-307.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc
FACET - European Journal of Cancer Care
May 2006
Re-thinking pain assessment (continued)
References and further
reading (continued)
Slide Eighteen
• Scarry E (1985) The Body in Pain. Oxford University
Press, Oxford.
• Schumacher KL West C, Dodd M, Paul SM. Tripathy D,
Koo P and Miaskowski CA (2002) Pain management
autobiographies and reluctance to use opioids for
cancer pain management. Cancer Nursing 25, 125-133.
• Sloan PA, Vanderveer BL, Snapp JS Johnson M & Sloan
DA (1999) Cancer Pain Assessment and Management
Recommendations by Hospice Nurses. Journal of Pain
and Symptom Management 18, 103-110.
• Wall P (1999) Pain the science of suffering. London,
Phoenix.
• Watt-Watson JH (1998) Effective pain management: is
empathy relevant? In: Perspectives on Pain (ed. Carter
B.), pp66-83. Arnold, London.
*Click on “View”; “Notes Page” for explanatory notes
slides available at: www.blackwellpublishing.com/journals/ecc