(specifically chapter 52 pages 461-462)
This is a text book that I used while in college and have referenced many times since. I will use the text to offer some further understanding to pain. The following has been re-typed exactly as it is in the text book.
The perception of pain is individualized. Pain is different in different people and at different times in the same person. The pain threshold is defined as the point at which a stimulus is described as being painful. The term pain tolerance denotes the point at which a person can no longer tolerate the pain without analgesia.
- Cultural: People with certain cultural backgrounds have been conditioned to cry out when in pain; others have been conditioned to be stoic.
- Age: Some researchers believe that very young and very old persons do not have as acute perception of pain as others. The very young child's nervous system is not fully developed, and damage and deterioration has affected the older person's nervous system. The older person may expect to have pain as a result of the aging process or may have developed an increased ability to cope with pain over the years.
- History of Pain: The person who is chronically ill and has almost constant pain often learns to tolerate the pain. On the other hand, if a previous experience was very painful, the person may have great pain when the experience is repeated (anticipatory pain).
- Anxiety: Anxiety can actually cause physical pain, an example of an emotional factor and its relationship to physical pain. Tense muscles reinforce pain.
- Body image/self-image: Feelings about oneself as a whole person can influence the reaction to pain. Embarrassment may cause the patient to keep pain a secret.
- Time of day: Many people express greater pain at night. This might be caused by loneliness, boredom, overexertion, or actual increase in pain.
- Suggestions: Sometimes the person can be preconditioned to feel or not to feel pain. For example, a woman told that childbirth is painful may have a great deal of discomfort; another woman may be preconditioned to have an uneventful delivery.
- Attention: If a person's attention can be diverted, he or she may not feel as much pain as would other-wise be the case. Pain may also go unperceived if the person is depressed, excited, or happy or is under a great deal of stress.
- Brain functioning: In some cases the perception of pain is distorted in the brain. It is possible to perceive pain when it seems that no cause exists or to interrupt the perception of pain so that the patient is no longer bothered by the discomfort.
Pain is subjective; that is, only the patient can describe it. Pain cannot be objectively observed by the nurse, although some of the manifestations of pain can be observed. For example, the nurse can observe the patient crying, screaming, wring the hands, or smoking excessively. However, the nurse does not know why the patient is doing these things unless told.
When the patient is admitted to the hospital and during the hospital stay, it is important to determine as much as possible about the pain. Questions asked about the pain should include location, onset, duration, frequency, description, and what makes the pain better or worse. Any factors that seem to precipitate the pain must be identified. Descriptions of pain include such terms as sharp, dull, stinging, pinching, cramping, gnawing, throbbing, vicelike pressure, shooting, burning, and intermittent.
Patients are often asked to rank their pain on a scale of 1 to 10. Their ranking from one time to the next gives you a more objective way of judging the severity of the pain. Other assessment formats have also been developed for pain assessment.
REMEMBER: if the patient feels pain, the pain is real.