Treatment Options for Clinical Pain Joy Wilson 07/26/2011 Facilitator: Diane Phillips

Treatment Options 2

Pain that requires and benefits from medical treatment is called clinical pain (Sarafino, 2000). There are many medical situations and conditions that require treatment of acute clinical pain. A patient stress and emotional level can be improved with the proper treatment of acute pain. When a patients pain level is alleviated or at a comfortable level, the patient tends to be more at ease and able to function better. To completely eliminate chronic pain may require a more aggressive and comprehensive plan of treatment. An aggressive and comprehensive approaches used in cases like this may include the multiple or combined approaches, consisting of pharmacological, behavioral, cognitive, and surgical treatments which are designed to have the greatest benefit for each individual patient (Sarafino, 2006).

There were three cases presented. Each case show be viewed and evaluated individually for potential approaches of clinical pain treatment. There are four approaches which include behavioral and cognitive therapies. These approaches will give the patient the proper tools and knowledge for coping with chronic clinical pain; medications; and surgical treatment for reducing or eliminating pain (Sarafino, 2006).

This assignment required that we take a look at three different of clinical pain. The first case discussed a patient suffers from clinical pain that resulted from a below the knee amputation. In the second case we examine an individual who has post-operative acute pain from an abdominal hysterectomy. In the third case the individual complained of chronic headache pain that was not diagnosed as migraines (Axia College, 2007). In the first case it was easy to identify that the cause of pain resulted from the phantom limb which is often a part of amputation (Sarafino, 2006). The patient should be evaluated to assess the possible underlying causes of the patients pain. One suggestion could be that a prosthetic limb does not fit properly. This can possibly cause the site of amputation to become irritated and uncomfortable. Another possible cause could be that the patient is not being receiving enough physical exercise, which can cause stiffness and irritation. In this patients case, surgical treatment wouldnt be recommended (Nelson-Hogan, 2007). The patient would probably benefit from shortterm pharmaceutical treatment along with cognitive and behavioral therapy. In the second Case the patient was experiencing acute post-operative pain, which may possibly require short-term pharmaceutical treatments for alleviating pain and discomfort that follows post major surgery. The approach to treat this type of pain could be as aggressive an additional surgery to alleviate the pain, or a minimal approach

like cognitive and behavioral therapy (Sarafino, 2006). It is not likely doctors would recommend surgical treatment is for the patient in the third case. The patient complains of suffering from chronic headaches. The headaches are more than likely the result of tension or stress (Serafino, 2006). Using pharmacological treatment for pain control should be used only in cases of severe, prolonged, and frequent headaches. Cognitive and behavioral approaches could be highly beneficial. Stress is a part of everyday life, but the reduction of stress can help reduce or even eliminate the frequency of headaches (Sarafino, 2006) The patient with clinical pain due to recovery from an abdominal hysterectomy will have her pain reduced or alleviated by using centralized pain medications, the reason being they are the most effective for treating severe acute pain (Sarafino, 2006). The patient can receive hydrocodone, codeine, morphine, Demerol, or dilaudid intravenously while an inpatient (Hanley Center, n.d.). Once discharged from the hospital, the patient can continue reducing any post-operative pain by using oral pain medications like Percocet, vicodin, or codeine. This will also help with the reduction of inflammation and swelling at the surgical site (Hanley Center, n.d.). While the patient is still an inpatient, she should receive cognitive training concerned with redefining pain as a way to cope with acute pain following her surgery

(Sarafino, 2006, p.332). If she does not comply with her care after surgery, an operant approach needs to be put into place. Complying with post surgery care is a major factor in recovering from pain after surgery. Not following the doctors recommendations after surgery may possibly result in prolonged pain after surgery, infection, or other complications. This patient will benefit greatly from following the doctors post care orders and taken the prescribed pain medications. The case of treating pain for the amputee can potentially be more difficult and may require more than one forms of treatment. This patient may benefit from the services available at a pain clinic. Amputation may not only affect the patient physically, but psychologically as well. In situations like this the patient may benefit from group therapy along with the pain medications. In this approach the patient can relate to other sufferers of chronic pain and other patients that are also dealing with the post affects of amputation. At group therapy sessions the patient will have the opportunity to hear other peoples stories, and the mechanisms they use to cope with stress and pain, which may leave a positive impact on the patient. The patient can also have a more positive outlook through redefinition (Sarafino, 2006). Along with therapy the amputee may also benefit pharmacological help with treating pain. If the patient is suffering from depression, he or she may also prescribed

an antidepressant along with the pain medication, can reduce the likelihood of depression as well as pain, and can help aid the patients ability to sleep. A sedative antidepressant that also contains analgesic properties can address several of the patients complaints (Nelson-Hogan, 2007). There have been cases where a combination of antidepressants and methadone successfully has treated phantom limb pain (Sarafino, 20060. I believe this patient will benefit from oral pain medication, group therapy treatment, as well as an antidepressant. This will be a major factor for managing the case of the amputee. Depending on the effectiveness of the pharmaceutical, cognitive and behavioral approaches to pain management, a TENS unit or massage therapy could also be beneficial (Sarafino, 2006). Examining the patients prosthetic limb for fit issues will address any problems that may be adding to the patients chronic pain and distress (Nelson-Hogan, 2007). The patient with chronic headaches is far more complex. Likely, social factors are a major contributing cause of this chronic pain. Stress from life circumstances, such as relationships, likely causes muscle and tendon tension. This patient needs extensive cognitive and behavioral methods of treatment. No surgical treatment is needed. The patient will also need psychotherapy to help him or her learn how to cope

well with stress and how to relax. Biofeedback, along with an operant approach to therapy, will also be utilized (Sarafino, 2006). For this patient, I anticipate biofeedback to have great benefits, as it has been proven to be 40% to 50% effective in reducing tension-type headaches (Sarafino, 2006). The uses of imagery to bring on relaxation, as well as redefining pain, are among the cognitive approaches to be used (Sarafino, 2006). Referrals to massage therapists or acupuncturists can help the patient in pain reduction and increase of relaxation (Sarafino, 2006). Additionally, the patient will assess personal levels of physical activity and create a regular routine of exercising as a means of reducing the effects of stress.

Although these may have been three different cases that did not require the use of surgical treatment for the reduction or elimination of clinical pain, this is an appropriate option for certain kinds of pain and should always be considered as such. All four types of treatmentbehavioral and cognitive, pharmacological, and surgical approachesmust be carefully evaluated during the development of a treatment plan for a patient with clinical pain. A complete, inclusive approach made up of multiple

approaches is the one most beneficial for treating pain.

References

Axia College. (2007). Treatment options for clinical pain. Retrieved May 28, 2009, from Axia College, Week Seven, HCA250 - The Psychology of Health. Hanley Center (n.d.). Managing post-surgical pain for those in addiction recovery. Retrieved May 28,2009, from http://www.hanleycenter.org/pdfs/postSurgicalBrochure.pdf

Nelson-Hogan, D. (2007). Diagnosis and treatment of post-amputation pain. The Pain Practitioner, 8-11. WebMD. (2010). Pain and Depression. Retrieved from http://www.webmd.com/painanddepression

Sarafino, E.P. (2006). Health psychology biopsychosocial interactions (5th ed.). Hoboken, N.J.John Wiley & Sons.