Pain is complex. Pain involves many dimensions that can affect the way it is expressed in how it responds to treatment. A person's pain is unique. It is expressed in many ways, both within the person and as the person relates to others. Let's review each of these ways and I'll offer some questions to ask yourself that will help you understand how various therapies can lessen pain. The physical or sensory experience of pain helps explain the cause of the pain. People need to tell us how their pain feels in their body so that we can understand the nature of their pain and choose a pain treatment. Some questions to ask yourself, what is causing the pain? What is the physical cause? Where in the body is the person feeling pain? How does the person describe it? For example, back pain is somatic, meaning muscular or bony in nature and can be described as achy or throbbing. Typical treatments are non-steroidal anti-inflammatory drugs or topical pain patches or creams, massage, heat and cold, or physical therapy may also help. The affective dimension of pain means the way the person responds emotionally to the pain experience. They might feel sad, angry, or distressed. They may feel anxious, unable to concentrate, moody, or out of control. A person's feelings and involvement in their palliative care may affect pain intensity and how well they feel their pain is managed. Ask yourself, how might the person's emotional state affect the way they experience pain? How does the pain influence the person's affect, their mood or their function? Medications like antidepressants may decrease certain pain types by affecting mood, counseling or relaxation therapy may also be used to help patients cope with pain. The cognitive dimension of pain refers to the way pain influences the person's thinking. This includes what people think, how they view themselves in relation to the pain, what they know about pain, the knowledge, attitudes, and beliefs they have about the pain and its management and the meaning of the pain. Past pain experiences may influence ideas about pain and what works best to manage it. Ask yourself the question: what does the person know about pain and pain treatment? Sharing educational handouts or information about pain and its treatment can help people better understand their pain and how it can best be managed. Pain behaviors are the way people express or cope with pain through their actions. Questions to consider is how do you know this man is in pain? What's he doing that tells you about the pain? You can see tears, a furrowed brow, a hand to his head. These are all obvious nonverbal cues that can tip you off that he is experiencing a severe headache or possibly distress. The sociocultural dimension involves a broad range of ethnic, cultural, social, and spiritual factors that influence a person's pain description, their experience, understanding and response to pain. We'll talk about each of these. Ask yourself the question: how might this patient's background affect pain expression, coping, and following a pain management plan? Elderly patients have many medical concerns and often suffer from chronic painful conditions. Elders also have physical, emotional, and social needs that are very different from younger and middle aged adults. They often under report pain as they believe pain is a part of aging and they don't wish to be a bother. Memory failure, loss of hearing, and vision, and depression may also hinder pain reporting. We need to be mindful of possible gender differences that may affect pain sensitivity, tolerance to pain, distress, willingness to report pain, and nonverbal expression. Research suggests that men show less emotion than women. Women show lower pain thresholds and less tolerance to pain stimuli than men. Women become more upset when pain prevents them from doing things they enjoy and women often seek care sooner. Medication response may also differ by gender but regardless, men and women should receive care based on their own personal pain experience. We also know that racial and ethnic differences lead to unequal pain treatment. The word ethnicity refers to differences among groups of people according to their common language, traditions, shared origins, social backgrounds, culture, and physical characteristics. Differences in cultural backgrounds between patients who speak English as a second language and English speaking healthcare providers may result in misunderstanding, lack of trust, and poor communication. Providers must be careful to avoid cultural stereotyping and bias, sharing culturally sensitive pain scales and handouts, and using an interpreter or a patient navigator; someone who speaks the patient's language can help. It's important to explore the type of support patients receive from family caregivers as it can impact pain expression, the meaning of the pain, and the ability to follow the pain management plan. Patients may need help from their loved ones in taking medications or using non-drug therapies or integrative therapies. A person's spirituality may also affect pain expression, their response, and experience. While pain refers to a physical sensation, suffering suggests a quest for meaning, purpose, and fulfillment. Unrelieved physical pain may cause emotional or spiritual suffering. Remember that suffering may also occur in the absence of pain. Assessing a patient's spiritual view of pain and suffering is important because it can affect the process of healing and dying. We should also consider the patient's financial status. Health care insurance companies may require a patient to take a stepped approach to pain medications, require the use of certain opioids over others, or even limit the amount of medication allowed in a given period of time. For example, they may limit how many pain pills the patient can receive each month. In addition, non-drug therapies can be costly and may not be paid for by insurance, medicaid or medicare and if patients can't get the medication or suggested non-drug treatment, pain relief may not be possible. Lastly, think about how noise, lighting, or extreme temperatures may be sources of stress for a person in pain. Creating a peaceful environment, free from bright light, loud noise, and extreme heat or cold may help lessen pain.
