Harmful Effects of Pain
Regardless of its nature, pattern, or cause, pain that is inade-quately treated has harmful effects beyond the suffering it causes. For example, unrelieved pain impairs the postoperative patient’s ability to sleep (Raymond, Nielsen, Lauigne et al., 2001). Zalon (1997) found that the most common response to severe pain in frail, elderly postoperative women was to lie absolutely still, a re-sponse likely to result in postoperative complications.
Unrelieved acute pain can affect the pulmonary, cardiovascular, gastrointestinal, endocrine, and immune systems. The stress re-sponse (“neuroendocrine response to stress”) that occurs with trauma also occurs with other causes of severe pain. The widespread endocrine, immunologic, and inflammatory changes that occur with stress can have significant negative effects. This is particularly harmful in patients compromised by age, illness, or injury.
The stress response generally consists of increased metabolic rate and cardiac output, impaired insulin response, increased pro-duction of cortisol, and increased retention of fluids. The stress response may in-crease the patient’s risk for physiologic disorders (eg, myocardial infarction, pulmonary infection, thromboembolism, and pro-longed paralytic ileus). The patient with severe pain and associ-ated stress may be unable to take a deep breath and may experience increased fatigue and decreased mobility. Although these effects may be tolerated by a young, healthy person, they may hamper recovery in an elderly, debilitated, or critically ill person. Effec-tive pain relief may result in a faster recovery and improved outcomes.
Like acute pain, chronic pain also has adverse effects. Suppres-sion of the immune function associated with chronic pain may promote tumor growth. Also, chronic pain often results in de-pression and disability. Although health care providers express concern about the large quantities of opioid medications required to relieve chronic pain in some patients, it is safe to use large doses of these medications to control progressive chronic pain. In fact, failure to administer adequate pain relief may be unsafe because of the consequences of unrelieved pain (McCracken & Iverson, 2001).
Regardless of how the patient copes with chronic pain, pain for an extended period can result in disability. Patients with a number of chronic pain syndromes report depression, anger, and fatigue (Meuser, Pietruck, Radruch et al., 2001; Raymond et al., 2001). The patient may be unable to continue the activities and interpersonal relationships he or she engaged in before the pain began. Disabilities may range from curtailing participation in physical activities to being unable to take care of personal needs, such as dressing or eating. The nurse needs to understand the ef-fects of chronic pain on the patient and family and needs to be knowledgeable about pain relief strategies and appropriate re-sources to assist effectively with pain management.
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