Frequently Asked Questions
Chapter 42: Pain

What are some common myths about pain and how would you address each myth?

The common myths about pain are (1) “The nurse is the best judge of a client’s pain.” Actually, pain is a subjective experience; (2) “If pain is ignored, it will go away.” Pain is real and can be treated. (3) “Clients shouldn’t take pain relief measures until the pain is unbearable.” Pain relief is possible with treatment. (4) “Most pain is purely psychological. Only ‘real’ pain will result in moaning or grimacing.” Most clients are honest about their pain, and physical responses or behaviors vary greatly. (5) “Clients with severe tissue damage will experience more pain.” Pain is subjective; physical responses are not necessarily proportional to the extent of pain experienced. (6) “Clients taking pain medications will become addicted to them.” Addiction is unlikely when the client’s use of analgesics is closely monitored.

What are endorphins and enkephalins and what are their purposes?

Endorphins and enkephalins are endogenous substances that bind to opioid receptor sites, providing pain relief and a sense of euphoria. They also enhance the individual’s mood and are involved in the “high” experienced by long-distance runners.

How is pain affected by age?

Infants and toddlers use crying and physical movement to indicate pain. Small children do not understand why pain occurs and are frightened by it. Older children often regress when faced by pain. Adolescents may be afraid to express pain for fear of being considered weak or overly sensitive. Adults continue pain behaviors learned as children and may be afraid to seek treatment, fearing the unknown or the effect of disease on lifestyle. Pain is underreported in older people because (1) they ignore pain, assuming it is part of aging; (2) they may have cognitive-perceptual deficits and cannot understand the pain sensation; or (3) family and health professionals may not recognize the pain.

How do stress and anxiety contribute to pain?

During acute pain, the release of substances from injured tissue lead to stress hormone responses, causing an increased metabolic rate, breakdown of tissue, impaired immune function, increased blood clotting, water retention, and the fight-or-flight reaction.

External stress and anxiety lead to increased muscle tension, sensitizing the nervous system to stimuli. The result is a “pain-anxiety-stress cycle,” in which pain is felt more acutely. Likewise, pain can lead to stress, anxiety, fatigue, and insomnia, and thus begin or intensify the cycle.

Why is behavior often not an accurate measurement of a client’s pain?

Behavior is often not an accurate measurement of a client’s pain because the client may (1) not admit to being in pain unless questioned carefully, (2) be using distraction to make pain more bearable, (3) want to be a “good patient” or not be considered a “sissy,” (4) be too exhausted to complain, (5) have a high pain threshold, (6) have strong coping capabilities, or (7) be demonstrating cultural differences in pain behavior

What are the common myths about pain in children and what are the facts?

The common myths about pain are that infants do not feel pain, children tolerate pain better than adults, children become accustomed to pain or painful procedures, and narcotics are more dangerous for children than adults. The facts are that the anatomic structures for pain processing reach adult maturity at 36 weeks after conception, children experience pain as adults do but may need special methods to express the pain, children show increased signs of discomfort with repeated pain, and narcotics are not more dangerous when used with children than they are when used with adults, when used appropriately.

What is the difference between drug tolerance, physical dependence, and addiction?

Tolerance occurs after repeated administration of an opioids analgesic when a specific dose loses its effectiveness and the client requires a higher dose to get the same effect. Physical dependence occurs when the body has physiologically adapted to opioids to the extent that withdrawal symptoms result when the opioids is discontinued. Addition is psychological dependence, which involves behavior of obtaining and using a drug for other than medical reasons.