Psychological mechanism of pain
Pain is an important task of the nervous system as it provides the body with signs of an actual or a potential injury (Coetzee, 2013). According to Taylor (2015), pain can be categorized as both emotional experience and sensory considering it is affected by psychological factors among them including past experience, anxiety or fear and beliefs about pain. Pain can also be described as a personal experience which has two corresponding aspects: the first aspect is a confined sensation in a specific part of the body and the other one is the unpleasant quality of variable severity which is commonly linked to the behaviour which is focused at either terminating or relieving the experience (Rezek, 2016).
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Sensory modalities and pain have got much in common, to begin with, the nerve endings are the specific receptors of pain, which is usually found in most body tissues that precisely to damaging or possibly damaging stimuli (Rezek, 2016). Secondly, the messages introduced by these noxious stimuli are often transmitted by identified spinal code which is often specific and is transmitted all the way to the spinal cord. Taylor (2015), stated that the nerve attached to the tissue which has sensitive never also attached to the tissue together form a unit which is known as the primary afferent nociceptor. Taylor (2015) goes further and states that the subsequent order pain transmission neurons are contacted by the primary afferent nociceptor in the spinal cord. Rezek (2016) goes further and explains that the second-order cells convey the message through a path which is well-defined to higher centres which include thalamus, cortex the brain stem reticular formation, limbic system and somatosensory cortex. It’s through the entire process that the underlying pain perception include primarily the cortex and thalamus
Historical background of Opioid in the United States
According to Marcovitz (2018), opioid abuse has been there in the United States for quite some time now. During the time of civil war, the soldiers who had severe injuries were injected with morphine to relieve their pain. In the late 1800s, synthetic opioids had begun to be produced by the pharmaceutical companies and during this time heroin was equally available. According to Office of Adolescent Health (2017), It is during this time that a clear evidence emerged on the fact that the derivatives of the opium were addictive therefore the United States decided to restrict the importation of Opium to be strictly for the medicinal purpose. The international Opium convention which was held in 1912 made the United States alongside other nations to sign the agreement to control the import of opioid (Marcovitz, 2018). However, the opioid issues continue to surface particularly following the war during this period. Veterans who used opioid for the relief of the acute pain linked to the injuries they received during combat continued to use and finally ended up misusing the drug when the war was over.
Approximately more than 115 people die in the United States after overdosing on an opioid. The dependence and misuse of opioids include artificial opioids like fentanyl, heroin as well as prescription which is meant for relief of the pain. This is serious national crisis that affects not only public health but also social and economic welfare. The economic burden that these drugs have caused its estimated by the centres for disease control and prevention to be approximately $78.5 billion a year which is inclusive of healthcare costs, the loss of productivity due to the addiction, treatment of addiction itself and finally the criminal justice involvement (Rezek, 2016).
According to Schnell, Currie, & National Bureau of Economic Research, (2017), pharmaceutical companies in the late 1990s came out reassuring the public that the patients would not end up getting addicted to the prescription of pain relievers and this led to the prescription of the Opioid by the healthcare providers at a higher rate. The massive prescription of the opioid pain relievers consequently led to extensive alteration and misuse of these medications prior to the fact becoming open about how addictive the medication could turn out to be and in this regard the rate of opioid overdose begun to increase (Taylor, 2015). It is noted that in the year 2015, over 33,000 Americans died as a result of the overdose of opioid and in this case the deaths include the prescription of opioids, illicitly manufacture fentanyl, heroin and a powerful synthetic opioid. In the same year, it is estimated that over 2 million Americans living in the United States suffered disordered associated with the prescription substance which in this case was opioid pain relievers, on the other hand, an estimated of 591,000 Americans suffered from a disorder linked to heroin use (Schnell, Currie, & National Bureau of Economic Research, 2017).
Across the 52 zones in the 45 states in the United States, there has been an increase of about 30% of opioid overdose in a span of one year that is from July 2016 to September 2017. This made President Trump declare Opioid a public health crisis and he pledged to allocate more resources in tackling the menace all this happened in October 2017 (Schnell, Currie, & National Bureau of Economic Research, 2017).
Prescribing practice that fuels the opioid crisis
The current opioid epidemic in the United States has been catalyzed by the prescribing practice of the health workers. It is evident that between the year 2001 to 2010 there was an increase of 49% where opioid was prescribed for the pain. In the year 2010 over 119 patients have prescribed Morphine which is equivalent in milligrams to the general prescription by all the healthcare specialist nationwide (Taylor, 2015).
The current state of the abuse of opioid has also been fuelled by the prescription in the emergency. According to Taylor (2015), the major challenge that the emergency department face in regard to the opioid epidemic is how to balance the need to professionally provide sufficient pain control for patients who are in the emergency department and at the same time minimizing the availability of opioids which can be easily abused or prone to diversion.
The prescription of a large amount of Opioid has also contributed to the abuse and the current epidemic in the United States. This has made accessibility of the drug easy as it’s easily replaced when destroyed or even stolen making the cycle constant creating a perfect environment whereby the drug can easily be abused (Marcovitz, 2018).
There has been also along belief that Opioids are safe and effective in dealing with chronic pain, this led to an overreliance on Opioid and significantly reduced the number of multidisciplinary pain centres all over the United States (Marcovitz, 2018).
According to the Office of Adolescent Health. (2017), the decision of the pharmaceutical companies, insurance companies, medical governing agencies as well as retail pharmacies to decrease the cost of pills though with good intention has contributed to the opioid crisis in the United States as it is affordable and also available therefore it’s easily being abused.
The aim of pain management is not certainly a total relief of pain. It includes reducing the amount of pain, improvement of the quality of life, improved psychological and physical functioning, improve the ability to function and work and finally reducing in health care operations (Coetzee, 2013).
According to Rezek (2016), a pain management plan does more compared to pain medication prescriptions. This is due to the fact that the pain management plan will include both psychological and physical modalities to contain pain. For instance, on considering a chronic pain much is needed besides the prescription of medication, it requires teamwork from the healthcare personnel as well as a holistic approach of care with the aim of improving the overall quality of life for the patient.
Nurses roles are critical for proper pain management, listening to the patient by nurses is a critical point of managing the pain and this is even vital for the patient especially those that suffer from chronic pain (Taylor, 2015). This is due to the fact that these patients usually live with extreme fear, uncertainty about their future, anxiety, loneliness and constant social isolations. The nurses provide a platform where the patient will connect to through their stories and this is therapeutic in itself.
The pain management plan should be shared with the patient and it should consist of important information such as the medication that has been prescribed, other options in regards to the treatment and the methods to that would enable the patient to contact the pain management team (Coetzee, 2013).
According to Coetzee (2013), a good management plan should have various consideration which includes the type of pain, the effect of the pain on the patient’s lifestyle this include social, psychological and biological aspects of the patient’s life.
Several factors affect a successful treatment plan of pain. For instance, the issues that are linked to the patient, issues like the ability of the patient to understand the management plan and apply it as advised, this will be helpful in determining the success of the plan. The proper management of the pain is based on the patient’s willingness to implement the whole plan (Coetzee, 2013).
For the patients who are experiencing the debilitating symptoms, there should be a referral to pain management specialist this include the patients who are in need of increased dosage of pain medication as well as those who have become non-responsive to the treatment or those with symptoms at multiple sites (Taylor, 2015).
According to Coetzee (2013), caregivers or healthcare professional should have a comprehensive information on the patient management plan. This is often a challenge because they may fear the fact that the client might end up being addicted to the drugs to curb this the healthcare providers and the patient should have a mutual goal set for the purpose of managing the pain.
Constrained substances should be precisely prescribed for the purpose of legitimate medical application with a contemplation of the patient’s safety, efficiency of the treatment and goals of the therapy. The treatment of the pain should not only involve pharmacotherapy but also psychological and physical therapies (Coetzee, 2013).
Ethical and legal implications
The healthcare practitioner that deals with the substance abuse must be able to balance between what is right in accordance with the professional standards and what is right for them as individuals. The health workers should familiarize themselves with the NASW Code of Ethics in order to merge personal beliefs with professional code. In both cases, it’s important to weigh what “feels right” personally with the policies and standards of the profession and the environment (Bucky, Callan & Stricker, 2013).
The common ethical dilemma that occurs in the regards to the patient of substance abuse is the conflict that is between client behaviour and the values of the clinician. It’s usually clear for the professional that if the clients turn to suicide or threaten homicide, they have an obligation to report the matter to the appropriate authority. In addition to this Ethical issues also emerge in several insignificant ways among the issues that arise are; was the client in a position to understand the release of information stated, or the healthcare worker just rushed so that he can get the next appointment, did the healthcare worker listen to the client concerns about his culture and how the treatment plan is bound to fail if is not created in a culturally competent manner? These are just but a few of the issues which arise on a daily basis and it affects the care that the client receives (Bucky, Callan & Stricker, 2013).
Bucky, S. F., Callan, J. E., & Stricker, G. (2013). Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards. Hoboken: Taylor and Francis.
Coetzee, J. F. (2013). Pain management. Philadelphia, PA: Elsevier.
Marcovitz, H. (2018). The opioid epidemic.
Office of Adolescent Health. (2017, November 29). Opioids and Adolescents. Retrieved from https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/opioids/index.html
Rezek, C. (2016). Pain Management. SPCK.
Schnell, M., Currie, J. M., & National Bureau of Economic Research, (2017). Addressing the opioid epidemic: Is there a role for physician education?.
Taylor, D. R. (2015). Managing patients with chronic pain and opioid addiction.
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