The psychological elements include the cognitive, emotional, motivational, attitudinal, and behavioral components that influence health. The social elements are the “actual or perceived social contacts on health” (Lehman, David, & Gruber, 2017, p. 3). Each element or component influences the overall health of a person over time. This can be seen when an individual experiences pain; the physical limitation may affect the social components of an individual’s life. Over time, the social components, together with the physical limitations, often will influence the psychological dimensions (Lehman et al., 2017). A review of the literature by Samoborec, Ruseckaite, Ayton, and Evans (2018) found that many of the factors that limit recovery were attributed to each component of this model. This study identifies biological and psychological components to be consistent factors that influence an individual’s recovery. While there is research to support certain social factors that can inhibit a person’s recovery, these factors should be addressed cautiously as there is a need for further research to support this relationship. Factors impacting recovery identified by these authors can be reviewed in Table 2.
Table 2: Factors Impacting Recovery Biological domain
● Pain, including the type, intensity, and duration. ● Age. ● Sex. ● Pre-accident physical or mental disability/ chronic condition. ● Pain catastrophizing and causal beliefs. ● Recovery expectations and coping skills. ● Post-traumatic stress disorder, anxiety, and depression. ● Pre-accident health-seeking behavior and somatization. ● Previous unemployment and low educational level. ● Hospitalization status. ● Procedural justice and compensation process. ● Lack of trust by insurers. ● Importance of timely healthcare decision making. ● Family and social support.
Psychological domain
Social domain (taken in context with all other factors)
Note. Adapted from Samoborec et al., 2018.
PAIN MYTHS
● If clients can sleep or be distracted by visitors, their pain cannot be very bad: False . Furthermore, the erroneous expectations of some health professionals that clients must act as if they are in pain can encourage clients to be manipulative (McCaffery & Robinson, 2002). Cultural beliefs among both clients and health professionals can play a large part in sustaining myths about pain. One of these beliefs is the myth, mentioned earlier, that clients must express and exhibit pain and pain behaviors. With the current concern around narcotic pain medication, the Joint Commission (2018) revised their standards on pain, and this in turn changed the beliefs and actions of the health profession. The Joint Commission’s Standards Interpretation Group developed 10 pain standards: Leadership 1. Develop, implement, and monitor performance improvement activities specific to pain management. 2. Provide nonpharmacologic pain treatment modalities. 3. Provide staff and practitioners with education and resources on pain management and safe use of opioid medications. 4. Provide staff and practitioners information on available services (internal or external) for consultation and referral of clients with complex pain management needs. 5. Identify opioid treatment programs for clients who need referrals. 6. Provide access to prescription drug monitoring program databases. 7. Develop a system to monitor patients following sedation or anesthesia (continuous intravenous opioids). Performance improvement 8. Analyze data collected on pain assessment and management to identify areas for improvement around safety and quality. Provision of care, treatment, and services 9. Ensure appropriate screening and assessment tools are available and used appropriately to measure client pain. 10. Educate client and family about discharge plans related to pain management. (Joint Commission, 2018) Clients who have been reluctant to express their need for pain relief are taught that it is their right (and responsibility) to be actively involved in pain management (Acello, 2000).
The following are just some of the myths that remain as barriers to effective pain management: ● Narcotics always take away the pain: False . There are great individual differences in client response to medications. There may be interference from interaction with another drug or the cognitive process involving the action of the drug, or there may be a problem with the metabolism of the drug. Some people, for example, lack the enzyme that converts codeine to morphine in the body. These clients usually excrete the medication before it can affect their pain (McGuire, 2006). ● Pain is a result of aging: False . Too often older adults endure “silently and needlessly” with chronic pain (S. T. Brown, Kirkpatrick, Swanson, & McKenzie, 2011). In addition, conditions that normally cause pain in earlier adulthood may be perceived differently by older adults. Older adults may hold the same misconceptions about pain as those held by healthcare providers. According to multiple studies reviewed by (Hallingbye, Martin, & Viscomi, 2011), “Older adults themselves may in fact believe that pain is something to be tolerated because it is an inevitable part of aging and may show increased stoicism when reporting pain” (p. 815). ● Clients must say they are in pain or show physical evidence of pain before other people can believe it: False . People may not express their pain willingly or may downplay its presence for many reasons. One study found that people with osteoarthritis had difficulty expressing their pain because of the “perception that nobody wants to hear about it,” the “necessity to preserve one’s self and social image,” and “self- imposed stoicism” that caused patients to attempt to cope with the pain by not thinking about it (Cedraschi et al., 2013, p. e79988). Prkachin (2011) found that healthcare providers may underestimate pain as the result of having had “high levels of exposure to facial expressions of pain” (p. 367). ● Taking a narcotic will lead to addiction: False . A number of studies have found that when pain is relieved, the need for narcotics abates (McCaffery & Robinson, 2002; Portenoy & Dahl, 2004). According to Vowles et al. (2015), between 8% and 12% of those prescribed opiates for chronic pain develop an addiction disorder.
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