Chronic Pain: Extended Literature Review

Summary: Managing Chronic Pain

Pain management is an essential responsibility if a nurse and an important element of meeting the patients’ needs. However, creating a uniform approach toward pain management is difficult because there are countless ways of classifying and, therefore, defining pain, i.e., based on the affected area, its source, the factors that contribute to pain development, etc. (Nalamachu, 2013). Therefore, the process of managing chronic pain is rather intricate and complex.

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Nalamachu (2013) provides a rather general overview of the concept of pain. According to the author, there are two categories allowing for the identification of an appropriate pain management type and the application thereof, i.e., the NSAID typology and the opioid category. Each of the frameworks provides its own approach toward categorizing the pain relief medicine based on its impact, the severity of the adverse effects, etc.

The NSAID framework distinguishes between five primary pain types: postoperative pain, pain located in the low back, osteoarthritis, and migraine pain (Nalamachu, 2013).Acetaminophen is typically viewed as the traditional tool for managing different types of pain, primarily, the ones that manifest themselves in mild and medium forms. However, the drug has a range of side effects, which has made the medicine containing it an over-the-counter product (Nalamachu, 2013).

The current dominance of opioids in the chronic pain treatment frameworks created the foundation for a range of health complications, the development of substance dependence and its further abuse being the primary reason for concern, as the study by Reuben et al. (2015) indicates. Furthermore, the study mentions that regular use of opioids as the means of stifling the pain finally leads to a drop in the drug efficacy and the increase in pain intensity (Reuben et al., 2015). The issues associated with the pain management process, however, are inherent to the current healthcare system, which has intrinsic flaws and, therefore, needs a redesign. For instance, the study points to the fact that there are currently no team-based approaches to managing pain. Therefore, a range of opportunities is missed.

Finally, the study by Feinstein et al. (2015) needs to be looked at as the guide to providing patients with the relevant information and promoting awareness about the subject matter. According to the study results, the increase in emotional awareness of pain allows for a much more efficient management thereof. Furthermore, the identification of the pain matrix, i.e., the changes in pain perception in the patient, is crucial to the further application of the strategies for reducing the painful experiences.

Synthesis: Developing a New and Improved Framework

When considering the existing evidence about the process of pain management, the strategies used in it, and the challenges associated with their implementation, one is likely to notice first that there is no rigid framework for pain classification. On the one hand, the identified phenomenon is quite understandable and easily explainable. Indeed, with the variety of factors that affect the development of chronic pain, as well as the numerous approaches based on which the concept of pain management can be designed, there are very few opportunities for developing a uniform approach toward pain classification. However, it is important to develop the common framework based on the nature of pain that would help determine the possible causes and, thus, identify the tools for managing the issue in a manner as efficient and expeditious as possible. Furthermore, a detailed analysis of the factors that make pain intensify or subside must be conducted so that a nurse could determine the course of actions to be taken.

The information provided by Reuben et al. (2015) implies that there is a need for designing a multidisciplinary approach toward pain management. Indeed, as the author stresses, there is no team strategy with the help of which the pain management process could be enhanced. As a result, the transfer and analysis of the relevant information occur at a very low speed, thus, leading to an immediate drop in quality of the nursing staff’s performance. The introduction of multidisciplinary practices and the enhancement of cooperation between experts from different areas would help address the identified issue and, therefore, improve the quality of pain management significantly. Particularly, the problems associated with the development of chemical dependency among the patients suffering from chronic pain needs to be listed among the areas that could be addressed once the multidisciplinary strategy was implemented. Therefore, there is an evident need in introducing the tools for enhancement of the communication and cooperation processes between the representatives of different departments as far as the issue of pain management is concerned.

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The issue of patient education is another area that needs a more elaborate strategy. Particularly, it is crucial that the target population should be aware of the issues that the consumption of opioid pain medications entails. Particularly, it is crucial that patients should be able to recognize the development of dependency and be ready to cooperate with the therapist to handle the problem in a manner as efficient as possible. For this purpose, an improved approach toward the management of information must be considered. Particularly, patients must be aware of the crucial side effects of pain relief drugs, the comorbid issues that they may trigger, and the available strategies for managing the problem. The enhancement of the effects that awareness programs have on the target population can be increased with the use of modern media as the means of disseminating information.

Resources Assessment: Strengths and Weaknesses

The articles under analysis have their advantages and disadvantages as the sources for retrieving essential information about pain management. When it comes to discussing the problems that each research has, the choice of the method with the help of which the issue was studied is typically the source thereof. For instance, the randomized controlled trial used by Feinstein et al. (2015) works only as a general pointer to the problems that the current approach toward pain management has since the design of a trial does not allow viewing each case individually. The same can be said about Nalamachu’s (2013) and Reuben et al.’s (2015) studies, which explored the problem from the perspective of a specific setting.

That being said, the articles have a range of strengths. For instance, the papers help view the problem from a multidisciplinary perspective, therefore, pointing to the factors that contribute to pain management efficacy. Moreover, the studies provide a deep insight into the problem of pain management, the nature of pain, the factors that contribute to its development, and the ethical issues associated with opioids prescription. As a result, a comprehensive analysis becomes a possibility. Therefore, every research adds to the understanding of the problem and helps develop a solution.


Feinstein, J. S., Khalsa, S. S., Salomons, T. V., Prkachin, K. M., Frey-Law, L. A.,. Lee, J. E.,… Rudrauf, D. (2015). Preserved emotional awareness of pain in a patient with extensive bilateral damage to the insula, anterior cingulate, and amygdala. Brain Structure and Function, 221(3), 1499-1511.

Nalamachu, S. (2013). An overview of pain management: The clinical efficacy and value of treatment. The American Journal of Managed Care, 19(14Suppl), 261-265.

Reuben, D. B., Alvanzo, A. A. H., Ashikaga, T., Bogat, A., Callahan, C. M., Ruffing, V., & Steffens, D. C. (2015). National Institutes of Health pathways to prevention workshop: The role of opioids in the treatment of chronic pain. Annals of Internal Medicine, 162(), 295-300.

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