The Body's Defenses Against Pain
The body has internal mechanisms that help to control pain and its perception: endorphins and inhibition of pain transmission.
Naturally occurring analgesics called endorphins are produced by the body. These endorphins are produced by the brain and spinal cord and are many times stronger than morphine. However, they are safe and occur naturally in the body as a result of exercise and certain other stimulation. They serve to kill pain and to elevate the patient's mood level Endorphin production is increased with acute pain but decreases or stops as pain becomes chronic. Some authorities believe that activities other than exercise, such as laughter, also increase endorphin production. It is also believed that intake of certain chemicals and foods, including caffeine, nicotine, alcohol, salt, and sugar decrease endorphin production in all people, whether they are in pain or not.
Another internal mechanism for pain control is referred to as inhibition of pain transmission and works on what is called the gate control theory of pain. The theory maintains that small-diameter nerve fibers conduct pain stimuli toward the brain, but large-diameter nerve fibers inhibit the pain impulses. When too many stimuli are sent, certain cells in the spinal column interrupt the transmission as if closing a gate. Certain nursing measures for pain relief are based on the gate control theory.
Physical measure to control pain include the following:
- Physical stimulus (cutaneous stimulation): Gentle message or pressure may relieve congestion or promote circulation and oxygenation, and thus relieve pain. Cutaneous electrical stimulation is used to relieve low back pain (TENS unit).
- Heat and cold: The application of heat or cold may help to control localized pain.
- Exercise: Exercise can relieve pain by promotion circulation of the part, distracting the patient and stimulating endorphin production.
- Comfort measures: A clean bed, a clean fade and hands, restful music, and a semilighted room may promote relaxation and pain relief. Positional changes help.
Several psychological techniques can be helpful in control of pain:
- Distraction and diversion: Activities such as visiting, games, television, or craft projects can serve to divert the patient's attention.
- Listening:: Sometimes the patient can relieve pain by verbalizing to the nurse about the pain.
- Relief of anxiety: The resolution of a problem may be all that is needed to relieve the pain.
- Deep relaxation: Deep relaxation techniques can be very effective in control of pain. The procedure often involves guided imagery. For example, the patient controls a migraine heachache with deep relaxation, followed by visualizing the dilation of cranial blood vessels.
- Deep controlled breathing: This technique has been used extensively in childbirth.
- Group therapy: Feelings can be verbalized and suggestions for pain control shared. The family may be involved with the group.
Some ointments and liniments relieve pain. They may contain a local anesthetic or may draw blood into the area to increase the temperature and improve circulation.
Analgesics are often used for pain control. However, medications may mask the symptoms, so that a serious disorder goes undetected. On the other hand, if the person truly is having pain, withholding an analgesic can intensify the pain. If a needed analgesic is withheld for too long, it may be ineffective when given.
Medication used commonly today for chronic pain improves the patient's mood and increases self-esteem, thus assisting in muscle relaxation. When the muscles are more relaxed, the pain improves and endorphin production is often increased.
The preventive approach is often appropriate for the patient in whom pain can be predicted (e.g., after surgery or before a painful treatment). If the medication is given before the pain occurs, the pain is often prevented, a smaller dose is usually needed, and the side-effects of the medication are usually prevented. It is possible to become habituated to the use of an analgesic, but addiction is not a problem when medications are given for a short-time.
This information comes to you from the text book of basic nursing fifth edition written by Caroline Bunker Rosdahl, RN, BSN, MA
(specifically chapter 52 pages 463-464)
This is a text book that I used while in college and have referenced many times since. The above information has been re-typed exactly as it is in the text book.