HCA250 Treatment Options for Clinical Pain
HCA250 Treatment Options for Clinical Pain fin571
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Date Created: 11/10/15
*This tutorial is to be used as a guide with examples of what your instructor is looking to see in your submission. Be sure work submitted is that of your own efforts to avoid copying the work provided in the tutorial. As this tutorial is likely to be presubmitted, original work you should not resubmit as your own original work. * Treatment Options for Clinical Pain SAMPLE TUTORIAL Clinical pain is pain which requires and benefits from medical treatment (Sarafino, 2006). The treatment of acute clinical pain is necessary for humane patient care as well as for promoting uncomplicated recovery. In treating acute clinical pain patient stress is greatly reduced thus contributing to increased healing times and overall positive emotional well being of the patient. In cases where pain has become chronic a more complex and comprehensive plan of pain treatment must be implemented. These comprehensive approaches can often include the multi angle approach including surgical, pharmacological, behavioral and cognitive treatment designed to best benefit the patient on an individual basis (Sarafino, 2006). Considerations of Treatment for 3 Individual Cases The use of four possible treatment approaches for the clinical pain patient should be assessed an individual case basis. These approaches include surgical treatment to eliminate or reduce pain, medications, and behavioral or cognitive therapies which can provide the patient with useful tools for dealing with their chronic clinical pain (Sarafino, 2006). For considerations sake we will assess three individual cases. Case 1 involves the patient who is suffering clinical pain resulting from below the knee amputation. Case 2 involves the individual suffering postoperative acute pain from abdominal hysterectomy. Case 3 involves an individual plagued by chronic headache pain which is not diagnosed as migraine headaches (Axia College, 2007). In assessing the first case we immediately understand the phantom limb pain often associated with amputation (Sarafino, 2006). We must also assess the patient for underlying causes of referred pain. Is it possible a prosthetic limb is not fitting properly causing irritation of additional stress at the amputation site? Is the patient receiving adequate physical exercise? Surgical treatment for the patient is not recommended (NelsonHogan, 2007). However, temporary pharmaceutical treatment combined with behavioral and cognitive treatment will benefit the patient. Case 2 involving acute post operative pain will require little more than temporary pharmaceutical treatment to relieve discomfort following major surgery. In addition, the patient might also be responsive to an operant approach to promote healing. Minor behavioral and cognitive approaches while hospitalized will be sufficient in treating such cases of acute pain (Sarafino, 2006). The chronic headache sufferer is also not recommended for surgical procedure as the headaches are likely definable as tension or stress related (Sarafino, 2006). In addition, pharmacological treatment through use of pain medication should be used only if the headaches are frequent, severe and prolonged. However, other pharmacological approaches may benefit the patient if he or she is also suffering from mood disturbances or poor coping skills related to the chronic pain produced by the headaches. Behavioral and cognitive approaches might be most beneficial for this patient as developing effective coping strategies and implementing relaxation techniques and stress reduction may eliminate or at minimum significantly reduce the frequency of occurrences (Sarafino, 2006). Recommended Treatment Approaches In assessing the needs of each patient the author would first rate the complexity of the cases. Case 2, the post operative acute pain patient, will require the least complex treatment plan as the pain is temporary and easily treatable with use of pain medication and minor behavioral and cognitive therapy approaches. Case 1, involving the amputee, would be more complex and require a multiangle approach. In addition, this patient will likely require a treatment plan which needs to be appropriately designed for prolonged care and management of symptoms. The most complex case, in the author’s opinion, would be Case 3, the headache patient. The reasoning in the author’s assessment is derived through the probability that multiple factors are contributing to the pain and will need to be addressed with careful use of pharmacological methods and most extensively with behavioral and cognitive approaches. The clinical pain suffered by the individual recovering from abdominal hysterectomy will be reduced or eliminated through use of centrally acting analgesics as they are proven most effective in treating severe acute pain (Sarafino, 2006). Codeine or hydrocodone can be administered to the patient orally or intravenously while recovering on a shortterm, inpatient basis (Hanley Center, n.d.). The patient, upon discharge from the hospital, may continue to reduce postoperative pain through use of a non steroidal antiinflammatory drug which will also aid in reduction of swelling and inflammation caused by the surgical procedure (Hanley Center, n.d.). While still on an inpatient level the individual having difficulty dealing with the acute pain following surgery should receive cognitive training on redefinition of pain and implementation of imagery or distraction techniques to promote healthy coping skills (Sarafino, 2006, p.332). Should the patient be noncompliant with after surgery care and plans which promote healing an operant approach should be implemented in dealing with the patient. Ignoring nonbeneficial behavior and rewarding positive behavior will address the patient’s behavior (Sarafino, 2006). Pain treatment for the amputee is a more complex issue. The patient will require comprehensive care, perhaps through a pain clinic, which will include group psychotherapy to address psychological aspects as the patient is able to relate with others suffering chronic pain. The patient will benefit by reducing isolation periods and reduce likelihood of depression. In addition, the patient may benefit from an increased social support network which may be found through such therapy. Individual therapy should also be implemented to help develop relaxation techniques as well as to strengthen cognitive skills by use of imagery and distraction techniques to help cope with pain. Redefinition may also help the patient develop a more positive outlook (Sarafino, 2006). This patient will also require a pharmacological approach to pain treatment. Antidepressants will reduce possible depression, aid sleep and reduce pain. Prescribing of a sedative antidepressant with analgesic properties will address multiple complaints of the patient (NelsonHogan, 2007). Phantom limb pain has been effectively treated with a combination of methadone and antidepressants (Sarafino, 2006) therefore the author feels this antidepressant treatment to be imperative for proper case management of the amputee patient. Other possible treatment methods which may be implemented dependent upon the effectiveness of the behavioral, cognitive and pharmaceutical approaches would be massage therapy or use of a TENS unit (Sarafino, 2006). In addition, the patient’s prosthetic limb will be examined for issue regarding fit on the stump which may be contributing to the patient’s distress and chronic pain issues (NelsonHogan, 2007). In treating the chronic headache patient things become far more complex. Social factors are likely playing a large role in this chronic pain. Stress from relationships or other life circumstances is likely causing tension in the muscles and tendons. The patient will require extensive behavioral and cognitive approaches to treatment. No surgical treatment is suggested. The individual will undergo psychotherapy to develop healthy coping skills and relaxation techniques. Biofeedback will be used and therapy will take an operant approach (Sarafino, 2006). Biofeedback is expected to have immense benefit as it has proven 40 to 50% effective in the reduction of tension type headaches (Sarafino, 2006). Cognitive approaches will include the use of imagery to induce relaxation as well as redefinition of pain (Sarafino, 2006). The patient may also be referred for acupuncture treatment or massage therapy to reduce pain and increase relaxation (Sarafino, 2006). In addition, the patient will work with the therapist in assessing physical activity and develop a regular regime of exercise in the attempt to reduce the adverse effects of stress on the patient. Conclusion While each of the three cases examined by the author include treatment plans excluding the use of surgical treatment for clinical pain it remains a suitable approach for various types of clinical pain and should not be excluded as an option for treatment. All four options of treatment, surgical, pharmacological, behavioral and cognitive approaches, should be carefully considered when developing a plan of treatment for the clinically pained patient. A comprehensive approach comprised of multiple approaches is often most beneficial for the treatment of pain and should therefore be available to all patients receiving care. References Axia College. (2007). Treatment options for clinical pain. Retrieved date?, from Axia College, Week Seven, HCA250 The Psychology of Health. Hanley Center (n.d.). Managing postsurgical pain for those in addiction recovery. Retrieved November 28, 2008, from http://www.hanleycenter.org/pdfs/postSurgicalBrochure.pdf NelsonHogan, D. (2007). Diagnosis and treatment of postamputation pain. The Pain Practitioner, 811. Sarafino, E.P. (2006). Health psychology biopsychosocial interactions (5th ed.). Hoboken, N.J.: John Wiley & Sons.
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