FACET - European Journal of Cancer Care May 2006

1. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment Arber, A.1 • Pain assessment • Why is a bio-cultural approach to pain recommended? • What is meant by an embodied approach to pain? • How does new thinkingabout pain affect assessment? Slide One *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

2. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • Why a bio-cultural approach to pain? • We need a theory of pain that involves changes in culture rather than biology alone • Cartesian models of pain, which split the mind from the body are inadequate to explain the complexity of pain Slide Two *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

3. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • Body – mind split • Descartes explained pain through the bodily mechanisms called nociceptors • Human pain is not a sensation but a perception dependent upon the mind’s active power to make sense of experience • The mind’s power to alter nociception makes pain far more complex than a Cartesian alarm bell Slide Three *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

4. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) Defining pain Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage International Association for the Study of Pain 1986 Slide Four *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

5. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • Embodied experience of pain • Discourses related to pain as organic/mental/emotional versus that of psychogenic concerned with causes rather than the experience itself • Knowing the cause of the pain is distinct from the embodied experience of pain • The experience of pain concerns feelings and emotions Slide Five *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

6. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • Criticisms of current approaches • Pain has become medicalised • The person’s experience of pain is neglected • There is lack of a framework that links pain with its social and cultural context (Bendelow & Williams 1995) Slide Six *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

7. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) A new model of pain In other words, a far more sophisticated model of pain is needed one which locates individuals within their social and cultural contexts, which allows for the inclusion of feelings and emotions (Bendelow & Williams 1995) Slide Seven *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

8. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) Total pain This concept expands the medical definition of pain into the emotional, spiritual, social as well as physical aspects of pain Slide Eight *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

9. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • Pain story • Narrative is basic to any account of pain • These narratives may not separate the physical and psychosocial aspects of the pain experience Slide Nine *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

10. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • Talking about pain • If patients believe that the physical causes constitute the meaning of the pain this makes it risky to talk about emotional and cognitive aspects • Pain has an ‘acultural’ dimension • Pain is both a medical entity and a lived experience Slide Ten *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

11. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • Implications for practice • Pain autobiography • Patient identity • Pain diary Slide Eleven *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

12. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • Reflecting on difficult cases • Negotiate with patients • Learn from difficult cases • Patient reputation Slide Twelve *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

13. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • Support for staff • Unrelieved pain may be difficult for health care professionals • Good support of staff is necessary when pain is difficult to relieve Slide Thirteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

14. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • References and further reading • Arber A (2004) Is pain what the patient says it is? Interpreting an account of pain. International Journal of Palliative Nursing. 10, 491-496. • Beck SL (2000) An ethnographic study of factors influencing cancer pain management in South Africa. Cancer Nursing. 23, 91-9. • Bendelow G & Williams SJ (1995) Transcending the dualisms: towards a sociology of pain. Sociology of Health & Illness. 17, 139-165. • Benoliel JQ (1995) Multiple Meanings of pain and Complexities of Pain Management. Nursing Clinics of North America. 30, 584-596. • Brockopp DY Downey E Powers P Vanderveer B Warden S Ryan P & Saleh U (2004) Nurses’ clinical decision-making regarding the management of pain. International Journal of Nursing Studies. 41, 613-636. Slide Fourteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

15. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • References and further reading • Clark D (1999) Total Pain, disciplinary power and the body in the work of Cicely Saunders, 1958-1967. Social Science and Medicine 49, 727-736 • Coward DD and Wilkie DJ (2002) Metastatic bone pain. Cancer Nursing 23, 101-108. • Fagherhaugh SY and Strauss A (1977) Politics of Pain Management: Staff-Patient Interaction. London, Routledge, London. • Frank A (1995) The Wounded Storyteller. The University of Chicago, London. • Hilbert RA (1984) The acultural dimension of chronic pain. Social Problems 31, 365-378. • Hunt M (1989) Dying at home: its basic “ordinariness” displayed in patients’, relatives’ and nurses’ talk Unpublished Phd Thesis, Goldsmiths College, University of London. Slide Fifteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

16. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • References and further reading (continued) • Illich I (1976) The Killing of Pain. In: Limits to Medicine. (ed. Illich I.) pp.133-154. Marion Boyers. London. • Jackson J (1994) Chronic pain and the tension between the body as subject and object. In: Embodiment and Experience. (ed. Csordas TJ), pp. 210-228. Cambridge University Press, Cambridge. • Kuglemann R (1999) Complaining about Chronic Pain. Social Science and Medicine 49, 1663-76. • Melzack R and Wall P (1965) Pain Mechanisms: A New Theory. Science 150, 971-979. • Merleau-Ponty M (1962) The Phenomenology of Perception. Routledge and Kegan Paul, London. Slide Sixteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

17. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • References and further reading (continued) • Merskey H. & International Association for the Study of Pain (Subcommittee on Taxonomy) (1979) Pain terms: a list with definitions and notes on usage. Pain 6, 249-252. • Murray SA Grant E Grant A Kendall M (2003) Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers. British Medical Journal 326,368-371. • Patiraki-Kourbani E, Tafas CA, McDonald DD, Papathanassoglou EDE (2004) Personal and professional pain experiences and pain management knowledge among Greek nurses. International Journal of Nursing Studies 41, 345-354. • Rogers MS & Todd CJ (2000) The ‘Right Kind of Pain’; talking about symptoms in outpatient oncology consultations. Palliative Medicine 14, 299-307. Slide Seventeen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

18. FACET - European Journal of Cancer Care May 2006 Re-thinking pain assessment(continued) • References and further reading (continued) • Scarry E (1985) The Body in Pain. Oxford University Press, Oxford. • Schumacher KL West C, Dodd M, Paul SM. Tripathy D, Koo P and Miaskowski CA (2002) Pain management autobiographies and reluctance to use opioids for cancer pain management. Cancer Nursing 25, 125-133. • Sloan PA, Vanderveer BL, Snapp JS Johnson M & Sloan DA (1999) Cancer Pain Assessment and Management Recommendations by Hospice Nurses. Journal of Pain and Symptom Management 18, 103-110. • Wall P (1999) Pain the science of suffering. London, Phoenix. • Watt-Watson JH (1998) Effective pain management: is empathy relevant? In: Perspectives on Pain (ed. Carter B.), pp66-83. Arnold, London. Slide Eighteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc