Pain And Its Alleviation (1960)

[Music] pain has no respect for fame or Fortune nor for sex nor age pain and its alleviation this is alleviation of pain on an intuitive level the patient normal reactions and characteristics are well known the degree of pain may be calculated here the extent of tissue damage Bears a close relationship to the intensity of the pain signal early in life man learns that this mysterious signal is to warn him of something wrong and willfully or instinctively he attempts to avoid or relieve the pain on a professional level alleviation of pain is highly complex here decisions may be instinctive but usually alleviation is based upon due consideration of all possible contributing factors when the nature of pain and its probable duration are unknown to the patient such elements of mystery make the sensation doubly ominous and magnify the problems of alleviation the very presence of the nurse often gives great comfort and support to the patient to the nurse pain is no great mystery to alleviate pain on a professional level involves study practice research pain what is it if on a normally sensitive area such as the skin an injury is sustained impulses are generated and transmitted through the peripheral and central nervous systems and register in the cerebral cortex as the sensation of pain nothing is flowing back along the nerves over which impulses have traveled this reference of a sensation back is purely a mental process called projection pain at the sight of injury is projection of sensation and after medication the patient having been freed from pain was able to cooperate more fully and early recovery now appears to you'll be okay oh God where's the doctor I don't know let's is terrible where's thect emergency maybe second degree pain intense I can't stop it must act fast no time to talk wish I could calm the mother she's [Music] tense you better clean off as much grease as you can get the grease off fast so as not to prolong the painer I can do it the less pain Jimmy will have must let him know I'm on tell him what's coming up pain is an angry thing it can explode into a thousand burning fragments alleviation can mean the subduing of these many Sparks in order to relieve the hot heavy weight of pain at its source for pain can weigh 300 tons why does it hurt how long will it last can they do anything what will they do was it my fault will I die pain is a mysterious ious monster that looms large in the darkness of the unknowing the healing light of Reason can cause the monster to retreat its sharp claws being dulled alleviation can be like driving 17 horses at once each unbridled Force must be controlled guided and urged forward in a case of accidental injury there is always the question of guilt who was at fault who had a part in making possible this pain each must be re assured an accident is a thing of chance it may as here also be a contingency accidents contingent upon conditions that are unforeseeable can well be fortuitous wherein no injury takes place it is all a matter of chance if all who are involved can be led to believe that the accident just happened then each is more able to support the other rather than generating further problems because of their own concerns this is especially true within the family group they must live with each other an accidental injury to any one is a family problem and we had a long talk afterward physically a clean but painful injury should heal well no problems on the cultural level emotional reaction about normal considering the number involved sudden unexpected pain can strike with electric shock dietary or systemic weakness can cause a gall stone to form or Lodge in the cystic duct blocking the flow of bile involuntary muscular contractions seek to dislodge the obstruction during spasms in the duct distension is severe pain is deep anti-spasmodics are often a first step what were all those other medicines they gave me one was to relax the duck which would let the bow through to prevent the pain of a spasm did you have much pain I hope you're more comfortable now the medicine with your explanation about gold Stones am I going to have to have surgery we don't know yet Dr sometimes Stones pass right on through oh you'll never know what I've been through oh it must have been awful oh it was awful it was just like a sharp Jagged knife cutting through me jabbing right through me that could be most frightening where was the pain I've never been sick a day in my life oh a little indigestion now and then but this a where it was right here below my ribs well actually it was my whole side and then I got a well it's gold Stones why should my shoulder hurt that's called referred pain you see your nervous system receives a signal that something's wrong alleviation can consist of attention support distraction action explanation Comfort peace of mind a logical acceptance of reality all enemies of pain pain thrives on mystery and anxiety alleviation can also be the evaluation of the many things that may be causing pain or discomfort and the selection of those measures of care that are most needed this is made easier by knowledge acquired in a previous relationship the incision is painful so was the abdominal distension would moving her be enough or should it be a haris flush throat may be sore from the tube should look into that she's getting a lot of glare from the window the IV is probably highly uncomfortable hand is really rigid she's been on her back a long time circulation problems needs repositioning Maybe maybe a back [Music] rub I'm going to do something to make you more comfortable oh nurse I feel so miserable I hurt all over every inch of me You' got to do something to help me or I'd sooner you'd leave me alone and I'll just die I'm going to get some medicine to relieve the pain I'll be right back pain cannot be measured like other quantities or volumes it can only be reported in some cultures reporting is conditioned or completely absent are you in pain I ain't jumping like I could be sister I know it hurts where the nurse is trained to recognize these differences in response to evaluate the approximate degree of pain being experienced and to act accordingly [Music] a differential may be established between the person who is naturally stolid and one who through cultural experience has acquired the philosophy of the stoic looks uncomfortable they say he had a pretty good day maybe he has nighttime blues or is just lonely he never complains but his illness often causes pain are you having pain yes I have pain where what is it like there it's nothing really I'll be all right observation can usually reveal the existence of pain signals in those inclined toward the nonverbal an approach to the assessment of pain and prediction of effective measures of alleviation May well differ from the approach used with those who are somewhat verbose or demonstrative [Music] oh I just got n forgive me for troubling you but I just can't stand it hand me another CES please no the oran one I feel so horrible when did it start I felt much better before my operation isn't that light awfully bright where does it hurt really no one should be expected to suffer this way what have I done to deserve such pain call my doctor Miss you're probably having gas pains distension is not uncommon for patients that have had this type of operation yes you do seem to have distension mostly on the right I you'll be more comfortable if you turn to your side oh no nurse that'll put all the weight just where it hurts the most gas accumulates in the large intestine stretching it Beyond normal and causing pain now if you move the gas moves relieving the pressure and the pain there now the gas can go up to transverse colon and out now how's that why I feel better already that's fine now I'll be back soon to see how you're getting along honey come back soon and [Music] [Applause] often doc you're killing me here hold this only a few more stitches early cultural experience can often overweigh later in intellectual and physical development in relation to response to pain physical characteristics may be highly deceptive as to possible patient response they may be in parallel or divergent or mixed any clue to cultural conditioning could be of great help in such an evaluation HT sure does i d absess you seem to place a high value on self-restraint few moments now what else can I squeeze in mhm Mr purcel I probably best tell him it'll soon be time to get up he doesn't like to be taken unawares hi girly how was the arthritis this morning Mr purcel see I got my knees down yes I see now what do what do you have to keep rubbing my knees for yes sure you know we must keep them flexible limber so you can get around and see things see things I've seen everything already hand me my tobacco will you thanks see things and people your old hauns friends places yeah well let them let them come and see me oh come now You Want To Be Your Own Boss don't you do what you want when you want actually it'll soon be time for you to get up gy you sound just like my old lady and I'm going to see what I can do about some visitors for him but Mr pcel is better he has no severe pressure areas no contractures I plan to get him up this afternoon of course he still has appreciable pain respiration okay yes although he does object to being turned strenuously wonderful fellow you know he really is pain when its causes or its consequences involve mystery often results in some deg Ree of anxiety the element of mystery can expand to the point wherein the patient feels that he should indeed close his eyes and lips feels that his initiation into the mysterious is being carried too far he may doubt his own ability to cope with the situation his instincts are to flee or fight even minimal anxiety is an emotional state that affects the heart rate respiration vasomotor reactions muscle tone oh nurse I'm so glad you came I brought you some milk you had so little dinner thank you n I'm so worried what's the matter my stomach feels so heavy and now the Pain's deep and boring too boring pain yeah I've had it several times during the past few weeks do you suppose I suppose I have cancer we don't know you are worried about it aren't you well my husband said that with female troubles anything can happen sometimes I wonder I wonder if Harry's afraid that well afraid that I won't be able to be a good wife to him any longer if only I knew he's such a good guy so are the kids here anxiety is normal in proportion to the threat as perceived mystery the element of the unknown has affected the degree of symptom response should the mysterious threat be greater anxiety can achieve a level wherein Behavior may become peculiar even antisocial let me help I'm okay don't touch me where's the dockor please be seated in the treatment chair the doctor will be right in he can't see from his left eye instrument maker Precision work he's really worried must be afraid of loss of vision so unable to work and support family sure is mad at everybody including me and probably himself needs help badly but we'll fight it well here we go clean up and see what you have there that hurts damn it look will you just get the doctor here hold this so we just clean the blood away yes your eye looks all right my all right is it bad a few stitches will pull it together nicely take it easy wa get me some more 4x4 how much longer looks like the doctor's nearly finished once the threat to the body image is dispelled anxiety usually diminishes or disappears completely threat anxiety pain often these feed on each other over prolonged periods of time the patient may acquire an undue fascination with each facet of his condition he is inclined to embrace the mystery he begins to lose touch with reality get me some milk I cannot do that Sirah get it I tell you nurse I must have some milk my stomach is on fire and these horrible pains it's gotten so that I can't eat or you won't let me now you must have your stomach empty for your x-rays you'll be getting some barium to swallow soon nobody seems to know when I'm to go in why don't they have a schedule around here I'll call and see what time they have you down to go maybe we can move up your schedule well thank you last time I was in they sent me the X at the wrong time and I missed my medicine Miss Medicine sure see that's where you're wrong they were supposed to bring it in on the hour and they took me to x-ray 10 minutes early so I missed my igel oh it's better than calcium carbonate that's chalk you know and besides it constipates me AO is much more effective particularly if I take a little fluid with it but do you know what they're doing at night I finally talk them into giving me seol instead of nimol and they never give me more than one and a half grains of seanol at a time I need three grains to hold me oh they're giving me this mil toown I know all about these TR izers they think it's all my nerves but I know this pain is real and I ought to be getting an analgesic an analgesic certainly an analgesic instead all they talk about is neurotic anxiety ma terminology as if you didn't know oh I've asked my doctor to call in a consultant but he wants me to see Dr antell state board you know but he doesn't understand my case just another head shrinker say you don't talk much do you you're the only one who's ever still around here the rest seem to run around all the time oh can't they get anything done oh nurse I'm sure you really understand that I have a severe physiological problem intense pain last week I had a board-like abdomen pain on rebound this week there is this terrible epigastric burning annoying oh now don't try to give me a placebo I'm too smart for that seemingly severe hypochondria gave all the help I could x-ray may be definitive long range encourage him to accept psychiatric help [Music] [Music] do something almost completely severed I'll go scrub doc can you save it if we're both extreme lucky no do no not that do something what else in God's name can a nurse do [Music]