Wednesday, January 18, 2012

Compact Clinical Guide to Geriatric Pain Management - An Evidence-Based Approach for Nurses | Ann Quinlan-Colwell / Yvonne D'Arcy

The care of older adults suffering with pain is a difficult task that calls for understanding as well as compassion. Dr. Quinlan-Colwell has written an excellent book that deals with every facet of the problems that are encountered by caregivers. Elderly people present challenges that call for recognition of the fact that pain affects sleep, appetite, social interactions, and many other facets of life that require attention. Dr. Quinlan-Colwell carries the reader into the lives of elderly people and provides the information necessary to bring psychological comfort as well as knowledge to help people control pains that destroy the quality of their lives. Needless pain is a tragedy that calls for a better understanding of the psychological, social, and medical dimensions of life. This book highlights all of these dimensions and provides the reader with valuable knowledge that will diminish suffering and enrich the lives of people confronting new, often frightening, problems.

The recognition that pain is a multidimensional experience determined by psychological as well as physical factors has broadened the scope of pain therapies. Patients with chronic pain need every possible therapy to battle the pain. Chronic pain is not a symptom but a syndrome in its own right and requires therapists from a wide range of disciplines.

Psychological therapies, which were once used as a last resort when drugs or neurosurgery failed to control pain, are now an integral part of pain management strategies. The recognition that pain is the result of multiple contributions gave rise to a variety of psychological approaches such as relaxation, hypnosis, and cognitive therapies. So too, transcutaneous electrical nerve stimulation and other physical therapy (PT) procedures emerged rapidly, bringing substantial pain relief to large numbers of people. Nursing is an integral part of all therapies and provides the binding unity essential for the elderly patient.

The field of pain continues to develop and there are reasons to be optimistic about its future. First, imaging techniques have confirmed pain-related activity in widely distributed, highly interconnected areas of the brain. An implication of the concept is that neural programs that evolved in the brain to generate acute pain as a result of injury or disease may sometimes go away and produce destructive chronic pain. Future imaging research may reveal the sites of abnormally prolonged activity in chronic pain patients. Second, the detailed knowledge and technical skills developed by scientists for research on the spinal cord can be used to explore brain mechanisms in humans and animals, especially in the brain stem reticular formation, which is known to play a major role on chronic pain. Third, our knowledge of the genetic basis of pain as well as the development of the brain is growing rapidly. Genetic factors are known to contribute to a large number of chronic pain syndromes, and future research will highlight their brain mechanisms. The inevitable convergence of these three approaches will hopefully lead to the relief of pain and suffering now endured by millions of people.

Ronald Melzack, PhD, FRSC

Professor Emeritus McGill University