Pain: A Concept Analysis

Pain: A Concept Analysis

Pain is a complex and multidimensional phenomenon that is subjective and unique to each individual. Pain is difficult to describe and often hard to measure; however, most healthcare professionals agree that pain is whatever the patient describes it to be. Pain is one of the most frequently used nursing diagnosis and is the most common problem for which patients in the clinical setting seek help (Cheng, Foster, & Huang, 2003). Unrelieved pain can have a profound impact on the lives of both the patient and his or her family members. The subjective nature of pain makes pain difficult to assess; therefore, many patients do not receive adequate relief. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), has recognized pain as a "major, yet largely avoidable, public health problem" (JCAHO, 1999, para. 1) for which the organization has "developed standards that create new expectations for the assessment and management of pain in accredited hospitals and other health care settings" (JCAHO, 1999, para. 1). These new standards make it essential for healthcare personnel to acquire a better understanding of the concept of pain.

The concept of pain is often inadequately defined. A concept analysis of pain would benefit nurses and other health providers and enable these individuals to achieve a better understanding of what pain is and how pain impacts patient care. The purpose of this concept analysis is to clarify the defining attributes of pain, identify factors that influence the perception of pain, and provide a clear understanding of the term pain. The 11 step concept analysis method described by Wilson will be used to (a) identify isolating questions of the concept of pain, (b) identifying the right answers or essential uses of the concept, (c) provide an example of a model case, (d) describe the social context of the concept of pain, (e) discuss underlying anxiety related to the concept of pain, (f) discuss practical results of understanding the elements of the concept of pain, (g) describe results in language or theoretical definition of the concept of pain, and (h) use the concept of pain in at least one clinical situation or setting.

Isolating Questions of a Concept

Nurses are often confronted with the dilemma of assessing pain and determining if a patient's pain is controlled effectively. "Pain cannot be assessed adequately if it remains vague, ambiguous and arbitrarily defined" (Montes-Sandoval, 1999, p. 935). Since nurses are at the bedside working closely with their patients, they are often in the best position to "identify the patient who has pain; to appropriately assess the pain and its impact on the patient, the patient's family, and health professionals; to initiate action to alleviate pain using available resources; and to evaluate the effectiveness of those actions" (International Association for the Study of Pain, para. 3). The first step in analyzing the concept of pain is to isolate questions of the concept. Questions of importance to be identified in this concept analysis include:

1. What is pain?

2. What are the defining attributes of pain?

3. What influences the perception of pain?

4. How can pain be accurately assessed?

Identification of Right Answers of the Concept of Pain

According to Wilson, as cited by Avant and Abbott (2000), there are "no right answers in a concept analysis" (p. 66); however, concepts have primary and central uses that can be distinguished through thoughtful analysis (p. 66). Pain can be defined in a variety of ways, and while "existing definitions often do not provide a complete sense of meaning, they are useful in identifying basic elements, perceptions or feelings related to the concept" (Montes-Sandoval, 1999, p. 936). Webster's Encyclopedic Unabridged Dictionary of the English Language (1989) defines pain as (a) bodily distress or suffering due to injury or illness; (b) a distressing sensation in a particular part of the body such as headache or backache; (c) mental or emotional torment or suffering (p. 1036). These definitions provide the most commonly accepted meaning of the word pain; however, the defining attributes and distinctive features that accompany pain are not addressed.

Critical attributes, or characteristics, associated with the pain serve to distinguish the concept of pain from closely related phenomena such as discomfort. While discomfort is often associated with pain, it has a different meaning and should not be included in the same analysis as pain. Several critical attributes associated with the concept of pain, as identified by Montes-Sandoval (1999), include: (a) an unpleasant, distressful, unwanted, and uncomfortable experience; (b) a neurophysiological, socio-cultural, and psychological response to a harmful stimuli; (c) a subjective and difficult to describe sensation that cannot truly be measured or accurately perceived by others; (d) a unique experience that serves as a protective mechanism for self-preservation; (e) an adverse sensation to an actual or potential threat of physical or emotional injury or damage; and (f) distressful thoughts resulting from a mental misperception (p. 938). While these critical attributes serve to characterize the concept of pain, factors such perception of pain can expert influence on the concept of pain.

Model Case

Tammy is a 34-year-old African American female, morbidly obese, with a past medical history significant for diabetes mellitus type 2 complicated by peripheral neuropathy and renal calculi. She was admitted to the rehabilitation facility for continuous medical management of her diabetic foot ulcer. The nurse enters the room to change the dressing on Tammy's foot and notices that Tammy is sitting on the edge of the bed. Tammy has tears in her eyes and is hunched over, rocking back and forth, and has both hands placed over the right flank. Her heart rate and blood pressure are elevated. When asked if she is in pain, Tammy responds, "It hurts, but it's just another kidney stone. It usually hurts like this until is passes". The nurse recognizes the physical symptoms of pain and acknowledges Tammy's admission of pain. Tammy rates her pain as a seven on a scale of zero to 10. Pain medication is administered. Upon reassessment, the nurse records Tammy's heart rate and blood pressure are within normal limits. Tammy is now lying in bed watching TV and reports that the pain has decreased to a two on a scale of zero to 10.

Social Context