pain intervention, the attempt to relieve pain by various measures, such as administration of NSAIDs and opiates. The psychological effects of pain must be considered. Effective pain intervention depends on proper evaluation of the type of pain the patient is experiencing, the physical and psychological origins of the pain, and the behavioral patterns commonly associated with different kinds of pain. The most common method of pain intervention is the administration of narcotics, such as morphine, but many authorities believe that the exclusive use of pain-killing drugs without consideration and implementation of psychological aids is too narrow an approach. There are few patients without a psychogenic overlay on the physical experience of pain, and comprehensive pain intervention uses methods and procedures that incorporate both psychological and physical measures. Methods of pain intervention for acute pain are different from those for chronic pain. Acute pain, occurring in the first 24 to 48 hours after surgery, is often difficult to relieve, and narcotics seldom alleviate it completely. Some authorities believe that the individual who has undergone repeated surgical operations has a decreased tolerance for pain. The type of pain intervention usually depends on the description of the pain by the individual experiencing it. Mild pain may best be relieved by comfort measures and the distraction afforded by television, visitors, reading, and other passive activities. Moderate pain may best be relieved by a combination of comfort measures and drugs. Cognitive dissonance, often used to ameliorate moderate pain, encourages the patient to reflect on pleasant experiences and describe them to health care personnel. Intervention to relieve severe pain often includes the administration of narcotics, purposeful interaction between the patient and attending hospital personnel, reduction of environmental stimuli, increased comfort measures, and “waking imagined analgesia,” in which the patient is encouraged to concentrate on and become distracted by former pleasant experiences, such as relaxing on a beach surrounded by cool ocean water. In the alleviation of all types of pain, dampening or decreasing stimuli that create pain is the chief goal. Pain often increases in a cold room because the muscles of the patient tend to contract, but the local application of cold, such as with an ice pack, often alleviates pain by reducing swelling. Pain intervention seeks to reduce the effects of other factors that compound pain, such as fatigue and anxiety. Coping with pain becomes increasingly difficult as the patient becomes more tired. Sensory restriction may increase pain because it blocks otherwise effective distraction; overstimulation may cause fatigue and anxiety, thus increasing pain. Pain intervention by the use of drugs includes the administration of mild nonnarcotic analgesics and of much more potent and potentially addictive opioids, such as morphine. Opioid analgesics administered for the relief of pain, cough, or diarrhea provide only symptomatic treatment and are used cautiously in the care of patients with acute or chronic diseases. They may obscure the symptoms or the progress of the disease, and repeated daily administration of any opioid eventually produces some tolerance to the therapeutic effects of the drug and some physical dependence on the dosage. The risk of development of psychological and physical dependency on any drug is always present, especially with opioids. In usual doses opioids relieve suffering by altering the emotional component of the painful experience and by effecting analgesia. Some caregivers are so concerned about the addictive dangers of opioids that they tend to prescribe initial doses that are too low or too infrequent to alleviate pain. Some other patients with more rapid metabolisms may require such drugs at shorter intervals. Many drugs are appropriate substitutes for the potent opioids morphine and codeine. Some of the effective semisynthetic substitutes are hydrocodone, dihydrocodeine, and meperidine. The narcotic analgesics act on the central nervous system, but the salicylates and other nonnarcotic drugs act at the site of origin of the pain. Some nonnarcotic drugs, such as aspirin, indomethacin, ibuprofen, or naproxen, also have antiinflammatory and antipyretic activity. In patients who are sensitive to or are unable to take aspirin, acetaminophen is an acceptable substitute, as are the nonsteroidal antiinflammatory drugs. Pain intervention in the treatment of terminal illnesses uses numerous drugs that relieve pain and produce euphoria and tranquility in patients who would otherwise suffer greatly. Nerve block by the injection of alcohol, chordotomy, and other neurosurgical interventions may sometimes be used. Other techniques include acupuncture; hypnosis; behavior modification, in which treatment consists of reducing medication and gradually increasing mobility through exercise and any other appropriate modality; biofeedback; and transcutaneous electrical nerve stimulation. See also pain assessment.
