PSY 5301 Writing a Pain Assessment Diary

PSY 5301 Writing a Pain Assessment Diary

PSY 5301 Writing a Pain Assessment Diary

Chronic tension headaches are the main source of pain currently plaguing me, with aches and pains from old injuries being secondary.  A tight neck and back, sometimes with pain or spasms, is also common; and often intertwined with my headache pain.  I began tracking the pain level of my headaches on April 25, 2022 as part of a behavioral modification plan (comparing headache intensity with time lingering in bed), so now have two weeks of data.  Additional pain has been recorded in a pain diary for this past week (Appendix B).

The pain level of my headaches is never greater than a 5.  I consider anything over 5 to be in a life-threatening range.  Due to my late husband’s cancer pain, my father’s amputation of a leg, and my own shorter-term experiences with severe pain, I consider a 10 to be so painful that a person loses consciousness.  However, I have personally experienced pain great enough to faint when I was in a dangerous situation and was able to ignore the pain until I reached a place of safety.

For the past ten days, my headaches have ranged from 1-4 and other pain no greater than a 2.  On the day I had a 4, I filled out the McGill Pain Questionnaire (Appendix A) (Melzack, n.d.).  In my opinion, this questionnaire provides a wide range of information to a physician and allows for a patient’s unique perception of pain.  For instance, I consider “sharp” and “stabbing” to be interchangeable words, but one word can have a vastly different meaning to someone else.  This chart is similar to one my neurologist specializing in migraines uses.  I feel her chart is informative for her to better understand my pain, but the McGill Pain Questionnaire goes even further by addressing emotions a person may be experiencing.  Adding the descriptive words “Tiring-Exhausting”, “Fearful”, and “Cruel-Punishing”, is a terrific way for a physician to better understand what may be at the root of a patient’s pain, as well as engender empathy.

My headaches are a good example of how the brain perceives emotional and physical pain similarly (Brannon et al, 2014), since they began following by husband’s death 4 years ago and are clearly related to grief-depression.  This is perhaps one reason why using both conventional and alternative therapies work well to control my headache pain (as well as help with pain from old injuries and achy joints).  Alternative therapies often require self-nurturing; which is half the cure, in my opinion.  I take a prescription migraine medication at bedtime, but also benefit from Cognitive Behavior Therapy, relaxation techniques, a healthy diet, exercise, and herbal/nutritional supplements.  On the day I reached a headache pain level of 4, I took a break from working, did relaxation exercises, took a turmeric formula supplement, and went for a walk.  My headache was then back to a typical 1 level and the pain and stiffness in my right knee (old injury) was also much relieved.

References

Brannon, L., Feist, J., & Updegraff, J.A.  (2014).  Health Psychology: An Introduction to

Behavior and Health (8th Ed.).  Wadsworth, Cengage Learning.

Melzack, R.W.  (n.d.).  Short Form McGill Questionnaire and Pain Diagram.  Retrieved from

Northcentral University website:

http://www.npcrc.org/files/news/mcgill_pain_inventory.pdf

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Pain Diary Reflection

Utilizing a pain diary is a common practice prescribed among health care professionals. Pain diaries can be complex, like the McGill Pain Inventory, or simplistic, like the visual analogue scale. In the McGill pain Inventory patients fill out a thorough sheet regarding their whole body pain and associated symptoms (Brannon & Updegraff, 2014, p. 158). On the other hand, in the visual analogue scale patients (usually children) identify a face that exhibits their physical and emotional pain level (Brannon & Updegraff, 2014). Both pain scales are useful and provide important information to providers about how to treat their patients; it is up the discretion of the provider which one they want to use.

After taking the visual analogue scale assessment, I believe that my initial pain scale (5/10) was lower than my actual

PSY 5301 Writing a Pain Assessment Diary
PSY 5301 Writing a Pain Assessment Diary

pain level (8/10). This tends to be a common occurrence for me; I usually deny any pain until the provider starts digging and asking more questions. Once I am aware of my body’s pain sensations, I tend to rate my pain higher, feeling more pain than I did before (throbbing headache, tired; 7/10). Thus, I personally prefer the McGill pain inventory over the visual analogue scale. The McGill pain scale clearly identifies where someone’s pain is as well as the appropriate symptoms they might use to describe their pain. The visual analogue scale, however, is mainly good for children.

In this assignment, the pain I rated was chronic back pain. Chronic back pain specifically continues to be a serious medical condition for most people. Falling under a pain syndrome, it causes more than 80% of people in the United States pain at some point (Brannon & Updegraff, 2014, p 161). Whether back pain began because of a physical disorder, or through aging and life experiences, research has shown us that back pain continues to contribute to significant symptoms (Knezevic et al., 2017). Specifically, Knezevic et al. (2017) identified that while providers usually have their go-to conservative and invasive treatments, there is promise in alternative treatments. Knezevic and colleagues (2017) noted that alternative methods of treatment, such as, yoga, chiropractic medicine, tai chi, and meditation have also been associated with improvements, when compared to pharmacological methods. I have personally used chiropractic medicine and pain medication to try to control my pain. That being said, it is possible that pain sufferers like myself can use some of the techniques we learned this week to combat pain like this.

References

Brannon, L., Feist, J., Updegraff, J. (2014) Health Psychology: An Introduction to Behavior and Health. (8th ed). Cengage Learning.

Knezevic, N. N., Mandalia, S., Raasch, J., Knezevic, I., & Candido, K. D. (2017). Treatment of chronic low back pain-new approaches on the horizon. Journal of Pain Research 10, 1111. https://doi.org/10.2147/JPR.S132769

I’m not sure what this assignment is about but it is my belief that the average person does not experience pain on a daily basis unless they are ill or mentally ill.  Pain is defined as an “unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”.  I personally, rarely ever experience pain unless it’s time for my monthly cycle.  I’m more of a happy person who laughs on a daily basis even in my time of pain.  Laughing releases endorphins and serotonin.  Endorphins are chemicals produced by the body to reduce stress and relieve pain.  Near the onset of my cycle, the pain is mild, but by day two, sometimes, I feel as if I should throw my entire uterus in the trash.  The pain level mentally feels as if it’s at a 10. According to statistics, African American woman cannot feel pain at this level, or they have a high tolerance for pain, more so than any other race.  I beg to differ.  Our pain is real and should not be preconceived as if it’s not.  I had the ability to take the Mcgill pain questionnaire and noted the central location of pain which is located in the lower abdomen area with moderate cramping and throbbing off and on during the week of my cycle.  In reality, if you really start to observe your body, you will discover we are all made of frequencies, each frequency has an emotion attached. There are lower frequencies such as fear, guilt and shame and there are higher frequencies, such as love, joy and peace.  It has been documented that our daily choices of what we eat, drink, think, hear and watch on television and social media could have the ability to either raise or lower the vibrational frequencies surrounding our body.  In an effort to combat pain, we must choose a healthier lifestyle that involves, exercise, sound healing, meditation and maybe even a walk in nature.

References

Lundeberg TC. Vibratory stimulation for the alleviation of chronic pain. Acta Physiol Scand Suppl. 1983;523:1-51. PMID: 6609524.

Yoko, M. (2021, July 20). IASP Announces Revised Definition of Pain. International Association for the Study of Pain (IASP). https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/

Discussion about pain.

There are three major types of pain: physical, emotional, and psychosomatic. Physical pain can be acute pain, which means short lasting, or it can be chronic pain, lasting more than six months. It is caused by physical trauma or disease damage to the body. Examples of psychological pain include guilt, shame, and grief. Psychosomatic pain is felt like physical pain but without any observable physical causes.

There are big differences in how people perceive pain. A traumatic injury can cause a little bit of discomfort to one person, while the same injury to another person can prove to be extremely painful. In addition, the same physical trauma can be felt differently by the same person in different circumstances.1

It is hard to measure pain, and therefore we rely on subjective estimations using scales zero to ten, or to a 100, to describe pain’s severity. Zero signifies no pain and the highest number on the scale – 10 or 100 – signifies the worst possible pain. Neuroscientists are working on finding ways to measure pain by looking at brain activity. In the lab they deliver stimulation under various conditions (for example preparation for pain versus unexpected pain) and then, monitor neural pathways responses via functional magnetic resonance imaging. (Wiech, 2022)

In addition to the pain severity scale, we use the location, and a description of the kind of pain, to help evaluate the experience. Pain can be throbbing or pulsating, which is typical for migraines. It can be described as sharp as when you cut yourself or shooting as in the case of pinched nerve. Other words commonly used to describe pain include burning, stubbing, or dull.

There are questions which can help to understand the pain further. Is there anything that makes it better? What makes it worse? What brought the pain on? Is the pain recurring or new? Is it deep or superficial?

Health psychologists would be interested in differentiating between physical, emotional, and psychosomatic pain.

During the pain diary exercise I discovered that emotional pain caused me to tighten my shoulder and neck muscles (2/10), which in turn led to neck pain (3/10) and a headache (3/10). This tells me that pain can be a combination of several types of pain, entangled together. One kind of pain can lead to another. In the future it might be possible to use neurological tests to determine the complexity of the pain using images of neuronal “pain matrix.” (Wiech, 2022)

Taesler and Rose (2022) were able to demonstrate that there is correlation between pain perception and preceding it circumstances. “A lot of information about the outcome of pain processing is already established prior to the actual stimulus and this cognitive state has a large influence of the development of the subjective feeling of pain.” (Taesler & Rose 2022) As we learn more about pain and factors influencing its severity, we will be able to better determine the kind of pain that patients suffer, and the best approach to pain amelioration.

References

Taesler, P., & Rose, M. (2022). Multivariate prediction of pain perception based on pre-stimulus activity. Scientific Reports, 12(1), 1–9. https://doi.org/10.1038/s41598-022-07208-1

Wiech, K. (2016) Deconstructing the sensation of pain: The influence of cognitive processes on pain perception. Science (80-) 354, 584-587. https://science.sciencemag.org/