Renita Weeks #3

Week 3 Discussion

            Pain is challenging to describe and define. According to Huether and McCance (2017), pain is an unpleasant sensory and emotional experience. Pain is caused by chemical, thermal, and mechanical stimuli of free nerve endings in the skin and deep tissues (Hammer & McPhee, 2019). Pain transmission travels from the peripheral nervous system to the spinal gate, then ascends to the central nervous system (Huether & McCance, 2017). There are many types and causes of pain. The kinds of pain discussed in this post are acute, chronic, and referred pain. Each is unique.

            Acute pain, or nociceptive pain a normal, protective pain that lasts up to three months (Huether & McCance, 2017). Acute pain begins suddenly and can cause increased heart rate, hypertension, sweating, and pupil dilation (Huether & McCance, 2017). Chronic pain is different than acute pain in that it lasts longer than three to six months. Chronic pain persists beyond normal healing time and serves no purpose (Huether & McCance, 2017). Furthermore, with persistent chronic pain, the same physiologic response may not apparent as with acute pain (hypertension, increased heart rate, sweating). Referred pain is a type of acute or chronic pain where the pain is felt in a place other than the point of origin. Huether and McCance (2017) state that referred pain is caused by impulses from many visceral or cutaneous neurons converging on the same ascending neuron, making it difficult for the brain to tell where the source of the pain is. The brain then interprets the pain information as being from the surface of the body (University of Minnesota Medical School Duluth, 2014).

Impact of Gender and Ethnicity on Pain

            There are gender differences when it comes to pain perception and mechanism. According to Pieretti et al. (2016), females experience more prevalence of painful diseases. Women also report more severe levels of pain more frequently and of longer duration (Pieretti et al., 2016). Women tend to experience more conditions, such as migraines, chronic headaches, fibromyalgia, and irritable bowel syndrome (Pieretti et al., 2016). However, women consume fewer opioids for some acute postoperative pain (Pieretti et al., 2016). Although the mechanism of differing pain perception among the genders is unknown, Pieretti et al. (2016) suggest that biological, psychological, and socio-cultural factors contribute to it. Women may also experience different referred pain than men. For example, women may experience jaw pain instead of chest pain when experiencing a myocardial infarction (American Heart Association, n.d.). Although women experience more pain disorders, they are more at risk of being undertreated for pain and are more likely to be referred to a psychologist (Pieretti et al., 2016).  It is crucial for clinicians to remember that there are gender differences in pain perception and that women are more likely to experience chronic pain.  

            Cultural differences shape how people see the world and how they respond to it. A small quantitative study shows that there are cultural differences in how people view and react to pain. For example, Caucasians and African Americans are more likely to see pain as negative, whereas Asians and Hispanics are more likely to view pain as a positive experience of growth (Liao, Henceroth, Lu, & LeRoy, 2016). African Americans and Hispanics are more likely to express pain than Caucasians and Asians (Liao et al., 2016). The authors also found that Caucasians and Asians are less likely to express pain to their families (Liao et al., 2016). It is important for clinicians to be aware of who is more likely to be stoic about pain, as it may be difficult to diagnose and treat painful disorders for those individuals. It is also useful for the clinician to know that cultural difference contributes to the patient’s expectations regarding pain control. For example, Caucasians are most likely to seek medication for pain, and others, such as Asians may be hesitant to ask for help (Liao et al., 2016).

References

American Heart Association. (n.d.). About heart disease in women. Retrieved on June 8, 2019     

            from  https://www.goredforwomen.org/en/about-heart-disease-in-women

Hammer, G.D., & McPhee, S.J. (2019). Pathophysiology of disease: An introduction to clinical

            medicine (8th ed.). New York, NY: McGraw-Hill Education.

Huether, S.E., & McCance, K.L. (2017). Understanding pathophysiology (6th ed.). St. Louis,

            MO: Mosby. 

Liao, K.Y., Henceroth, M., Lu, Q., & LeRoy, A. (2016). Cultural differences in pain experience

            among four ethnic groups: A qualitative pilot study. Journal of Behavioral Health, 5(2),

            75-81. doi: 10.5455/jbh.20160204094059

Pieretti, S., Giannuario, A., Giovannandrea, R., Marzoli, F., Piccaro, G., Minosi, P., & Aloisi, A.

(2016). Gender differences in pain and its relief. Annali Dell’istituto Superiore Di Sanita, 52(2), 184-189. doi: 10.4415/ANN_16_02_09

University of Minnesota Medical School Duluth. (2014). Referred pain. Retrieved from

https://www.d.umn.edu/~jfitzake/Lectures/DMED/Somatosensation/Somatosensation/ReferredPain.html