A client is arousing from a coma and keeps saying, “Just stop the pain.” The nurse responds based on the knowledge that the human body typically and automatically responds to pain first with attempts to:
A. Tolerate the pain.
B. Decrease the perception of pain.
C. Escape the source of pain.
D. Divert attention from the source of pain.
Correct Answer: C. Escape the source of pain.
The client’s innate responses to pain are directed initially toward escaping from the source of pain. For example, in sudden strong pain like that generated by pricking the finger, a reflex response occurs within the spinal cord. Motor neurons are activated and the muscles of the arm contract, moving the hand away from the sharp object. This occurs in a fraction of a second — before the signal has been relayed on to the brain — so the client will have pulled his arm away before even becoming conscious of the pain.
Option A: Tolerance is also tied to the cognitive and affective aspects of pain. For patients with cancer, pain may be a sign that the tumor has recurred or spread and that death is near. For such patients, the suffering is due not only to the pain’s intensity but also to its meaning. Anguish, suffering, and anxiety commonly accompany pain.
Option B: The experience of pain is known to have two distinct neural pathways. In the first pathway, the pain signal comes from any part of the body and activates the anterior cingulate cortex of the brain, which is associated with the perception of pain. People react differently to this stimulation because the feeling is determined by the activation of the second pathway involving the medial prefrontal cortex and nucleus accumbens, which are associated with motivation and emotion.
Option D: Variations in individuals’ tolerance and perception of pain are apparent only in conscious clients, and only conscious clients are able to employ distraction to help relieve pain. Interventions aimed at enabling patients to break out of the perseverance loop aforementioned and change their perception of pain may be more effective than interventions that appear to endorse the patient’s view of the problem as one that can only be solved by pain relief.
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