Pain: the 4 letter word

Clients suffer from pain in many ways. Pain can rob clients of their lives. They may become depressed or anxious and want to end their lives. Clients are sometimes unable to do many of the things they did without pain, and this pain affects their relationships with others. This can lead to loss of employment or social issues with friends and family.

What is often overlooked is that pain has physically harmful effects. It is often actually physiologically unsafe to have pain.¹³ The effects of pain on the endocrine and metabolic system, cardiovascular system, gastrointestinal system, and immune system—and the potential for future pain—are but a few of examples of how unsafe unrelieved pain may be.¹³

Pain causes stress. The endocrine system reacts by releasing an excessive amount of hormones, ultimately resulting in carbohydrate, protein, and fat catabolism (destruction); poor glucose use; and other harmful effects. This reaction combined with inflammatory processes can produce weight loss, fast heart beat, increased respiratory rate, fever, and shock. Unrelieved pain prolongs the stress response, adversely affecting the client’s recovery.¹³

The cardiovascular system responds to stress of pain by activating the sympathetic nervous system, which produces a variety of unwanted effects. In the postoperative period, these include an excess of blood clotting, increased heart rate, blood pressure, cardiac work load, and oxygen demand.¹³

Since the stress response causes an increase in sympathetic nervous system activity (fight or flight), intestinal movement and stomach churning slow. This response can cause temporary impairment of gastrointestinal function.^13,

Unrelieved pain may be especially harmful for clients with metastatic cancers. Stress and pain can suppress immune functions, including the natural killer (NK) cells that play a role in preventing tumor growth and controlling metastasis.^13, 16

Unrelieved acute pain can result in chronic pain at a later date. Thus, pain now can cause pain later. A survey of clients having undergone surgery found a high percentage of chronic postsurgical pain in patients whose acute postsurgical pain was inadequately managed.²⁰

13. Pasero C, Paice JA, McCaffery M. Basic mechanisms underlying the causes and effects of pain. In: McCaffery M, Pasero C, editors. Pain: clinical manual. 2. St. Louis, MO: Mosby; 1999. pp. 15–34.

16. Page GG, Ben-Eliyahu SJ. The immuno-suppressive nature of pain. Semin in Oncol Nurs. 1997;13(1):10–5.

20. Goldstein DH, Ellis J, Brown R, et al. Meeting proceedings: recommendations for improved acute pain services: Canadian Collaborative Acute Pain Initiative. Pain Res Manage. 2004;9(3):123–30.