Pain Management Interventions and Chronic Pain Disorders

Pain Management Interventions and Chronic Pain Disorders Introduction This essay will identify the issue of how poorly addressed acute pain in hospitalized patients may lead to chronic pain disorders, critically compare and discuss a range of pain assessment tools referring to contemporary research literature and practice guidelines for patients who are able to self describe their pain and who are unable to self describe their pain due to verbal communication barriers, critical illness or delirium/dementia. Main Body According to the International Association for the Study of Pain, pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage. The emphasis of this definition is both the sensory and emotional experience of an individual in pain. According to Tsui, Chen Ng (2010, p.20.), Pain can be emotional, behavioral, sociocultural and spiritual. The exhibition of pain is multidimensional. Therefore, in the assessment of pain, not only a general guideline for a quick review is needed, but also a specific tool to help the professionals to have a more accurate assessment of the experience of pain from a multidimensional perspective. Clinically, â€Å"Pain is whatever the experiencing person says it is, existing whenever he/she says it does† (McCaffery, 1968). The temporal profile classification is most commonly used to classify pain.This broad classification of pain duration is often used to better understand the biopsychosocial aspects that may be important when conducting assessment and treatment. For example, many times chronic pain is a result of unresolved acute pain episodes, resulting in accumulative biopsychosocial effects such as prolonged physical reconditioning, anxiety, and stress. It is obvious that this type of time categorisation information can be extremely helpful in directing specific treatment approaches to the type of pain that is being evaluated (Gatchel Oordt, 2003). Acute pain is usually indicative of tissue damage and is characterized by momentary intense noxious sensations (i.e., nociception). It serves as an important biological signal of potential tissue/ physical harm. Some anxiety may initially be precipitated, but prolonged physical and emotional distress usually is not. Indeed, anxiety, if mild, can be quite adaptive in that it stimulates behaviors needed for recovery, such as the seeking of medical attention, rest, and removal from the potentially harmful situation. As the nociception decreases, acute pain usually subsides. Unlike acute pain, chronic pain persists. Chronic pain is traditionally defined as pain that lasts 6 months or longer, well past the normal healing period one would expect for its protective biological function. Arthritis, back injuries, and cancer can produce chronic-pain syndromes and, as the pain persists, it is often accompanied by emotional distress, such as depression, anger, and frustration. Such pain can also often significantly interfere with activities of daily living. There is much more health care utilization in an attempt to find some relief from the pain symptoms, and the pain has a tendency to become a preoccupation of an individuals everyday living. Assessment of a patient’s experience of pain is a crucial component in providing effective pain management. A systematic process of pain assessment, measurement and re-assessment (re-evaluation), enhances the health care teams’ ability to achieve: increased satisfaction with pain management. According to Buckley (2000) nurses are the primary group of health care professionals responsible for the ongoing assessment and monitoring of patients to ensure that pain is effectively and appropriately managed and that patients and families are informed of the consequences of acute pain. Assessment of pain can be a simple and straightforward task when dealing with acute pain and pain as a symptom of trauma or disease. Assessment of location and intensity of pain often sufà ¯Ã‚ ¬Ã‚ ces in clinical practice. However, other important aspects of acute pain, in addition to pain intensity at rest, need to be deà ¯Ã‚ ¬Ã‚ ned and measured when clinical trials of acute pain treatment are planned. If not, meaningless data and false conclusions may result. The 5 key components: Words, Intensity, Location, Duration, Aggravating factors pain assessment are incorporated into the process. Objective data are collected by using one of the pain assessment tools which are specià ¯Ã‚ ¬Ã‚ c to special types of pain. The main issues in choosing the tool are its reliability and its validity. Moreover, the tool must be clear and, therefore, easily understood by the client, and require little effort from the client and the nurse. According to Husband (2001) to measure the pain severity or intensity, several scales can be used such as a numeric rating scale (NRS), the visual analog scale (VAS), observation scales with indicators of pain, and even creative depictions of pain intensity with scale using a pain thermometer. The numeric rating scale allows patients to rate their pain on and 11-point scale of 0 (no pain) to 10 (worst pain imaginable). The majority of patients, even older adults can use this scale. The thermometer scale may be useful in the elderly, according to Rakel and Herr (2004). It shows a picture of a thermometer arranged on a background with a vertical word scale. Finally categoric scales use verbal descriptors to quantify the level of pain and those scales have been validated and are considered to be reliable. Pain assessment in older adults can be challenging and very difficult in some situations (Rakel Herr, 2004). When the patient cannot report his/her subjective pain experience, proxy measurements of pain must be used, such as pain behaviours and reactions that may indicate that the person is suffering painful experiences. Besides communication difà ¯Ã‚ ¬Ã‚ culties caused by language problems, patients in the extremes of age, and critically ill patients in the intensive care setting, are common assessment problems. Older patients may prefer to use alternate means to express their pain through the use of word descriptors that best characterize the pain, such as aching, hurting, and soreness (Herr Garand, 2001). The most important components of pain assessment in older adults are regular assessable, standardized tools, and consistent documentation (Horgas, 2003). Pain assessment may also be complicated by decreases in hearing and visual acuity, so tools that require extensive explanation or visualization to perform will be more difficult and possibly less reliable. The verbal descriptor scale may be the easiest tool for the elderly to use. This measure allows patients to describe what they are feeling with common words rather than having to convert how they feel to a number, facial representation, or a point somewhere on a straight line. An observational assessment of pain behavior may be more appropriate for people with severe cognitive impairment, for example, the Abbey pain scale. Identifying pain in the cognitively impaired older adult depends heavily on knowing the patient and paying attention to slight changes in behavior (Soscia, 2003). An interesting veiw was expressed that nurses ma y lack knowledge and have attitudes and practices toward pain management that may compromise pain management for older patients ( Yates et al., 2002, p.403). Conclusion In conclusion, References American Geriatric Society Panel on Chronic Pain in Older Persons (2002). The management of persistent pain in older persons: AGS panel on persistent pain in older persons.Journal of the American Geriatrics Society, 6(50), supplement 205-224. Horgas, A.L. (2003). Pain management in elderly adults.Journal of Infusion Nursing, 26,161-165. Soscia, J. (2003). Assessing pain in cognitively impaired older adults with cancer.Clinical Journal of Oncology Nursing, 7, 174-177 Drayer, R. A., Henderson, J., Reidenberg, M. (1999). Barriers to Better Pain Control in Hospitalised Patients. Journal of Pain and Symptom Management, 17(6), 434-440. Yates, P. M., Edwards, H. E., Nash, R. E., Walsh, A. M., Fentiman, B. J., Skerman, H. M., Najman, J. M. (2002). Barriers to Effective Cancer Pain Management: A Survey of Hospitalised Cancer Patients in Australia. Journal of Pain and Symptom Management, 23(5), 393-405. 1

Genetically Modified Food Essay

Genetically modified (GM) foods are ethically unacceptable. GM foods are food product derived in whole or part from a genetically modified organism by human intention. It is a special set of technologies that concerns the alteration, deletion, or addition of the genetic makeup of living organisms such as animals, plants, or bacteria. This is an important issue because GM foods have been dubbed as the â€Å"Food of the Future† and although studies have shown that genetically modified foods may bring about many benefits to mankind, we must also look into the ethical issues involved in producing such food before we even consider accepting it as the way of the future. First, we must understand that the word â€Å"ethical† is defined as having to do with ethics or morality; or of conforming to moral standards. There will be 3 parts to this essay. Firstly, I will be presenting and defending 2 arguments that support my stand. Following that, I’ll take into consideration some common objections against my thesis. Lastly, I will summarize the main points in this essay before drawing to a conclusion. The essay’s argument takes the form of Modus Ponens: If GM is X, GM is unethical GM is X > GM is unethical My main argument is that it is unethical to tamper with nature by mixing genes among the different species. By doing so, it may actually lead to a violation of natural organisms’ intrinsic values. There is a very delicate balance that links this world together and this is the balance that makes things work. GM foods might actually give rise to more complications such as the disturbance of nature’s food pyramid. For example, the pesticide produced in the crop may unintentionally harm other creatures while producing a benefit to others. The introduction of pest-resistant genes into crops could lead to the death of the pests and other animals causing an imbalance in the food chain that could possibly lead to the extinction of some species especially if they are only localized in one particular area. In Britain, a native farm bird, the Skylark, was indirectly affected by the introduction of GM sugar beets that were designed to resist herbicides. The result in planting this crop was that weeds were reduced substantially. However, since the birds rely on the seeds of this weed in autumn and winter, researchers expect that up to 80% of the Skylark population would have to find other means of finding food. Another issue brought up is that GM crops may also pose a health risk to native animals that eat the plants and may be poisoned by the built-in pesticides. Although others might also argue that the cutting down of trees to construct buildings might also be a way of tampering with nature, GM food not just tampers with physical nature but with the foundation of nature – genes. Every organism, no matter how small, is made up of genes. These genes control the physical development and behavior of the organism and are passed down from parent to offspring. The word â€Å"genes† (comes from the Greek word â€Å"genos† meaning â€Å"origin†) actually defines nature’s origin and the production of GM food would mean to change the origin of nature. Furthermore, religious communities – Christians, Hindus, Jews and Muslims Ââ€" also share such concerns regarding GM products. According to Bishop Jeff Davies from the SA Council of Churches, â€Å"With genetic engineering, we are tampering with the structures of life that have taken millions of years to evolve and we have the arrogance to think that we can improve on them in 10 years†¦ to transfer a gene from one species into another.† Different religious communities have different believes and one of them would be their food such as kosher and halal food. But with the introduction of animal genes into plants how will they define a tomato with a fish gene? This will also be a major concern to vegetarians. All in all, I believe that people should be happy with what nature has to give and not â€Å"play God† and try to control nature. It is unethical to sacrifice other creatures and meddle with the delicate balance of nature. Furthermore, there will be potential chain reactions that may be unstoppable. One other argument is how GM products can affect our health especially in the long run. The unpredictable changes in our food could lead to negative reactions that are not detected by research techniques until much later. A quick acceptance of GE foods without proper testing could show corporate profitability to be very influential but that would be too dangerous because there has been no adequate safety testing to ensure that using other organism’s genes is going to have the same useful effects if inserted into a totally unrelated species. Furthermore, testing has only been done on a small scale currently and it’s hard to predict what will happen when it’s used on a wider ecology. In 1989, dozens of Americans died and several thousands were afflicted and impaired by a genetically altered version of the food supplement L-tryptophan. Studies have been done to show how viruses can mix with genes of other viruses to give rise to more deadly viruses. To mass market the use of GM food when it has not been properly tested for safety issues would mean that businesses are gaining at the expense of consumer’s health and is therefore ethically unacceptable. On the other hand, some organizations insist that GM technology is the solution to solving the problem of world hunger. However, I feel that it is simply a ploy of corporations and countries that are using the plight of the developing world as a marketing strategy to gain acceptance of GE foods. GM technology is not an economical method that can be easily implemented by most countries. In fact, genetic engineering techniques are currently being applied to crops important to the industrialized world and not on crops which the world’s hungry depend on. GM foods could actually reduce developed countries’ reliance on crops from developing countries, resulting in loss of trade and severe economic damage for them and intensifying their problem of poverty. This would mean that there’s a conflict of interest. Furthermore, an important factor that Friends of the Earth has pointed out is that â€Å"many people in the world are suffering from malnutrition and hunger because they cannot afford to buy food, not because it is unavailable.† Therefore, even with GM food, people would still not be able to afford it or have it distributed appropriately. Most of the causes of hunger are found in global politics, rather than issues of agriculture and technology. As a result, a variety of groups and people are questioning the motives behind GM foods as the political causes of hunger appear to be ignored. An article from Food First observed that â€Å"most innovations in agricultural biotechnology have been profit-driven rather than need-driven† and it questions whether GE technology can really ensure food security, protect the environment and reduce poverty in the developing world or is it produced simply because it’s patentable and thus, profitable to businesses. In some cases, as reported by The Institute for Science, pesticide usage is actually increasing, and GE crop actually yield less than conventional crops. In this essay, I have come up with several valid reasons why Genetically Modified Foods are ethically unacceptable. GM foods tamper with the origin of nature which is the genes and there is inadequate safety testing to prove that GM food is safe for human consumption. Therefore, businesses are mass marketing GM food at the expense of consumer’s health and proclaiming that GM Food is the solution to world hunger when it might not be true. Although there might be potential and benefits in GE technology, there are still many unknown areas that might prove to be more harmful then beneficial. Furthermore, there are still too many important ethical issues that have been ignored and that reason by itself makes it ethically unacceptable.

A Guide to Online Paper Editing

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Does Marijuana Legalization Increase the Demand

With the legalization of substances like marijuana come not only changes to the law, but changes to the economy. For example, what can be expected of demand for marijuana as states legalize its use? Is there an outward shock in the demand and if so, is it a  short-term or long-term shock? As laws change in the United States, we will see this scenario play out, but lets look at some of the common assumptions. Legalization and Increased Demand Most economists agree that with legalization, we can expect demand to increase in the short-term, as the penalties for being caught with marijuana go down (to zero) and marijuana should be easier to attain. Both of these factors suggest that in the short-term, demand should rise. Its much harder to say what will happen in the long-run. I suspect that marijuana may appeal to some people precisely because it is illegal; humans have been tempted by the forbidden fruit since the time of Adam and Eve. Its possible that once marijuana has been legal for a period of time, it will no longer be seen as cool and some of the original demand will drop off. But, even as the cool factor may decrease, demand may continue to increase for any number of factors from an increase in the study of medicinal applications to availability and the increase in businesses catering to its recreational use. What the Experts Say Thats my gut instinct on what would happen to demand under marijuana legalization. Gut instincts, however, are no replacement for serious study and evidence. Since I have not studied the subject in any great detail, the prudent thing to do would be to see what those who have studied it say. What follows is a sampling from a few different organizations. The U.S. Drug Enforcement Agency believes that demand for marijuana would skyrocket if legalized: Legalization proponents claim, absurdly, that making illegal drugs legal would not cause more of these substances to be consumed, nor would addiction increase. They claim that many people can use drugs in moderation and that many would choose not to use drugs, just as many abstain from alcohol and tobacco now. Yet how much misery can already be attributed to alcoholism and smoking? Is the answer to just add more misery and addiction? From 1984 to 1996, the Dutch liberalized the use of cannabis. Surveys reveal that lifetime prevalence of cannabis in Holland increased consistently and sharply. For the age group 18-20, the increase is from 15 percent in 1984 to 44 percent in 1996. In a report titled The Budgetary Implications of Marijuana Prohibition, Jeffrey A. Miron, a Visiting Professor of Economics at Harvard University felt that the quantity demand for marijuana after legalization would largely be determined by price; thus there would not likely be an increase in quantity demanded if the price stayed the same. He went on to say: If the price decline under legalization is minimal, then expenditure will not change regardless of the demand elasticity. If the price decline is noticeable but the demand elasticity is greater than or equal to 1.0 in absolute value, then expenditure will remain constant or increase. If the price decline is noticeable and the demand elasticity is less than one, then expenditure will decline. Since the decline in price is unlikely to exceed 50% and the demand elasticity is likely at least -0.5, the plausible decline in expenditure is approximately 25%. Given the estimate of $10.5 billion in expenditure on marijuana under current prohibition, this implies expenditure under legalization of about $7.9 billion. In another report, The Economics of Cannabis Legalization, the author, Dale Gieringer, suggests that the demand for marijuana would likely go up after legalization. However, he does not see this as negative, as it may cause some to switch from more harmful drugs to marijuana: Legalization of cannabis would also divert demand from other drugs, resulting in further savings. If legalization reduced current narcotics enforcement costs by one-third to one-fourth, it might save $6 - $9 billion per year. Nobel Prize winner Gary Becker, however, is uncertain that demand for marijuana would increase under legalization: I obviously do agree that legalization would likely increase drug use if it lowered prices of drugs- the quantity demanded of drugs also tends to decline as their price falls. That is why I did not assume a zero price elasticity, but used 1/2 as my estimate. However, whether legalization would increase quantity demanded at a given price is far less clear. Forces go in both directions, such as the desire to obey the law versus the desire to oppose authority. In states where marijuana has been legalized for both medicinal and recreational use, it may still be too soon to tell what the long-term impact legalization will have on demand, but each state will serve as a case study into the factors that affect the new industry.