Meanings of Pain Volume 3: Vulnerable or Special Groups of People

Thank you to APS members Simon van Rysewyk, Emre Ilhan and Joshua Pate for sharing the following recent publication.

Book first published online: 18 May, 2022

Book Reference: https://link.springer.com/ book/10.1007/978-3-030-95825-1

DOI: https://doi.org/10.1007/978-3-030-95825-1

Abstract

Introduction

This interdisciplinary book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time. Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including Black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions. This brief review focusses on two chapters in this book.

BLOG WEB

Results

Researchers and clinicians have used nonverbal behavioural, physiological, and neurophysiological cues to conceive pain in the neonate and infant. Pain assessment of the neonate and infant based on nonverbal behavioural cues is not an “indirect” means of inferring pain in the neonate and infant, since pain experience is not totally separable from its behavioural manifestations. Health professionals’ (HCP) self-perceived role as carers and their understanding of suffering are major determinants of their concept of neonatal or infant pain. HCP attributes (e.g., discipline, education, level of empathy, observational skills), attributes within the NICU (e.g., care priorities within the NICU, institutional benchmarks of viability, current workload), and context influence the conceptualisation of neonatal or infant pain. For parents, the concept of pain is heavily influenced by emotional proximity to their child. The neonate and infant expresses pain by virtue of a courtesy extended to signs of pain by linguistically competent adults who have already mastered the practice of using “pain”, who treat these signs as genuine expressions of pain.

Conclusions

Co nceptualising Pain in Critically Ill Neonates or Infants by Emre Ilhan and Simon van Rysewyk (Pag es 1-16)

Aims

This chapter describes clinician and researcher concepts of neonatal or infant pain, and implications these conceptions have on the study of neonatal or infant pain.

Methods

Scientific literature review and conceptual analysis.

The existence of over 50 pain assessment tools to assess pain in this population attests to the complexity of the expression of pain in neonates or infants. This is partly reflective of uncertainty and disagreement in clinical judgements of pain in neonatal or paediatric patients, due in turn to the constitutional indefiniteness of our concept of pain. Overall, our results underscore the dependence that the baby has on the adult caregiver, and more broadly on the social environment.

Implications

Set against the indefiniteness of the concept of pain, poor observational skills and education in the HCP may exacerbate accurate detection of pain in behavioural signs.