Pain behavior and interactions with the environment

Acute pain may last for minutes (e.g. cannulation) or weeks to months following a burn. In a small but significant proportion of patients, pain persists and becomes chronic or there are recurring episodes of acute pain.

In this situation management involves assessment of the 'whole picture' and not just the pain. Interactions between psychological, environmental, and somatic factors have been shown to influence the nature, intensity, and persistence of pain and disability ( JurklllaDdll Melllzack.l1992)^ Patients' reaction to their pain (known as pain behavior), their moods, their beliefs, their coping strategies, 'internal conversations', and interactions with their family and environment, in particular the ward, also need consideration. Pain behavior refers to speech, posture, and facial expressions (e.g. grimacing) which would lead one to infer that the individual has pain. Pain behavior has been shown to be influenced by a variety of factors other than an identifiable pathological process. This is a highly specialized area, and its thorough evaluation and treatment require the skills of a multidisciplinary pain management team including a clinical psychologist or psychiatrist with expertise in pain assessment and management. Treatment may be required to address psychological factors including 'maladaptive' behavior and to encourage 'well' behavior.

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