tag:blogger.com,1999:blog-63775984369557687672024-03-13T08:02:32.112-07:00DRISTANDristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.comBlogger21125tag:blogger.com,1999:blog-6377598436955768767.post-45700376585684624132010-05-04T03:23:00.000-07:002010-05-04T04:16:58.615-07:00Essential nursing skills for parctice (English)The contents of nursing skills yang harus di kuasai oleh perawat pada umumnya adalah<div><br /></div><div><b>FAKTOR FISIK :</b><br /><div><ol><li>observation and monitoring, </li><li>Resuscitation</li><li>intravenous therapy</li><li>central venous catheters</li><li>nutrition and hydration</li><li>medicines</li><li>elimination</li><li>prevention of cross infection</li><li>wound assessment</li><li>patient hygiene</li><li>respiratory care</li><li>immobility and associated problems</li></ol><b>FAKTOR PSIKOLOGI (TRUST)</b></div><div><ol><li>TRUST, bina rasa percaya, show your <i><b>confidence</b></i></li><li>RESPECT ABILITY, menghargai pasien tanpa memandang dari mana pasien itu berasal kaya miskin, tua muda, ras, etc.</li><li>UNDERSTAND, get information of patient - baca data-data pasien sebaik-baiknya diagnosis, past history, allergic, riwayat dirawat, etc.</li><li>SUPPORT AND MOTIVATION, berikan dorongan or support bahwa segala sesuatu yang mereka sedang hadapi pasti akan membaik.</li><li>TEACHING, provide a health education (pendidikan kesehatan)</li></ol></div><div>if you would like to know more or detail of what is the nursing skills above, akan di jelaskan lebih rinci lagi di article selanjutnya, <b><i>just keep check in of my blog or you are becoming my follow. will be published soon....</i></b></div><div><b><i><br /></i></b></div><div><b><i>written by Riss</i></b></div></div>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-84891014489803579922010-04-28T07:35:00.000-07:002010-04-28T09:33:34.836-07:00How to notice immediately patient with acute conditionIf acute changes to the patient and patient's condition is immediately life-threatening, you need to concern to the following of the deteriorating criteria,<div><ol><li><b> Airway ---- threatened / obstructed</b></li><li><b>Breathing---Respiratory rate kurang 8x/mnt atau lebih dari 30x/menit</b></li><li><b>O2 Saturation---- kurang dari 90 percent</b></li><b><b><li><b>Circulation---- heart rate kurang dari 45x/menit atau lebih dari 130x/menit</b></li><li><b>Systolic BP---- less than 90 or more than 200 mmhg</b></li><li><b>Neurological ---- seizures, decrease level of consciousness</b></li><li><b>Urine output---- less than 200 mls per 8 hours</b></li><b><b><b><li><b>BSL---- less than 3</b></li><b><b></b></b></b></b></b></b></b></ol><b><b><b><b><b><b><b><div><span class="Apple-style-span" style="font-weight: normal;">whilst you find patient's condition deteriorates further as above, you require immediately help.</span></div><div><span class="Apple-style-span" style="font-weight: normal;">get the doctor in-charge or senior staff to reassess the patient.</span></div><div><span class="Apple-style-span" style="font-weight: normal;">All the deteriorating criteria mentioned above can virtually cause the death if respond is unable to stabilise within 1 hours, to prevent death, escalation extremely required.</span></div><div><span class="Apple-style-span" style="font-weight: normal;"><br /></span></div><div><span class="Apple-style-span" style="font-weight: normal;">Written by Riss</span></div></b></b></b></b></b></b></b></div><b><b><b><b><b><b><b></b></b></b></b></b></b></b>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com1tag:blogger.com,1999:blog-6377598436955768767.post-25860755805397530832010-04-27T00:17:00.000-07:002010-04-27T01:23:33.803-07:00Do you know what is different among AIN, EEN, RN, CNS, CNC, NE, and NUMDear perawat Indonesia,<div>Some of you, probably do not know apa itu AIN,EEN,RN,CNS,CNC,NE,and NUM? iya kan?</div><div>so here I will figure out partly what are their definiton and simply job description on the ward.</div><div><ul><li><b>AIN : Assistant in nursing</b>, they working to assist RN in providing such as showering, toileting, feeding, and more related to basic of nursing to the patient.</li><li><b>EEN: Endorse enroll nurse</b>, A Basically they working like RN but they can not administer a sedation medication, and advance nursing skills such as giving IV medication via PICC line or giving a Blood Transfusion as an example of this.</li><li><b>RN : Registered Nurse</b>, we call them "comprehensive nurse" because they can give everything and perform everything on the ward like basic care, medication, education, admission, discharging, consultation, referral to others team, etc.job <a href="http://www.nets.org.au/PDF/NETS%20Position%20Description%20-%20RN.pdf">http://www.nets.org.au/PDF/NETS%20Position%20Description%20-%20RN.pdf</a></li><li><b>CNS: Clinical nurse specialist</b>, RN who has a specific studied meaning they had graduated from another course like RN + 1 years of Aged care course, RN + 1 years of oncology course dsb which they were promoted by the hospital in where their work.</li><li><b>CNC: Clinical nurse consultant</b>, RN who had promoted by the hospital and has more experience in one specific skill and knowledges like wound care, pain management, stoma care, aged care etc. we can say " the expert " " AHLI " dalam ilmu itu. jadi kalau kita punya masalah di ruangan dan kita tidak tahu dalam menangani masalah tindakan atau perawatan we can ask them to get information.</li><li><b>NE : Nurse Educator</b>, RN who had graduated from the management nursing course or has more experience in nursing and also was promoted by the hospital to entitle getting that position. NE is basically the same as CNC on the ward but NE is more general so they can assist you in general nursing skills on the ward. However, if they are unsure with the question that we ask, they normally will refer the problems to CNC for confirmation eventually.</li><li><b>NUM : Nursing Unit Manager atau "kepala ruangan"</b>. we know what is kepala ruangan ? isn't it?</li></ul>well, itu hanya pengertian yang sederhana mengenai tugas2 mereka if you would like to know more you can find out on the website, I figured out as per nursing Australian version, regardless of nursing job description among USA, Canada, England, Ireland, Philipine, Singapore etc are the same, it may be Indonesia is the only country that has a different system about the nursing hierarchy possibly...???.</div><div><br /></div><div>Written by Riss </div>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-58467106658488511922010-04-26T23:39:00.000-07:002010-04-27T00:07:40.054-07:00How to get A visa sambil kerja and earn DOLLAR in Australia for Free,Teman2 perawat di Indonesia,<div><br /></div><div>Punya keinginan pergi ke Australia? sedikit punya modal buat holiday ke Australia, <b>jangan pesimis</b> karena saat ini mereka sedang menyediakan visa kerja sambil liburan for "FREE" <b>satu tahun!! sudah gitu kamu bisa perpanjang.....visa</b></div><div><b>lumayan bukan?<span class="Apple-style-span" style="font-weight: normal; ">kita bisa liburan kita juga bisa kerja, pingin tahu caranya?</span></b></div><div><ol><li>Of course, your English must be improved first, you can test your english capabilty by <b>IELTS or TOEFL</b> kamu bisa tanya ke staff berapa minimum untuk persyaratan keluar negeri? kalau gak salah recently their change the score, it should be <b>5</b> for each brand, if you feel competent enough with your English ability then you can log in or applying to get <b>free working holiday visa.</b></li><li>Your nursing skills must be up to date maksudnya cari info tentang masalah keperawatan in Australia karena between Australia and Indonesia ada perbedaan slightly.</li><li>if you have a bit money for deposit you can just get it done go to Australian Immigration in Jakarta and find out an information about the job opportunities. if you don't have enough money? find out the Agency or sponsors which may recruit you as their staff, because siapa tahu kalau kamu sudah fully understand of nursing and fluent in English, they may be impressing on you.</li><li>lastly, or go to this website FREE WORKING HOLIDAY <a href="http://www.visas-australia.com/visas/free.asp">http://www.visas-australia.com/visas/free.asp</a>.</li><li>By the time you get here don't worry we have a number indonesian community will assisst you to reside or you can contact me.</li></ol>So, all done...now be ready jangan pesimis don't give up! masa depan di tangan anda if you change your future and improve standard of your life why you just try this simple metode, think about the world - <b>NURSES IS BEING DEMANDED BY THE WORLD</b></div><div><b><span class="Apple-style-span" style="font-weight: normal; "><br /></span></b></div>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com1tag:blogger.com,1999:blog-6377598436955768767.post-79301933301333460372010-04-26T22:50:00.000-07:002010-04-26T22:52:18.561-07:00Effects of Hypertension to the patient<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; "><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; "><b><i><span class="Apple-style-span" style="color:#FF0000;"><span class="Apple-style-span" style="font-size: medium;">Hypertension</span></span></i></b>, defined as blood pressure that is elevated and higher than normal, is one of the most common medical conditions in the world. With several resulting conditions and significant healthcare expenses, the societal impact of hypertension is tremendous. Measures to prevent and treat hypertension have one common goal: to minimize the risk of complications stemming from high blood pressure.</p><h3 class="dynamic" style="font-size: 13px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Atherosclerosis</h3><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Hypertension is one of the major risk factors of atherosclerosis. In combination with other factors such as high cholesterol and diabetes mellitus, hypertension accelerates the process by which plaques form in the walls of the arteries. Complications result depending on which arteries are affected and, consequently, which organs receive inadequate delivery of blood and oxygen. Of these complications, two are especially common and associated with morbidity and mortality: heart attack and stroke.</p><h3 class="dynamic" style="font-size: 13px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Congestive Heart Failure</h3><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Hypertension can lead to a heart attack, which can result in <a href="http://heartdiseasediabetes.suite101.com/article.cfm/congestive_heart_failure" style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; color: rgb(51, 102, 102); text-decoration: underline; font-weight: bold; ">congestive heart failure</a> over time because of impaired heart muscle contraction. However, hypertension can also lead to congestive heart failure in a different way. If the blood pressure is consistently high, the heart has to constantly pump against a high level of resistance. This causes the heart muscle of the left ventricle to thicken (left ventricular hypertrophy, or LVH). If it continues, the thickening can be so great that it reduces the space within the ventricle, limiting the amount of blood that gets pumped out.</p><h3 class="dynamic" style="font-size: 13px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Kidney Failure</h3><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Another effect of untreated high blood pressure is <a href="http://chronicillness.suite101.com/article.cfm/kidney_failure" style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; color: rgb(51, 102, 102); text-decoration: underline; font-weight: bold; ">kidney failure</a>. Along with diabetes mellitus, hypertension is a major risk factor for this condition because of damage to the filtering portions of the kidney (glomeruli). Additionally, such kidney disease, in turn, can increase blood pressure. Between 80% and 90% of patients with chronic kidney failure have hypertension.</p><h3 class="dynamic" style="font-size: 13px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Aortic Dissection</h3><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Hypertension can cause <a href="http://heartdiseasediabetes.suite101.com/article.cfm/aortic_dissection" style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; color: rgb(51, 102, 102); text-decoration: underline; font-weight: bold; ">aortic dissection</a> in which the layers of the wall of the aorta separate from each other. This generally occurs when the blood pressure remains consistently at a moderate to severe level. Inherent weakness of the aortic wall, as with Marfan's syndrome, may also play a role.</p><br /><br /><br /></span>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-56289353582616042552010-04-26T01:10:00.001-07:002010-04-26T01:49:12.428-07:00Improve your English to be betterI encourage you to keep studying of English as English is recently a international language, therefore if you have an ambition would like to go overseas you need to improve your English first then you ll be able to compete with the world.<div><br /><div>A number of job vacancy is widely available for nurses like in USA, Australia, Canada, Middle East, and Asia like Japan currently offering Indonesia to send more nurses to their country because of shortages of nurse in their country, even in Australia, however, Indonesian nurses is never requested by other countries as a result of language barriers that experienced by Indonesian nurses. </div><div>we need to rise our head up from now as era globalization is coming gradually, there was a riot in Batam clash antara indonesian and indian.</div><div>indian was insulting us and they were saying we are "stupid" in working, unable to recognize and follow the instruction as by the time the supervisor given a instruction in English, in fact, some indonesian was unable to follow the command. bagaimana reaksi kita menghadapi kasus seperti ini??</div><div>Based on my personal experience, Indonesian Nurses who have been working in Overseas for example Australia they have ever experienced the same situation like the incident which I mentioned above, this problems can not be tolerated we need to rise your head up now, encourage your self to be the best both on skills and communication ability.</div><div>We can not blame them whose not liable to speak English fluently, it is hard, as English in Indonesia not a compulsory languages but we are as nurses do not ever think to stick our self in Indonesia try to open our mind that we want to compete with others nurse worldwide.</div><div><br /></div><div>Philipina is now the country called as the king of nurse supplier worldwide, a thousand of nurses they send to other countries constantly every years, because of their English is better than us, I have shared an experience with one of "philipino" they said " you know? why our English is a bit better than others due to English always used everyday".</div><div>As a consequently, a number of investor or nursing agency from overseas invest their business in their country to recruit nurses to be employed in their country such as USA, Canada, England, Australia, Middle East, Ireland, Scotland, etc.</div><div><br /></div><div>Obviously, it is not about skills if we want to go overseas working as a Nurse but it is all about communication ability (English), We believe that Indonesian nurses may be better than others if we are as a nurse are able to show our performance is not only in nursing skills but also communication skill.</div><div><br /></div><div>Now, we just look forward to the investor hopefully in short period of time, there are investors that look into nursing development in Indonesia and then they will provide us a gate to compete with others nurse worldwide.</div><div><br /></div><div>Good luck....my Nurses's friend , </div><div><br /></div><div>Written and published by Rislan</div><div><br /></div><div><br /></div><div><br /></div></div>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-72268297040515271232010-04-26T00:22:00.000-07:002010-04-26T00:44:48.619-07:00AGED CARE NURSING IS BEING DEMANDED IN AUSTRALIA<span class="Apple-style-span" style=" ;font-family:Verdana, Arial, Helvetica, sans-serif;font-size:13px;"><div class="contentHeader" style="list-style-type: none; font-family: Verdana, Arial, Helvetica, sans-serif; margin-top: 10px; margin-right: 0px; margin-bottom: 20px; margin-left: 200px; font-size: 7pt; color: rgb(0, 0, 96); "><h1 class="indentSmall" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 96); "><span class="Apple-style-span" style="font-weight: normal;"><span class="Apple-style-span" style="font-size: medium;">DO YOU WANNA GO TO OVERSEAS THEN WORKING AS A NURSE WITH A MILLION RUPIAH THAT YOU CAN EARN MONTHLY</span></span></h1><div><span class="Apple-style-span" style="font-size: medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size: medium;">YOU DO NOT NEED A HIGHLY NURSING SKILLS OR KNOWLEDGES YOU SHOULD BRING WITH.</span></div><div><span class="Apple-style-span" style="font-size: medium;">HOWEVER, YOU MUST BE ABLE TO COMMUNICATE IN ENGLISH AS ONE OF THE REQUIREMENTS.</span></div><div><span class="Apple-style-span" style="font-size: medium;">DO YOU WANT TO KNOW HOW TO BE PART OF AGED CARE NURSES??</span></div><h1 class="indentSmall" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 96); "><ol><li><span class="Apple-style-span" style="font-weight: normal;"><span class="Apple-style-span" style="font-size: medium;">IMPROVE YOUR ENGLISH TO BE BETTER, ONE YOU ARE CONFIDENCE ENOUGH WITH YOUR ENGLISH, THEN FIND OUT THE AGENCY/SPONSORS THAT MIGHT ASSIST YOU TO GO TO AUSTRALIA.</span></span></li><li><span class="Apple-style-span" style="font-weight: normal;"><span class="Apple-style-span" style="font-size: medium;">A NUMBER OF NURSING AGENCY IS AVAILABLE IN AUSTRALIA WHICH WILL ASSIST YOU TO ALLOCATE YOU IN AGED CARE FACILITIES OR HOSPITAL.</span></span></li><li><span class="Apple-style-span" style="font-weight: normal;"><span class="Apple-style-span" style="font-size: medium;">START TO GET MORE MONEY AND BECOME A WEALTH NURSES... </span></span></li></ol></h1><h1 class="indentSmall" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; color: rgb(0, 0, 96); "><span class="Apple-style-span" style="font-weight: normal;"><span class="Apple-style-span" style="font-size: medium;">Aged Care Nursing IN AUSTRALIA</span></span></h1></div><div id="content" style="list-style-type: none; font-family: Verdana, Arial, Helvetica, sans-serif; margin-left: 200px; "><table width="100%" border="0" cellspacing="0" cellpadding="0" style="list-style-type: none; font-family: Verdana, Arial, Helvetica, sans-serif; "><tbody><tr><td style="list-style-type: none; font-family: Verdana, Arial, Helvetica, sans-serif; width: 863px; vertical-align: top; text-align: left; "><table border="0" width="99%" style="list-style-type: none; font-family: Verdana, Arial, Helvetica, sans-serif; "><tbody><tr><td class="indent" style="list-style-type: none; font-family: Verdana, Arial, Helvetica, sans-serif; margin-left: 5px; padding-left: 5px; vertical-align: top; text-align: left; width: 844px; height: 1321px; "><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 10px; padding-left: 0px; list-style-type: none; font-family: Verdana, Arial, Helvetica, sans-serif; "><b><span class="Apple-style-span" style="font-weight: normal;">"Aged care nurses look after the ageing members of the community, who might need help with day-to-day activities. At present, there is a large demand for nurses in aged care, and in the future, this is likely to dramatically increase further"</span></b></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 10px; padding-left: 0px; list-style-type: none; font-family: Verdana, Arial, Helvetica, sans-serif; "><b><span class="Apple-style-span" style="font-weight: normal;"><br /></span></b></p></td></tr></tbody></table></td></tr></tbody></table></div></span>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-45282028736591583562010-04-25T23:00:00.000-07:002010-04-25T23:02:31.270-07:00HEART FAILURE AND NURSING MANAGEMENT<span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif; font-size: 12px; "><div style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 10px; padding-right: 0px; padding-bottom: 15px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; float: right; width: 340px; "><div style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 5px; margin-right: 0px; margin-bottom: 5px; margin-left: 0px; position: relative; width: inherit; "><div class="rb_wrapper small_text" style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; overflow-x: hidden; overflow-y: hidden; display: block; color: rgb(0, 0, 0); background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: rgb(238, 238, 238); background-position: initial initial; background-repeat: initial initial; "><br /><br /></div></div></div><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; "></p><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">The heart pumps out blood that supplies the body with oxygen and nutrients. Heart failure is a condition where the heart cannot pump enough blood to the rest of the body. This results in a reduction in blood supply to the different organs in the body. It can be caused by factors such as</p><ul style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; "><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">rheumatic fever</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">bacterial endocarditis</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">anemia</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">and valvular defects to name a few</li></ul><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Some symptoms of heart failure are: shortness of breath on exertion or with activity, cough, swelling of the feet, stomach area and ankles, tiredness, loss of appetite and frequently urinating at night.</p><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Nursing Diagnoses for Heart Failure</p><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">After assessing a patient with heart failure, the nurse may come across one or more symptoms of this disorder such as shortness of breath. The nurse formulates nursing diagnoses based on the symptoms the patient displays. Some nursing diagnoses for heart failure are:</p><ul style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; "><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">decreased cardiac output related to decreased myocardial contractility</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">fatigue due to poor oxygenation</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">altered tissue perfusion related to insufficient blood flow</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">impaired gas exchange related to lung congestion</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">and fluid volume excess related to compensatory mechanisms of heart failure</li></ul><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Nursing Interventions for Decreased Cardiac Output</p><div style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 1px; border-right-width: 0px; border-bottom-width: 1px; border-left-width: 0px; border-top-style: solid; border-right-style: none; border-bottom-style: solid; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 10px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 10px; margin-left: 0px; border-top-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); "><div id="adsense_placeholder_2" style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><span class="Apple-style-span" style="font-size:100%;color:#888888;"><span class="Apple-style-span" style="font-size: 11px;"><br /></span></span></div></div><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Decreased cardiac output refers to low blood supply in the body because the heart is not contracting efficiently enough to push blood to the rest of the body. The nurse nurse administers medication that increase the contractility of the heart as ordered by a physician. Some of these medications are digoxin, inotropic agents like dobutamine and dopamine and diuretics. Other nursing interventions for heart failure include administering diuretics and weighing the patient.</p><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Nursing Interventions for Fatigue due to Heart Failure</p><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">fatigue occurs when the cells in the body are inadequately oxygenated. This occurs when blood supply through the body is reduced. Nursing interventions for fatigue are:</p><ul style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; "><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">placing items often used by the patient close by so that they dont have to exert themselves to reach such items.</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">using slow progression during the patients daily activity to avoid sudden exertion.</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">teach the patient how to use environmental aids such as hand rails, chairs in the bathroom or bedside commode to avoid getting tired.</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">teach the patient energy conserving practices like sitting down to perform tasks and pushing instead of pulling.</li></ul><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Nursing Interventions for Altered Tissue perfusion and Impaired Gas Exchange</p><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Altered tissue perfusion describes a situation where the cells do not receive enough oxygen therefore the tissues where they are located are oxygen deprived and at risk for injury. Gas exchange occurs in the lungs and in heart failure, the lungs may become congested with blood and this reduces it's ability to absorb oxygen. The nurse can do a few things to address these problems like:</p><ul style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; "><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">administering oxygen as ordered to increase tissue oxygenation</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">elevating the head of the patients bed to alleviate lung congestion</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">inspecting the patients skin for wounds and instituting pressure ulcer precautions</li><li style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">raising the side rails of the bed to prevent falls incase the patient gets confused due to hypoxia-- reduced oxygen in the brain.</li></ul><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">Nusing interventions for the other nursing diagnoses related to heart failure include restricting fluids as ordered by a physician, to prevent or address excess fluid volume in the patient's body. The patient should also be taught to avoid high sodium intake by not eating processed and cooked foods with a lot of salt in them. The expected outcome of the nursing interventions for this condition is that the patient's level of fatigue is reduced therefore, the patient can perform activities of daily living and other lifestyle activities the patient engages in.</p><p style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; line-height: 17px; ">References:</p><br /><br /><span style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Read more at Suite101: <a href="http://heart-disease-treatment.suite101.com/article.cfm/heart-failure-and-nursing-management#ixzz0mBQaZKYn" style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; color: rgb(51, 102, 102); text-decoration: underline; font-weight: bold; ">Heart Failure and Nursing Management: Nursing Management Of A Congestive Heart Failure Patient</a> <a href="http://heart-disease-treatment.suite101.com/article.cfm/heart-failure-and-nursing-management#ixzz0mBQaZKYn" style="font-size: 12px; font-family: Arial, Helvetica, sans-serif; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; color: rgb(51, 102, 102); text-decoration: underline; font-weight: bold; ">http://heart-disease-treatment.suite101.com/article.cfm/heart-failure-and-nursing-management#ixzz0mBQaZKYn</a></span></span>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-57816905017114990862010-04-25T04:10:00.001-07:002010-04-25T04:25:19.142-07:00Jobs description of Community Nurses yang sebenarnya!!!<span class="Apple-style-span" style=" color: rgb(60, 66, 69); line-height: 15px; font-family:Arial, Verdana, sans-serif;font-size:12px;"><div id="division_description" style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 10px; margin-left: 0px; padding-top: 20px; padding-right: 13px; padding-bottom: 10px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: rgb(200, 228, 241); ">Perawat komunitas atau perawat PUSKESMAS di Indonesia sungguh berbeda dengan negara lain di dalam menjalankan peranya sebagai perawat komunitas, if we refer to literatur or theory that the community nurses's job description is that the following statement below, perawat puskesmas in Indonesia sometime not perform their duty appropriately, is more tend to general nurse jobs otherwise.</div><div id="division_description" style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 10px; margin-left: 0px; padding-top: 20px; padding-right: 13px; padding-bottom: 10px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; background-image: initial; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: rgb(200, 228, 241); ">Community Nursing includes a full range of Nursing services delivered in-home . These include health screening and assessment, complex personal care, post-acute care, symptom control, medication management, stomal therapy, wound management, palliative care, continence management, mental health and chronic disease management.<br /></div><div class="program_description" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 13px; padding-bottom: 2px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; "><h2 style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 15px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: bold; font-style: inherit; font-size: 18px; font-family: Myriad, 'Myriad Pro', Arial, Helvetica, sans-serif; color: rgb(73, 166, 210); ">Chronic Disease Management</h2><p style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 18px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: Arial, Verdana, sans-serif; color: rgb(60, 66, 69); line-height: 15px; ">provides a range of services to clients living with a chronic illness such as Diabetes, heart disease, respiratory disease and renal disease. Services include assessment, management, education and referral.</p></div><div class="program_description" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 13px; padding-bottom: 2px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; "><h2 style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 15px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: bold; font-style: inherit; font-size: 18px; font-family: Myriad, 'Myriad Pro', Arial, Helvetica, sans-serif; color: rgb(73, 166, 210); ">Complex Personal Care</h2><p style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 18px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: Arial, Verdana, sans-serif; color: rgb(60, 66, 69); line-height: 15px; ">Complex Personal Care is provided to clients who require a high level of assistance with showering, dressing and assistance with daily living</p></div><div class="program_description" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 13px; padding-bottom: 2px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; "><h2 style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 15px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: bold; font-style: inherit; font-size: 18px; font-family: Myriad, 'Myriad Pro', Arial, Helvetica, sans-serif; color: rgb(73, 166, 210); ">Continence Management</h2><p style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 18px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: Arial, Verdana, sans-serif; color: rgb(60, 66, 69); line-height: 15px; ">This service provides treatment, information and education to adults and children who are at risk of, or who are experiencing, incontinence. Consultancy, information and education on incontinence are offered to health professionals and the genera...</p></div><div class="program_description" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 13px; padding-bottom: 2px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; "><h2 style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 15px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: bold; font-style: inherit; font-size: 18px; font-family: Myriad, 'Myriad Pro', Arial, Helvetica, sans-serif; color: rgb(73, 166, 210); ">Health Screening and Assessment</h2><p style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 18px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: Arial, Verdana, sans-serif; color: rgb(60, 66, 69); line-height: 15px; "> Nurses are qualified to conduct a variety of health screening procedures including physical, social, psychological and environmental home assessments. Nursing staff are competent in the practice of venipuncture, ECG recording, abdominal pain</p></div><div class="program_description" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 13px; padding-bottom: 2px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; "><h2 style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 15px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: bold; font-style: inherit; font-size: 18px; font-family: Myriad, 'Myriad Pro', Arial, Helvetica, sans-serif; color: rgb(73, 166, 210); ">Medication Management</h2><p style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 18px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: Arial, Verdana, sans-serif; color: rgb(60, 66, 69); line-height: 15px; ">staff liaise with medical practitioners and pharmacies to provide management and support with medication management.</p></div><div class="program_description" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 13px; padding-bottom: 2px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; "><h2 style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 15px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: bold; font-style: inherit; font-size: 18px; font-family: Myriad, 'Myriad Pro', Arial, Helvetica, sans-serif; color: rgb(73, 166, 210); ">Palliative Care</h2><p style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 18px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: Arial, Verdana, sans-serif; color: rgb(60, 66, 69); line-height: 15px; ">This service provides specialist and general Nursing care to clients in the final stages of their lives. Ozcare Nurses ensure clients remain comfortable and with optimal quality of life. Our Nurses specialise in pain control through medicatio...</p></div><div class="program_description" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 13px; padding-bottom: 2px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; "><h2 style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 15px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: bold; font-style: inherit; font-size: 18px; font-family: Myriad, 'Myriad Pro', Arial, Helvetica, sans-serif; color: rgb(73, 166, 210); ">Stomal Therapy</h2><p style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 18px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: Arial, Verdana, sans-serif; color: rgb(60, 66, 69); line-height: 15px; "> provides stomal therapy education, support and management for people with a colostomy, ileostomy or urostomy.</p></div><div class="program_description" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 10px; padding-right: 13px; padding-bottom: 2px; padding-left: 13px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: inherit; width: 635px; "><h2 style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 15px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: bold; font-style: inherit; font-size: 18px; font-family: Myriad, 'Myriad Pro', Arial, Helvetica, sans-serif; color: rgb(73, 166, 210); ">Wound Management</h2><p style="text-align: left;margin-top: 0px; margin-right: 0px; margin-bottom: 18px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-weight: inherit; font-style: inherit; font-size: 12px; font-family: Arial, Verdana, sans-serif; color: rgb(60, 66, 69); line-height: 15px; "> Community Nurses and Allied Health staff provide specialist services for wound care, leg ulcers and stomal therapy. Ozcare’s highly qualified staff assess and treat acute or chronic wounds and provide advice on future prevention. ...</p></div></span>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-68722694243914798962010-04-25T03:09:00.000-07:002010-04-25T04:46:01.388-07:00NURSING MANAGEMENT ( Indonesia )<span class="Apple-style-span" style=" line-height: 21px; font-family:Verdana, Tahoma, Arial, sans-serif;font-size:13px;"><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Pengertian</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Manajemen adalah proses untuk melaksanakan pekerjaan melalui upaya orang lain. Menurut P. Siagian, manajemen berfungsi untuk melakukan semua kegiatan yang perlu dilakukan dalam rangka pencapaian tujuan dalam batas – batas yang telah ditentukan pada tingkat administrasi. Sedangkan Liang Lie mengatakan bahwa manajemen adalah suatu ilmu dan seni perencanaan, pengarahan, pengorganisasian dan pengontrol dari benda dan manusia untuk mencapai tujuan yang ditentukan sebelumnya.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Sedangkan manajemen keperawatan adalah proses pelaksanaan pelayanan keperawatan melalui upaya staf keperawatan untuk memberikan asuhan keperawatan, pengobatan dan rasa aman kepada pasien, keluarga dan masyarakat. (Gillies, 1989).</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Kita ketahui disini bahwa manajemen keperawatan adalah suatu tugas khusus yang harus dilaksanakan oleh pengelola keperawatan untuk merencanakan, mengorganisasikan, mengarahkan serta mengawasi sumber – sumber yang ada, baik sumber daya maupun dana sehingga dapat memberikan pelayanan keperawatan yang efektif baik kepada pasien, keluarga dan masyrakat.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Fungsi – Fungsi Manajemen</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Secara ringkas fungsi manajemen adalah sebagai berikut :</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">a. Perenacanaan (planning), perncanaan merupakan :</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">1) Gambaran apa yang akan dicapai</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">2) Persiapan pencapaian tujuan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">3) Rumusan suatu persoalan untuk dicapai</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">4) Persiapan tindakan – tindakan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">5) Rumusan tujuan tidak harus tertulis dapat hanya dalam benak saja</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">6) Tiap – tiap organisasi perlu perencanaan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">b. Pengorganisasian (organizing), merupakan pengaturan setelah rencana, mengatur dan menentukan apa tugas pekerjaannya, macam, jenis, unit kerja, alat – alat, keuangan dan fasilitas.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">c. Penggerak (actuating), menggerakkan orang – orang agar mau / suka bekerja. Ciptakan suasana bekerja bukan hanya karena perintah, tetapi harus dengan kesadaran sendiri, termotivasi secara interval</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">d. Pengendalian / pengawasan (controling), merupakan fungsi pengawasan agar tujuan dapat tercapai sesuai dengan rencana, apakah orang – orangnya, cara dan waktunya tepat. Pengendalian juga berfungsi agar kesalahan dapat segera diperbaiki.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">e. Penilaian (evaluasi), merupakan proses pengukuran dan perbandingan hasil – hasil pekerjaan yang seharusnya dicapai. Hakekat penilaian merupakan fase tertentu setelah selesai kegiatan, sebelum, sebagai korektif dan pengobatan ditujukan pada fungsi organik administrasi dan manajemen.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Adapun unsur yang dikelola sebagai sumber manajemen adalah man, money, material, methode, machine, minute dan market.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Prinsip – Prinsip Manajemen</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Prinsip – prinsip manajemen menurut Fayol adalah</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">a. Division of work (pembagian pekerjaan)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">b. Authority dan responsibility (kewenangan dan tanggung jawab)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">c. Dicipline (disiplin)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">d. Unity of command (kesatuan komando)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">e. Unity of direction (kesatuan arah)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">f. Sub ordination of individual to generate interest (kepentingan individu tunduk pada kepentingan umum)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">g. Renumeration of personal (penghasilan pegawai)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">h. Centralization (sentralisasi)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">i. Scalar of hierarchy (jenjang hirarki)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">j. Order (ketertiban)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">k. Stability of tenure of personal (stabilitas jabatan pegawai)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">l. Equity (keadilan)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">m. Inisiative (prakarsa)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">n. Esprit de Corps (kesetiakawanan korps)</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Proses Manajemen Keperawatan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Proses manajemen keperawatan sesuai dengan pendekatan sistem terbuka dimana masing – masing komponen saling berhubungan dan berinteraksi dan dipengaruhi oleh lingkungan. Karena merupakan suatu sistem maka akan terdiri dari lima elemen yaitu input, proses, output, kontrol dan mekanisme umpan balik.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Input dari proses manajemen keperawatan antara lain informasi, personel, peralatan dan fasilitas. Proses dalam manajemen keperawatan adalah kelompok manajer dari tingkat pengelola keperawatan tertinggi sampai ke perawat pelaksana yang mempunyai tugas dan wewenang untuk melakukan perencanaan, pengorganisasian, pengarahan dan pengawasan dalam pelaksanaan pelayanan keperawatan. Output adalah asuhan keperawatan, pengembangan staf dan riset.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Kontrol yang digunakan dalam proses manajemen keperawatan termasuk budget dari bagian keperawatan, evaluasi penampilan kerja perawat, prosedur yang standar dan akreditasi. Mekanisme timbal balik berupa laporan finansial, audit keperawatan, survey kendali mutu dan penampilan kerja perawat.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Prinsip-Prinsip yang Mendasari Manajemen Keperawatan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Prinsip – prinsip yang mendasari manajemen keperawatan adalah :</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">a. Manajemen keperawatan seyogyanya berlandaskan perencanaan karena melalui fungsi perencanaan, pimpinan dapat menurunkan resiko pengambilan keputusan, pemecahan masalah yang efektif dan terencana.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">b. Manajemen keperawatan dilaksanakan melalui penggunaan waktu yang efektif. Manajer keperawatan yang menghargai waktu akan menyusun perencanaan yang terprogram dengan baik dan melaksanakan kegiatan sesuai dengan waktu yang telah ditentukan sebelumnya.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">c. Manajemen keperawatan akan melibatkan pengambilan keputusan. Berbagai situasi maupun permasalahan yang terjadi dalam pengelolaan kegiatan keperawatan memerlukan pengambilan keputusan di berbergai tingkat manajerial.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">d. Memenuhi kebutuhan asuhan keperawatan pasien merupakan fokus perhatian manajer perawat dengan mempertimbangkan apa yang pasien lihat, fikir, yakini dan ingini. Kepuasan pasien merupakan poin utama dari seluruh tujuan keperawatan.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">e. Manajemen keperawatan harus terorganisir. Pengorganisasian dilakukan sesuai dengan kebutuhan organisasi untuk mencapai tujuan.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">f. Pengarahan merupakan elemen kegiatan manajemen keperawatan yang meliputi proses pendelegasian, supervisi, koordinasi dan pengendalian pelaksanaan rencana yang telah diorganisasikan.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">g. Divisi keperawatan yang baik memotivasi karyawan untuk memperlihatkan penampilan kerja yang baik.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">h. Manajemen keperawatan menggunakan komunikasin yang efektif. Komunikasi yang efektif akan mengurangi kesalahpahaman dan memberikan persamaan pandangan, arah dan pengertian diantara pegawai.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">i. Pengembangan staf penting untuk dilaksanakan sebagai upaya persiapan perawat – perawat pelaksana menduduki posisi yang lebih tinggi atau upaya manajer untuk meningkatkan pengetahuan karyawan.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">j. Pengendalian merupakan elemen manajemen keperawatan yang meliputi penilaian tentang pelaksanaan rencana yang telah dibuat, pemberian instruksi dan menetapkan prinsip – prinsip melalui penetapan standar, membandingkan penampilan dengan standar dan memperbaiki kekurangan.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Berdasarkan prinsip – prinsip diatas maka para manajer dan administrator seyogyanya bekerja bersama – sama dalamperenacanaan danpengorganisasian serta fungsi – fungsi manajemen lainnya untuk mencapai tujuan yang telah ditetapkan sebelumnya.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Lingkup Manajemen Keperawatan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Mempertahankan kesehatan telah menjadi sebuah industri besar yang melibatkan berbagai aspek upaya kesehatan. Pelayanan kesehatan kemudian menjadi hak yang paling mendasar bagi semua orang dan memberikan pelayanan kesehatan yang memadai akan membutuhkan upaya perbaikan menyeluruh sistem yang ada. Pelayanan kesehatan yang memadai ditentukan sebagian besar oleh gambaran pelayanan keperawatan yang terdapat didalamnya.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Keperawatan merupakan disiplin praktek klinis. Manajer keperawatan yang efektif seyogyanya memahami hal ini dan memfasilitasi pekerjaan perawat pelaksana. Kegiatan perawat pelaksana meliputi:</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">a. Menetapkan penggunakan proses keperawatan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">b. Melaksanakan intervensi keperawatan berdasarkan diagnosa</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">c. Menerima akuntabilitas kegiatan keperawatan yang dilaksanakan oleh perawat</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">d. Menerima akuntabilitas untuk hasil – hasil keperawatan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">e. Mengendalikan lingkungan praktek keperawatan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Seluruh pelaksanaan kegiatan ini senantiasa di inisiasi oleh para manajer keperawatan melalui partisipasi dalam proses manajemen keperawatan dengan melibatkan para perawat pelaksana. Berdasarkan gambaran diatas maka lingkup manajemen keperawatan terdiri dari:</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">a. Manajemen operasional</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Pelayanan keperawatan di rumah sakit dikelola oleh bidang keperawatan yang terdiri dari tiga tingkatan manajerial, yaitu:</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">1) Manajemen puncak</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">2) Manajemen menengah</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">3) Manajemen bawah</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Tidak setiap orang memiliki kedudukan dalam manajemen berhasil dalam kegiatannya. Ada beberapa faktor yang perlu dimiliki oleh orang – orang tersebut agar penatalaksanaannya berhasil. Faktor – faktor tersebut adalah</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">1) Kemampuan menerapkan pengetahuan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">2) Ketrampilan kepemimpinan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">3) Kemampuan menjalankan peran sebagai pemimpin</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">4) Kemampuan melaksanakan fungsi manajemen</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">b. Manajemen asuhan keperawatan</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Manajemen asuhan keperawatan merupakan suatu proses keperawatan yang menggunakan konsep – konsep manajemen didalamnya seperti perencanaan, pengorganisasian, pengarahan dan pengendalian atau evaluasi.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Persyaratan Ruangan Menjalankan MPKP</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">Syarat-syarat Ruangan menjalankan MPKP adalah sebagai berikut:</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">a. Memiliki fasilitas perawatan yang memadai.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">b. Memiliki jumlah perawat minimal sejumlah tempat tidur yang ada.</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">c. Memiliki perawat pendidikan yang telah terspesialisasi</span></p><p style="text-align: justify;line-height: 1.65em; "><span class="Apple-style-span" style="font-size:small;">d. Seluruh perawat telah memiliki kompetensi dalam perawatan primer.</span></p></span>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-61034406128583157072010-04-25T00:59:00.000-07:002010-04-25T01:06:16.324-07:00Nursing Management's Visionary Leader<span class="Apple-style-span" style=" ;font-family:Arial, Verdana, Tahoma, sans-serif;font-size:13px;"><p id="P9" style="text-align: justify;margin-top: 5px; margin-bottom: 5px; float: left; width: 354px; "><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;"><b>The definition of nurse unit manager</b> is that nurse leader who views nursing as both an art and a science by promoting caring and competence as the link between science and human. Therefore, </span><span class="Apple-style-span" style="font-family:Arial, Verdana, Tahoma, sans-serif;"><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">the planning, development, implementation, and evaluation of a sustainable change in the </span></span><strong><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">work environment</span></span></strong><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;"> or</span></span><strong><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">clinical practice</span></span></strong><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;"> that has resulted in a positive outcome. The manuscript should articulate evidence that addresses the following guidelines:</span></span></span></span></p><p id="P11" style="text-align: justify;margin-top: 5px; margin-bottom: 5px; float: left; width: 354px; "><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">* </span></span><strong><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">Work environment:</span></span></strong><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;"> Significantly influences the work environment through the implementation of creative strategies to improve a professional model of care, nurse satisfaction, or professional development.</span></span></p><p id="P12" style="text-align: justify;margin-top: 5px; margin-bottom: 5px; float: left; width: 354px; "><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">* </span></span><strong><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">Clinical practice:</span></span></strong><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;"> Active implementation of strategies that support the advancement of nursing science through clarifying, refining, and expanding the nursing knowledge base by influencing patient care delivery.</span></span></p><p id="P13" style="margin-top: 5px; margin-bottom: 5px; float: left; width: 354px; "></p><p id="P14" style="text-align: justify;margin-top: 5px; margin-bottom: 5px; float: left; width: 354px; "><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size: medium;">The entry should address the leader's ability to sustain excellence through insight, inspiration, creativity, and the ability to reproduce results in other organizations.</span></span></p></span>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-82682061627254479952010-04-23T01:08:00.001-07:002010-04-23T01:09:12.465-07:00PAIN MANAGEMENT 2<span class="Apple-style-span" style="font-family: sans-serif; font-size: 13px; line-height: 19px; "><h1 id="firstHeading" class="firstHeading" style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0.1em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0px; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(170, 170, 170); font-size: 24px; line-height: 1.2em; background-position: initial initial; background-repeat: initial initial; "><br /></h1><div id="bodyContent"><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; "><b>Pain</b> is the unpleasant feeling common to such experiences as stubbing a toe, burning a finger, putting iodine on a cut and bumping the "<a href="http://en.wikipedia.org/wiki/Funny_bone" title="Funny bone" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">funny bone</a>".<sup id="cite_ref-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-0" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>1<span>]</span></a></sup> The <a href="http://en.wikipedia.org/wiki/International_Association_for_the_Study_of_Pain" title="International Association for the Study of Pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">International Association for the Study of Pain</a> defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage".<sup id="cite_ref-IASPterms_1-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-IASPterms-1" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>2<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Pain motivates us to withdraw from damaging or potentially damaging situations, protect the damaged body part while it heals, and avoid those situations in the future.<sup id="cite_ref-Lynn1984_2-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Lynn1984-2" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>3<span>]</span></a></sup> It is initiated by stimulation of <a href="http://en.wikipedia.org/wiki/Nociceptors" title="Nociceptors" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">nociceptors</a> in the <a href="http://en.wikipedia.org/wiki/Peripheral_nervous_system" title="Peripheral nervous system" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">peripheral nervous system</a>, or by damage to or malfunction of the peripheral or <a href="http://en.wikipedia.org/wiki/Central_nervous_system" title="Central nervous system" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">central</a> nervous systems.<sup id="cite_ref-3" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-3" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>4<span>]</span></a></sup> Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or pathology.<sup id="cite_ref-4" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-4" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>5<span>]</span></a></sup> Social support, cultural values, hypnotic suggestion, excitement in sport or war, distraction, and appraisal can all significantly <a href="http://en.wikipedia.org/wiki/Modulate" title="Modulate" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">modulate</a>pain's intensity or unpleasantness.<sup id="cite_ref-Eisenberger2005_5-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Eisenberger2005-5" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>6<span>]</span></a></sup><sup id="cite_ref-Melzack1968_6-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Melzack1968-6" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>7<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Pain is the most common reason for physician consultation in the United States.<sup id="cite_ref-Turk_.26_Dennis_2004_7-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Turk_.26_Dennis_2004-7" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>8<span>]</span></a></sup> It is a major symptom in many medical conditions, and can significantly interfere with a person's <a href="http://en.wikipedia.org/wiki/Quality_of_life" title="Quality of life" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">quality of life</a> and general functioning.<sup id="cite_ref-Breivik2008_8-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Breivik2008-8" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>9<span>]</span></a></sup> <a href="http://en.wikipedia.org/wiki/Pain_medicine" title="Pain medicine" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Pain medicine</a> is a subspecialty under such medical specialties as <a href="http://en.wikipedia.org/wiki/Anesthesiology" title="Anesthesiology" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">anesthesiology</a>, <a href="http://en.wikipedia.org/wiki/Physiatry" title="Physiatry" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">physiatry</a>, <a href="http://en.wikipedia.org/wiki/Neurology" title="Neurology" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">neurology</a>, <a href="http://en.wikipedia.org/wiki/Palliative_medicine" title="Palliative medicine" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">palliative medicine</a> and <a href="http://en.wikipedia.org/wiki/Psychiatry" title="Psychiatry" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">psychiatry</a>.<sup id="cite_ref-9" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-9" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>10<span>]</span></a></sup> The study of pain has in recent years attracted many different fields including <a href="http://en.wikipedia.org/wiki/Pharmacology" title="Pharmacology" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">pharmacology</a>, <a href="http://en.wikipedia.org/wiki/Neurobiology" title="Neurobiology" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">neurobiology</a>, <a href="http://en.wikipedia.org/wiki/Nursing" title="Nursing" style="text-decoration: none; color: rgb(90, 54, 150); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">nursing</a>, <a href="http://en.wikipedia.org/wiki/Dentistry" title="Dentistry" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">dentistry</a>, <a href="http://en.wikipedia.org/wiki/Physiotherapy" title="Physiotherapy" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">physiotherapy</a>, and <a href="http://en.wikipedia.org/wiki/Psychology" title="Psychology" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">psychology</a>.</p><table class="infobox" cellspacing="5" style="font-size: 11px; color: black; background-color: rgb(249, 249, 249); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-top-color: rgb(170, 170, 170); border-right-color: rgb(170, 170, 170); border-bottom-color: rgb(170, 170, 170); border-left-color: rgb(170, 170, 170); margin-top: 0.5em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 1em; padding-top: 0.2em; padding-right: 0.2em; padding-bottom: 0.2em; padding-left: 0.2em; float: right; clear: right; width: 22em; text-align: left; line-height: 1.5em; "><caption class="" style="font-size: 14px; font-weight: bold; ">Pain</caption><tbody><tr class=""><th style="vertical-align: top; text-align: left; "><a href="http://en.wikipedia.org/wiki/ICD" title="ICD" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">ICD</a>-<a href="http://en.wikipedia.org/wiki/List_of_ICD-10_codes" title="List of ICD-10 codes" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">10</a></th><td class="" style="vertical-align: top; ">R52</td></tr><tr class=""><th style="vertical-align: top; text-align: left; "><a href="http://en.wikipedia.org/wiki/ICD" title="ICD" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">ICD</a>-<a href="http://en.wikipedia.org/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">9</a></th><td class="" style="vertical-align: top; "><a href="http://www.icd9data.com/getICD9Code.ashx?icd9=338" class="external text" rel="nofollow" style="text-decoration: none; color: rgb(51, 102, 187); background-image: url(http://bits.wikimedia.org/skins-1.5/monobook/external.png); background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; padding-top: 0px; padding-right: 13px; padding-bottom: 0px; padding-left: 0px; background-position: 100% 50%; background-repeat: no-repeat no-repeat; ">338</a></td></tr><tr class=""><th style="vertical-align: top; text-align: left; "><a href="http://en.wikipedia.org/wiki/Diseases_Database" title="Diseases Database" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">DiseasesDB</a></th><td class="" style="vertical-align: top; "><a href="http://www.diseasesdatabase.com/ddb9503.htm" class="external text" rel="nofollow" style="text-decoration: none; color: rgb(51, 102, 187); background-image: url(http://bits.wikimedia.org/skins-1.5/monobook/external.png); background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; padding-top: 0px; padding-right: 13px; padding-bottom: 0px; padding-left: 0px; background-position: 100% 50%; background-repeat: no-repeat no-repeat; ">9503</a></td></tr><tr class=""><th style="vertical-align: top; text-align: left; "><a href="http://en.wikipedia.org/wiki/MedlinePlus" title="MedlinePlus" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">MedlinePlus</a></th><td class="" style="vertical-align: top; "><a href="http://www.nlm.nih.gov/medlineplus/ency/article/002164.htm" class="external text" rel="nofollow" style="text-decoration: none; color: rgb(51, 102, 187); background-image: url(http://bits.wikimedia.org/skins-1.5/monobook/external.png); background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; padding-top: 0px; padding-right: 13px; padding-bottom: 0px; padding-left: 0px; background-position: 100% 50%; background-repeat: no-repeat no-repeat; ">002164</a></td></tr><tr class=""><th style="vertical-align: top; text-align: left; "><a href="http://en.wikipedia.org/wiki/Medical_Subject_Headings" title="Medical Subject Headings" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">MeSH</a></th><td class="" style="vertical-align: top; "><a href="http://www.nlm.nih.gov/cgi/mesh/2009/MB_cgi?field=uid&term=D010146" class="external text" rel="nofollow" style="text-decoration: none; color: rgb(51, 102, 187); background-image: url(http://bits.wikimedia.org/skins-1.5/monobook/external.png); background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; padding-top: 0px; padding-right: 13px; padding-bottom: 0px; padding-left: 0px; background-position: 100% 50%; background-repeat: no-repeat no-repeat; ">D010146</a></td></tr></tbody></table><div style="float: right; clear: right; margin-top: 0.5em; margin-right: 0px; margin-bottom: 0.8em; margin-left: 1.4em; width: 325px; padding-top: 6px; padding-right: 6px; padding-bottom: 6px; padding-left: 6px; border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-top-color: rgb(170, 170, 170); border-right-color: rgb(170, 170, 170); border-bottom-color: rgb(170, 170, 170); border-left-color: rgb(170, 170, 170); font-size: 11px; background-color: rgb(249, 249, 249); "><div style="position: relative; text-align: left; "><div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; "><b>Etymology</b> : "Pain (n.) 1297, "punishment," especially for a crime; also (c.1300) "condition one feels when hurt, opposite of pleasure," from O.Fr. peine, from L. poena "punishment, penalty" (in L.L. also "torment, hardship, suffering"), from Gk. poine "punishment," from PIE *kwei- "to pay, atone, compensate" (...)."</p></div></div><div style="text-align: left; "><a href="http://www.etymonline.com/index.php?search=pain&searchmode=none" class="external text" rel="nofollow" style="text-decoration: none; color: rgb(51, 102, 187); background-image: url(http://bits.wikimedia.org/skins-1.5/monobook/external.png); background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; padding-top: 0px; padding-right: 13px; padding-bottom: 0px; padding-left: 0px; background-position: 100% 50%; background-repeat: no-repeat no-repeat; ">Online Etymology Dictionary</a></div></div><table id="toc" class="toc tochidden" style="font-size: 12px; color: black; background-color: rgb(249, 249, 249); border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-top-color: rgb(170, 170, 170); border-right-color: rgb(170, 170, 170); border-bottom-color: rgb(170, 170, 170); border-left-color: rgb(170, 170, 170); padding-top: 5px; padding-right: 5px; padding-bottom: 5px; padding-left: 5px; margin-top: 0.5em; "><tbody><tr><td><div id="toctitle" style="text-align: center; "><h2 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.6em; margin-left: 0px; padding-top: 0px; padding-bottom: 0px; border-bottom-style: none; font-size: 12px; display: inline; border-top-style: none; border-right-style: none; border-left-style: none; border-width: initial; border-color: initial; padding-right: 0px; padding-left: 0px; border-width: initial; border-color: initial; background-position: initial initial; background-repeat: initial initial; ">Contents</h2> <span class="toctoggle" style="font-size: 11px; ">[<a id="togglelink" class="internal" href="http://en.wikipedia.org/wiki/Pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">show</a>]</span></div></td></tr></tbody></table><h2 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0.6em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(170, 170, 170); font-size: 19px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=1" title="Edit section: Classification" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Classification">Classification</span></h2><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=2" title="Edit section: Duration" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Duration">Duration</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Pain is usually transitory, lasting only until the noxious stimulus is removed or the underlying damage or pathology has healed, but some painful conditions, such as <a href="http://en.wikipedia.org/wiki/Rheumatoid_arthritis" title="Rheumatoid arthritis" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">rheumatoid arthritis</a>, <a href="http://en.wikipedia.org/wiki/Peripheral_neuropathy" title="Peripheral neuropathy" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">peripheral neuropathy</a>, cancer and <a href="http://en.wikipedia.org/wiki/Idiopathic" title="Idiopathic" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">idiopathic</a> pain, may persist for years. Pain that lasts a long time is called <i><a href="http://en.wikipedia.org/wiki/Chronic_pain" title="Chronic pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">chronic</a></i>, and pain that resolves quickly is called <i><a href="http://en.wikipedia.org/wiki/Acute_(medicine)" title="Acute (medicine)" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">acute</a></i>. Traditionally, the distinction between <i>acute</i>and <i>chronic</i> pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the onset of pain,<sup id="cite_ref-Turk.26Okifuji2001_10-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Turk.26Okifuji2001-10" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>11<span>]</span></a></sup> though some theorists and researchers have placed the transition from acute to chronic pain at 12 months.<sup id="cite_ref-11" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-11" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>12<span>]</span></a></sup> Others apply <i>acute</i> to pain that lasts less than 30 days, <i>chronic</i> to pain of more than six months duration, and <i>subacute</i> to pain that lasts from one to six months.<sup id="cite_ref-Thienhaus1_12-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Thienhaus1-12" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>13<span>]</span></a></sup> A popular alternative definition of <i>chronic pain</i>, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."<sup id="cite_ref-Turk.26Okifuji2001_10-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Turk.26Okifuji2001-10" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>11<span>]</span></a></sup> Chronic pain may be divided into "cancer" and "benign".<sup id="cite_ref-Thienhaus1_12-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Thienhaus1-12" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>13<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=3" title="Edit section: Region and system" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Region_and_system">Region and system</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Pain can be classed according to its location in the body, as in headache, low back pain and pelvic pain; or according to the body system involved, i.e., myofascial (emanating from skeletal muscles or the fibrous sheath surrounding them), rheumatic (emanating from the joints and surrounding tissue), causalgic ("burning" pain in the skin of the arms or, sometimes, legs; thought to be the product of peripheral nerve damage), neurologic (caused by damage to or malfunction of any part of the nervous system), or vascular (pain from blood vessels).<sup id="cite_ref-Turk.26Okifuji2001_10-2" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Turk.26Okifuji2001-10" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>11<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=4" title="Edit section: Etiology (cause)" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Etiology_.28cause.29">Etiology (cause)</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">The crudest example of classification by etiology simply distinguishes "somatogenic" pain (arising from a perturbation of the body) from "<a href="http://en.wikipedia.org/wiki/Psychogenic" title="Psychogenic" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">psychogenic</a>" pain (arising from a perturbation of the mind. When a thorough physical exam, imaging, and laboratory tests fail to detect the cause of pain, it is assumed to be the product of psychic conflict or psychopathology).<sup id="cite_ref-Turk.26Okifuji2001_10-3" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Turk.26Okifuji2001-10" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>11<span>]</span></a></sup>Portenoy divided <i>somatogenic</i> pain into "nociceptive" (caused by activation of <a href="http://en.wikipedia.org/wiki/Nociceptors" title="Nociceptors" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">nociceptors</a>) and <a href="http://en.wikipedia.org/wiki/Neuropathic_pain" title="Neuropathic pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">"neuropathic"</a> (caused by damage to or malfunction of the nervous system).<sup id="cite_ref-13" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-13" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>14<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=5" title="Edit section: Nociceptive" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Nociceptive">Nociceptive</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Nociceptive pains may be classified according to the mode of noxious stimulation; the most common categories being "thermal" (heat or cold), "mechanical" (crushing, tearing, etc.) and "chemical" (iodine in a cut, chilli powder in the eyes).</p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Nociceptive pains may also be divided into "superficial" and "deep", and deep pains into "deep <a href="http://en.wikipedia.org/wiki/Somatic" title="Somatic" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">somatic</a>" and "<a href="http://en.wikipedia.org/wiki/Viscus" title="Viscus" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">visceral</a>". <i>Superficial</i> pains are initiated by activation of nociceptors in the skin or superficial tissues, and are sharp, well-defined, clearly localized pains. Examples of injuries that produce superficial pain include minor wounds and minor (first degree) burns. <i>Deep somatic</i> pains are initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, <a href="http://en.wikipedia.org/wiki/Fasciae" title="Fasciae" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">fasciae</a> and muscles, and are dull, aching, poorly-localized pains; examples include<a href="http://en.wikipedia.org/wiki/Sprain" title="Sprain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">sprains</a>, broken bones and <a href="http://en.wikipedia.org/wiki/Myofascial_pain_syndrome" title="Myofascial pain syndrome" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">myofascial pain</a>. <i>Visceral</i> pains originate in the <a href="http://en.wikipedia.org/wiki/Viscus" title="Viscus" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">viscera</a> (organs) and are usually more aching or cramping than somatic pains. Visceral pains may be well-localized, but often they are extremely difficult to locate, and several visceral regions produce "referred" pain when injured, where the sensation is located in an area completely unrelated to the site of injury.<sup id="cite_ref-14" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-14" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>15<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=6" title="Edit section: Neuropathic" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Neuropathic">Neuropathic</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Neuropathic pain is divided into "peripheral" (originating in the <a href="http://en.wikipedia.org/wiki/Peripheral_nervous_system" title="Peripheral nervous system" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">peripheral nervous system</a>) and "central" (originiting in the brain or spinal cord).<sup id="cite_ref-Bogduk1994_15-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Bogduk1994-15" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>16<span>]</span></a></sup> Peripheral neuropathic pain is often described as “burning,” “tingling,” “electrical,” “stabbing,” or “pins and needles.” <sup id="cite_ref-Paice2003_16-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Paice2003-16" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>17<span>]</span></a></sup> Bumping the "funny bone" elicits peripheral neuropathic pain.</p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=7" title="Edit section: IASP Multiaxial classification system" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="IASP_Multiaxial_classification_system">IASP Multiaxial classification system</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">The <a href="http://en.wikipedia.org/wiki/International_Association_for_the_Study_of_Pain" title="International Association for the Study of Pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">International Association for the Study of Pain</a> (IASP) synthesizes much of the above and recommends describing pains according to five categories, or axes: its anatomical location (neck, lower back, etc.), the body system involved (gastrointestinal, nervous, etc.), temporal characteristics (intermittent, constant, etc.), intensity and time since onset, and <a href="http://en.wikipedia.org/wiki/Etiology" title="Etiology" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">etiology</a>(cause).<sup id="cite_ref-17" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-17" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>18<span>]</span></a></sup> This IASP system has been criticized by Woolf and others as inadequate for guiding research and treatment.<sup id="cite_ref-Woolf1998_18-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Woolf1998-18" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>19<span>]</span></a></sup> They propose the development of an additional category based, not on symptoms or underlying conditions, but on the type of neurochemical mechanism generating the pain.<sup id="cite_ref-Turk.26Okifuji2001_10-4" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Turk.26Okifuji2001-10" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>11<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=8" title="Edit section: MPI" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="MPI">MPI</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Using the Multidimensional Pain Inventory (MPI), a questionnare designed to assess the chronic pain patient's <a href="http://en.wikipedia.org/wiki/Psychosocial" title="Psychosocial" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">psychosocial</a> state, Turk and Rudy<sup id="cite_ref-Turk.26Rudy1988_19-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Turk.26Rudy1988-19" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>20<span>]</span></a></sup> found three types of chronic pain patient: "(a) dysfunctional, patients who perceived the severity of their pain to be high, reported that pain interfered with much of their lives, reported a higher degree of psychological distress caused by pain, and reported low levels of activity; (b) interpersonally distressed, patients with a common perception that significant others were not very supportive of their pain problems; and (c) adaptive copers, patients who reported high levels of social support, relatively low levels of pain and perceived interference, and relatively high levels of activity."<sup id="cite_ref-Turk.26Okifuji2001_10-5" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Turk.26Okifuji2001-10" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>11<span>]</span></a></sup> Turk and Okifuji recommend combining MPI characterization of the patient with the IASP multiaxial profile of their pain to arrive at the most useful case description.<sup id="cite_ref-Turk.26Okifuji2001_10-6" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Turk.26Okifuji2001-10" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>11<span>]</span></a></sup></p><h2 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0.6em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(170, 170, 170); font-size: 19px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=9" title="Edit section: In health care" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="In_health_care">In health care</span></h2><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=10" title="Edit section: As an aid to diagnosis" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="As_an_aid_to_diagnosis">As an aid to diagnosis</span></h3><div class="rellink boilerplate seealso" style="font-style: italic; padding-left: 2em; margin-bottom: 0.5em; ">See also: <a href="http://en.wikipedia.org/wiki/Pain_scales" title="Pain scales" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Pain scales</a></div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Pain is a symptom of many medical conditions. Knowing the time of onset, location, intensity, pattern of occurrence (continuous, intermittent, etc.), exacerbating and relieving factors, and quality (burning, sharp, etc.) of the pain will help the examining physician to accurately diagnose the underlying trauma or pathology. For example, chest pain described as extreme heaviness may indicate <a href="http://en.wikipedia.org/wiki/Myocardial_infarction" title="Myocardial infarction" style="text-decoration: none; color: rgb(90, 54, 150); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">myocardial infarction</a>, while chest pain described as tearing may indicate <a href="http://en.wikipedia.org/wiki/Aortic_dissection" title="Aortic dissection" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">aortic dissection</a>.<sup id="cite_ref-20" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-20" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>21<span>]</span></a></sup><sup id="cite_ref-21" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-21" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>22<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Patient report is the most reliable measure of these factors; health professionals tend to underestimate pain.<sup id="cite_ref-Prkachin2007_22-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Prkachin2007-22" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>23<span>]</span></a></sup> A definition of pain widely employed in nursing, emphasizing its subjective nature and the importance of believing patient reports, was introduced by <a href="http://en.wikipedia.org/wiki/Margo_McCaffery" title="Margo McCaffery" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Margo McCaffery</a> in 1968: "Pain is whatever the experiencing person says it is, existing whenever he says it does".<sup id="cite_ref-23" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-23" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>24<span>]</span></a></sup><sup id="cite_ref-24" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-24" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>25<span>]</span></a></sup> To assess intensity, the patient may be asked to locate their pain on a scale of 0 to 10, with 0 being no pain at all, and 10 the worst pain they have ever felt. Quality can be established by having the patient complete the <a href="http://en.wikipedia.org/wiki/McGill_Pain_Questionnaire" title="McGill Pain Questionnaire" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">McGill Pain Questionnaire</a> indicating which words best describe their pain.<sup id="cite_ref-Breivik2008_8-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Breivik2008-8" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>9<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=11" title="Edit section: Assessment in nonverbal patients" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Assessment_in_nonverbal_patients">Assessment in nonverbal patients</span></h3><dl style="margin-top: 0.2em; margin-bottom: 0.5em; "><dd style="line-height: 1.5em; margin-left: 2em; margin-bottom: 0.1em; "><i>See also: <a href="http://en.wikipedia.org/wiki/Pain_and_dementia" title="Pain and dementia" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Pain and dementia</a> and <a href="http://en.wikipedia.org/wiki/Pain_in_babies" title="Pain in babies" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Pain in babies</a></i></dd></dl><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">When a patient is <a href="http://en.wikipedia.org/wiki/Nonverbal_communication" title="Nonverbal communication" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">non-verbal</a> and cannot self report pain, observation becomes critical, and specific behaviors can be monitored as pain indicators. Behaviors such as facial grimacing and guarding indicate pain, as well as an increase or decrease in vocalizations, changes in routine behavior patterns and mental status changes. Patients experiencing pain may exhibit withdrawn <a href="http://en.wikipedia.org/wiki/Social_behavior" title="Social behavior" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">social behavior</a> and possibly experience a <a href="http://en.wikipedia.org/wiki/Anorexia_(symptom)" title="Anorexia (symptom)" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">decreased appetite</a> and decreased nutritional intake. A change in condition that deviates from baseline such as moaning with movement or when manipulating a body part, and limited <a href="http://en.wikipedia.org/wiki/Range_of_motion" title="Range of motion" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">range of motion</a> are also potential pain indicators. In patients that are vocal but incapable of expressing themselves effectively, such as those with a dementia related diagnosis, an increase in confusion or display of aggressive behaviors, including agitation, may signal that discomfort exists, and further assessment is necessary.</p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; "><a href="http://en.wikipedia.org/wiki/Pain_in_babies" title="Pain in babies" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Infants feel pain</a>. Pre-term babies are more sensitive to painful stimuli than full term babies. They lack the verbal skills needed to report pain, so communicate distress by crying. A non-verbal pain assessment should be conducted which should involve the parents, who will notice changes in the infant not obvious to the health care provider.<sup id="cite_ref-Jarvis2004_25-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Jarvis2004-25" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>26<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=12" title="Edit section: Other barriers to reporting" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Other_barriers_to_reporting">Other barriers to reporting</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">An aging adult may not respond to pain in the way that a younger person would. Their ability to recognize pain may be blunted by illness or the use of multiple <a href="http://en.wikipedia.org/wiki/Prescription_drug" title="Prescription drug" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">prescription drugs</a>. Depression may also keep the older adult from reporting they are in pain. The older adult may also quit doing activities they love because it hurts too much. Decline in self-care activities (dressing, grooming, walking, etc.) may also be indicators that the older adult is experiencing pain. The older adult may refrain from reporting pain because they are afraid they will have to have surgery or will be put on a drug they become addicted to. They may not want others to see them as weak, or may feel there is something impolite or shameful in complaining about pain, or they may feel the pain is deserved punishment for past transgressions.<sup id="cite_ref-26" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-26" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>27<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Cultural barriers can also keep a person from telling someone they are in pain. <a href="http://en.wikipedia.org/wiki/Religion" title="Religion" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Religious beliefs</a> may prevent the individual from seeking help. They may feel certain pain treatment is against their religion. They may not report pain because they feel it is a sign that death is near. Many people fear the stigma of addiction and avoid pain treatment so as not to be prescribed addicting drugs. Many Asians do not want to lose respect in society by admitting they are in pain and need help, believing the pain should be borne in silence, while other cultures feel they should report pain right away and get immediate relief.<sup id="cite_ref-Jarvis2004_25-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Jarvis2004-25" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>26<span>]</span></a></sup> Gender can also be a factor in reporting pain. <a href="http://en.wikipedia.org/wiki/Gender_differences" title="Gender differences" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Gender differences</a> are usually the result of social and cultural expectations, with women expected to be emotional and show pain and men stoic, keeping pain to themselves.<sup id="cite_ref-Jarvis2004_25-2" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Jarvis2004-25" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>26<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=13" title="Edit section: Medical treatment and management" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Medical_treatment_and_management">Medical treatment and management</span></h3><div class="rellink relarticle mainarticle" style="font-style: italic; padding-left: 2em; margin-bottom: 0.5em; ">Main article: <a href="http://en.wikipedia.org/wiki/Pain_management" title="Pain management" style="text-decoration: none; color: rgb(90, 54, 150); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Pain management</a></div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Medicine treats injury and pathology to promote healing; and addresses distressing symptoms such as pain to relieve <a href="http://en.wikipedia.org/wiki/Suffering" title="Suffering" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">suffering</a> during treatment and healing. When a painful injury or pathology is resistant to treatment and persists, when pain persists after the injury or pathology has healed, and when medical science cannot identify the cause of pain, the job of the physician is to relieve suffering. Transitory pain is usually managed by one practitioner with drugs such as <a href="http://en.wikipedia.org/wiki/Anesthetics" title="Anesthetics" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">anesthetics</a>, <a href="http://en.wikipedia.org/wiki/Analgesics" title="Analgesics" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">analgesics</a> and (occasionally) <a href="http://en.wikipedia.org/wiki/Anxiolytics" title="Anxiolytics" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">anxiolytics</a>. The effective management of long term pain, however, frequently requires the coordinated efforts of a <a href="http://en.wikipedia.org/wiki/Pain_management" title="Pain management" style="text-decoration: none; color: rgb(90, 54, 150); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">pain management</a> team. The typical pain management team includes a <a href="http://en.wikipedia.org/wiki/Medical_practitioner" title="Medical practitioner" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">medical practitioner</a>, a <a href="http://en.wikipedia.org/wiki/Clinical_psychologist" title="Clinical psychologist" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">clinical psychologist</a>, a <a href="http://en.wikipedia.org/wiki/Physiotherapist" title="Physiotherapist" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">physiotherapist</a>, an <a href="http://en.wikipedia.org/wiki/Occupational_therapist" title="Occupational therapist" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">occupational therapist</a>, and a <a href="http://en.wikipedia.org/wiki/Nurse_practitioner" title="Nurse practitioner" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">nurse practitioner</a>.<sup id="cite_ref-27" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-27" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>28<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Inadequate treatment of pain is widespread throughout surgical wards, intensive care units, accident and emergency departments, in general practice, in the management of all forms of chronic pain including cancer pain, and in end of life care.<sup id="cite_ref-Brown2004_28-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Brown2004-28" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>29<span>]</span></a></sup><sup id="cite_ref-Cullen2001_29-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Cullen2001-29" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>30<span>]</span></a></sup><sup id="cite_ref-Rupp2004_30-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Rupp2004-30" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>31<span>]</span></a></sup><sup id="cite_ref-Smith2007_31-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Smith2007-31" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>32<span>]</span></a></sup><sup id="cite_ref-Jacobson2003_32-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Jacobson2003-32" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>33<span>]</span></a></sup><sup id="cite_ref-Deandrea2008_33-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Deandrea2008-33" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>34<span>]</span></a></sup><sup id="cite_ref-Okuyama2003_34-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Okuyama2003-34" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>35<span>]</span></a></sup><sup id="cite_ref-Perron2001_35-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Perron2001-35" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>36<span>]</span></a></sup> This neglect is extended to all ages, from neonates to the frail elderly.<sup id="cite_ref-Selbest.26Fein2006_36-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Selbest.26Fein2006-36" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>37<span>]</span></a></sup><sup id="cite_ref-Taylor2006_37-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Taylor2006-37" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>38<span>]</span></a></sup><sup id="cite_ref-Cleeland1998_38-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Cleeland1998-38" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>39<span>]</span></a></sup> African and Hispanic Americans are more likely to suffer needlessly in the hands of a physician than whites;<sup id="cite_ref-Bonham2001_39-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Bonham2001-39" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>40<span>]</span></a></sup><sup id="cite_ref-Green2003_40-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Green2003-40" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>41<span>]</span></a></sup> and women's pain is more likely to be undertreated than men's.<sup id="cite_ref-Hoffman2001_41-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Hoffman2001-41" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>42<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Failure to provide adequate pain relief may be due to physicians' fear of being accused of over-prescribing (See the cases of Drs <a href="http://en.wikipedia.org/wiki/William_E._Hurwitz" title="William E. Hurwitz" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">William E. Hurwitz</a> and <a href="http://en.wikipedia.org/wiki/Richard_Paey" title="Richard Paey" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Richard Paey</a>), despite the rarity of such prosecutions; physicians' poor understanding of the risks attached to opioid prescription;<sup id="cite_ref-Burt2007_42-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Burt2007-42" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>43<span>]</span></a></sup> or physicians' adherance to the biomedical model of disease which focuses on<a href="http://en.wikipedia.org/wiki/Pathophysiology" title="Pathophysiology" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">pathophysiology</a> rather than <a href="http://en.wikipedia.org/wiki/Quality_of_life" title="Quality of life" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">quality of life</a>, marginalizing pain management.<sup id="cite_ref-Brennan2007_43-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Brennan2007-43" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>44<span>]</span></a></sup> As a result of two recent cases in California though, where physicians who failed to provide adequate pain relief were successfully sued for elder abuse, the North American medical and health care communities appear to be undergoing a shift in perspective. The California Medical Board publicly reprimanded the physician in the second case; the federal Center for Medicare and Medicaid Services has declared a willingness to charge with fraud health care providers who accept payment for providing adequate pain relief while failing to do so; and clinical practice guidelines and standards are evolving into clear, unambiguous statements on acceptable pain management, so health care providers can no longer avoid culpability by claiming that poor or no pain relief meets community standards<sup id="cite_ref-Burt2007_42-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Burt2007-42" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>43<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=14" title="Edit section: Complementary and alternative medicine" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Complementary_and_alternative_medicine">Complementary and alternative medicine</span></h3><div class="rellink relarticle mainarticle" style="font-style: italic; padding-left: 2em; margin-bottom: 0.5em; ">Main article: <a href="http://en.wikipedia.org/wiki/Alternative_medicine" title="Alternative medicine" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Alternative medicine</a></div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Pain is the most common reason that people use <a href="http://en.wikipedia.org/wiki/Complementary_and_alternative_medicine" title="Complementary and alternative medicine" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">complementary and alternative medicine</a>.<sup id="cite_ref-Astin1998_44-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Astin1998-44" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>45<span>]</span></a></sup><sup id="cite_ref-Eisenberg1993_45-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Eisenberg1993-45" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>46<span>]</span></a></sup> <a href="http://en.wikipedia.org/wiki/Traditional_Chinese_medicine" title="Traditional Chinese medicine" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Traditional Chinese medicine</a> views pain as a 'blocked' <a href="http://en.wikipedia.org/wiki/Qi" title="Qi" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">qi</a>, akin to <a href="http://en.wikipedia.org/wiki/Electrical_resistance" title="Electrical resistance" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">electrical resistance</a>, with treatments such as <a href="http://en.wikipedia.org/wiki/Acupuncture" title="Acupuncture" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">acupuncture</a> claimed as more effective for nontraumatic pain than <a href="http://en.wikipedia.org/wiki/Physical_trauma" title="Physical trauma" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">traumatic</a> pain. Although the mechanism is not fully understood, acupuncture may stimulate the release of large quantities of endogenous <a href="http://en.wikipedia.org/wiki/Opioid" title="Opioid" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">opioids</a>.<sup id="cite_ref-46" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-46" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>47<span>]</span></a></sup> There is interest in the relationship between <a href="http://en.wikipedia.org/wiki/Vitamin_D" title="Vitamin D" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">vitamin D</a> and pain, but the evidence from <a href="http://en.wikipedia.org/wiki/Clinical_trial" title="Clinical trial" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">controlled trials</a> for such a relationship, other than in <a href="http://en.wikipedia.org/wiki/Osteomalacia" title="Osteomalacia" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">osteomalacia</a>, is unconvincing.<sup id="cite_ref-Straube_47-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Straube-47" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>48<span>]</span></a></sup> A 2007 review of 13 studies found evidence for the efficacy of <a href="http://en.wikipedia.org/wiki/Hypnosis" title="Hypnosis" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">hypnosis</a> in the reduction of pain in some conditions, though the number of patients enrolled in the studies was low, bringing up issues of power to detect group differences, and most lacked credible controls for placebo and/or expectation. The authors concluded that "although the findings provide support for the general applicability of hypnosis in the treatment of chronic pain, considerably more research will be needed to fully determine the effects of hypnosis for different chronic-pain conditions." (p. 283)<sup id="cite_ref-Elkins2007_48-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Elkins2007-48" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>49<span>]</span></a></sup> Physical manipulation and exercise are showing interesting results in some pain conditions.<sup id="cite_ref-49" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-49" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>50<span>]</span></a></sup></p><h2 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0.6em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(170, 170, 170); font-size: 19px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=15" title="Edit section: Evolutionary and behavioral role" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Evolutionary_and_behavioral_role">Evolutionary and behavioral role</span></h2><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Pain is part of the body's defense system, producing a <a href="http://en.wikipedia.org/wiki/Nervous_system#Reflexes_and_other_stimulus-response_circuits" title="Nervous system" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">reflexive</a> retraction from the painful stimulus, and tendencies to protect the affected body part while it heals, and avoid that harmful situation in the future.<sup id="cite_ref-Lynn1984_2-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Lynn1984-2" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>3<span>]</span></a></sup><sup id="cite_ref-Bernston2008_50-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Bernston2008-50" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>51<span>]</span></a></sup> It is an important part of animal life, vital to healthy survival. People with <a href="http://en.wikipedia.org/wiki/Congenital_insensitivity_to_pain" title="Congenital insensitivity to pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">congenital insensitivity to pain</a> have reduced <a href="http://en.wikipedia.org/wiki/Life_expectancy" title="Life expectancy" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">life expectancy</a>.<sup id="cite_ref-51" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-51" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>52<span>]</span></a></sup> <a href="http://en.wikipedia.org/wiki/Idiopathic" title="Idiopathic" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Idiopathic</a> pain (pain that persists after the trauma or pathology has healed, or that arises without any apparent cause), may be an exception to the idea that pain is helpful to survival, although John Sarno argues that such pain is <a href="http://en.wikipedia.org/wiki/Psychogenic" title="Psychogenic" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">psychogenic</a>, enlisted as a protective distraction to keep dangerous emotions unconscious.<sup id="cite_ref-Sarno-DividedMind_52-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Sarno-DividedMind-52" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>53<span>]</span></a></sup> It is not clear what the survival benefit of some extreme forms of pain (e.g.<a href="http://en.wikipedia.org/wiki/Toothache" title="Toothache" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">toothache</a>) might be, and the intensity of some forms of pain (for example as a result of injury to <a href="http://en.wikipedia.org/wiki/Fingernails" title="Fingernails" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">fingernails</a> or <a href="http://en.wikipedia.org/wiki/Toenails" title="Toenails" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">toenails</a>) seems to be out of all proportion to any survival benefits.</p><h2 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0.6em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(170, 170, 170); font-size: 19px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=16" title="Edit section: Theory" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Theory">Theory</span></h2><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=17" title="Edit section: Specificity" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Specificity">Specificity</span></h3><div class="thumb tright" style="margin-bottom: 0.8em; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; width: auto; clear: right; float: right; border-width: initial; border-color: initial; border-width: initial; border-color: initial; margin-top: 0.5em; margin-right: 0px; margin-left: 1.4em; background-color: white; "><div class="thumbinner" style="min-width: 100px; border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); padding-top: 3px !important; padding-right: 3px !important; padding-bottom: 3px !important; padding-left: 3px !important; background-color: rgb(249, 249, 249); font-size: 12px; text-align: center; overflow-x: hidden; overflow-y: hidden; width: 222px; "><a href="http://en.wikipedia.org/wiki/File:Descartes-reflex.JPG" class="image" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; "><img alt="" src="http://upload.wikimedia.org/wikipedia/commons/thumb/8/8a/Descartes-reflex.JPG/220px-Descartes-reflex.JPG" width="220" height="233" class="thumbimage" style="border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-width: initial; border-color: initial; vertical-align: middle; border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); background-color: rgb(255, 255, 255); " /></a><div class="thumbcaption" style="border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; text-align: left; line-height: 1.4em; padding-top: 3px !important; padding-right: 3px !important; padding-bottom: 3px !important; padding-left: 3px !important; font-size: 11px; "><div class="magnify" style="float: right; border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial !important; border-color: initial !important; background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: initial !important; background-position: initial initial !important; background-repeat: initial initial !important; "><a href="http://en.wikipedia.org/wiki/File:Descartes-reflex.JPG" class="internal" title="Enlarge" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: initial !important; display: block; border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial !important; border-color: initial !important; background-position: initial initial !important; background-repeat: initial initial !important; "><img src="http://bits.wikimedia.org/skins-1.5/common/images/magnify-clip.png" width="15" height="11" alt="" style="border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial; border-color: initial; vertical-align: middle; display: block; border-width: initial !important; border-color: initial !important; background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: rgb(255, 255, 255); background-position: initial initial !important; background-repeat: initial initial !important; " /></a></div>Descartes' pain pathway.</div></div></div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">In his 1664 <i>Treatise of Man,</i> <a href="http://en.wikipedia.org/wiki/Ren%C3%A9_Descartes" title="René Descartes" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">René Descartes</a> traced a pain pathway. "Particles of heat" (A) activate a spot of skin (B) attached by a fine thread (cc) to a valve in the brain (de) where this activity opens the valve, allowing the <a href="http://en.wikipedia.org/wiki/Balloonist_theory" title="Balloonist theory" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">animal spirits</a> to flow from a <a href="http://en.wikipedia.org/wiki/Ventricular_system" title="Ventricular system" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">cavity</a> (F) into the muscles that then flinch from the stimulus, turn the head and eyes toward the affected body part, and move the hand and turn the body protectively. The underlying premise of this model - that pain is the direct product of a noxious stimulus activating a dedicated pain pathway, from a <a href="http://en.wikipedia.org/wiki/Nociceptor" title="Nociceptor" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">receptor</a> in the skin, along a thread or chain of nerve fibers to the pain center in the brain, to a mechanical behavioral response - remained the dominant perspective on pain until the mid-nineteen sixties.<sup id="cite_ref-MelzackKatz_53-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-MelzackKatz-53" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>54<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=18" title="Edit section: Pattern" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Pattern">Pattern</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; "><i>Specificity theory</i> (dedicated <a href="http://en.wikipedia.org/wiki/Nociceptor" title="Nociceptor" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">pain receptor</a> and pathway) has been challenged by the theory, proposed initially in 1874 by <a href="http://en.wikipedia.org/wiki/Wilhelm_Heinrich_Erb" title="Wilhelm Heinrich Erb" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Wilhelm Erb</a>, that a pain signal can be generated by stimulation of <i>any</i> <a href="http://en.wikipedia.org/wiki/Sensory_receptor" title="Sensory receptor" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">sensory receptor</a>, provided the stimulation is intense enough: the pattern of stimulation (intensity over time and area), not the receptor type, determines whether <a href="http://en.wikipedia.org/wiki/Nociception" title="Nociception" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">nociception</a> occurs. <a href="http://en.wikipedia.org/wiki/Alfred_Goldscheider" title="Alfred Goldscheider" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Alfred Goldscheider</a> (1894) proposed that over time, activity from many sensory fibers might accumulate in the <a href="http://en.wikipedia.org/wiki/Dorsal_horn" title="Dorsal horn" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">dorsal horns</a> of the spinal cord and begin to signal pain once a certain threshold of accumulated stimulation has been crossed. In 1953, Willem Noordenbos observed that a signal carried from the area of injury along large diameter "touch, pressure or vibration" fibers may inhibit the signal carried by the thinner "pain" fibers - the ratio of large fiber signal to thin fiber signal determining pain intensity; hence, we rub a smack. This was taken as a demonstration that pattern of stimulation (of large versus thin fibers in this instance) modulates pain intensity.<sup id="cite_ref-54" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-54" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>55<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=19" title="Edit section: Gate Control" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Gate_Control">Gate Control</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">This all set the scene for Melzack and Wall's classic 1965 <a href="http://en.wikipedia.org/wiki/Science_(journal)" title="Science (journal)" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; "><i>Science</i></a> article "Pain Mechanisms: A New Theory".<sup id="cite_ref-55" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-55" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>56<span>]</span></a></sup> Here the authors proposed that the large diameter ("touch, pressure, vibration") and thin ("pain") fibers meet at two places in the <a href="http://en.wikipedia.org/wiki/Posterior_horn" title="Posterior horn" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">dorsal horn</a> of the spinal cord: the "transmission" (T) cells, and the "inhibitory" cells. Both large fiber signals and thin fiber signals excite the T cells, and when the output of the T cells exceeds a critical level, pain begins. The job of the inhibitory cells is to inhibit activation of the T cells. The T cells are the gate on pain, and inhibitory cells can shut the gate. If your large diameter and thin fibers have been activated by a noxious event, they will be exciting T cells (opening the pain gate). At the same time, the large diameter fibers will be <i>exciting</i> the inhibitory cells (tending to close the gate), while the thin fibers will be <i>impeding</i> the inhibitory cells (tending to leave the gate open). So, the more large fiber activity relative to thin fiber activity, the less pain you will feel. They had conceived a <a href="http://en.wikipedia.org/wiki/Neural_network" title="Neural network" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">neural "circuit diagram"</a> to explain why we rub a smack.<sup id="cite_ref-MelzackKatz_53-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-MelzackKatz-53" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>54<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">The authors then added the most enduring and influential element of their theory: a pain modulating signal coming down from the brain to the <a href="http://en.wikipedia.org/wiki/Dorsal_horn" title="Dorsal horn" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">dorsal horn</a>. They pictured the large fiber signals traveling, not only from the site of injury to the inhibitory and T cells in the dorsal horn, but also up to the brain where, depending on the state of the brain, they may trigger a signal back down to the dorsal horn to further modulate T cell activity and so pain intensity. This model provided a <a href="http://en.wikipedia.org/wiki/Neuroscience" title="Neuroscience" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">neuroscientific</a> rationale for taking seriously the effect of motivation and cognition on pain.<sup id="cite_ref-MelzackKatz_53-2" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-MelzackKatz-53" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>54<span>]</span></a></sup></p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=20" title="Edit section: Dimensions" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Dimensions">Dimensions</span></h3><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">In 1968 Melzack and Casey described pain in terms of its three dimensions: "Sensory-discriminative" (sense of the intensity, location, quality and duration of the pain), "Affective-motivational" (unpleasantness and urge to escape the unpleasantness), and "Cognitive-evaluative" (cognitions such as appraisal, cultural values, distraction and hypnotic suggestion).<sup id="cite_ref-Melzack1968_6-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Melzack1968-6" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>7<span>]</span></a></sup>They theorized that pain intensity (the sensory discriminative dimension) and unpleasantness (the affective-motivational dimension) are not simply determined by the magnitude of the painful stimulus, but “higher” cognitive activities (the cognitive-evaluative dimension) can influence perceived intensity and unpleasantness. Cognitive activities "may affect both sensory and affective experience or they may modify primarily the affective-motivational dimension. Thus, excitement in games or war appears to block both dimensions of pain, while suggestion and placebos may modulate the affective-motivational dimension and leave the sensory-discriminative dimension relatively undisturbed." (p. 432) The paper ended with a call to action: "Pain can be treated not only by trying to cut down the sensory input by anesthetic block, surgical intervention and the like, but also by influencing the motivational-affective and cognitive factors as well." (p. 435)</p><h3 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 17px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=21" title="Edit section: Theory today" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Theory_today">Theory today</span></h3><div class="thumb tright" style="margin-bottom: 0.8em; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; width: auto; clear: right; float: right; border-width: initial; border-color: initial; border-width: initial; border-color: initial; margin-top: 0.5em; margin-right: 0px; margin-left: 1.4em; background-color: white; "><div class="thumbinner" style="min-width: 100px; border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); padding-top: 3px !important; padding-right: 3px !important; padding-bottom: 3px !important; padding-left: 3px !important; background-color: rgb(249, 249, 249); font-size: 12px; text-align: center; overflow-x: hidden; overflow-y: hidden; width: 222px; "><a href="http://en.wikipedia.org/wiki/File:Schematic_of_cortical_areas_involved_with_pain_processing_and_fMRI.jpg" class="image" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; "><img alt="" src="http://upload.wikimedia.org/wikipedia/commons/thumb/5/57/Schematic_of_cortical_areas_involved_with_pain_processing_and_fMRI.jpg/220px-Schematic_of_cortical_areas_involved_with_pain_processing_and_fMRI.jpg" width="220" height="254" class="thumbimage" style="border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-width: initial; border-color: initial; vertical-align: middle; border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); background-color: rgb(255, 255, 255); " /></a><div class="thumbcaption" style="border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; text-align: left; line-height: 1.4em; padding-top: 3px !important; padding-right: 3px !important; padding-bottom: 3px !important; padding-left: 3px !important; font-size: 11px; "><div class="magnify" style="float: right; border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial !important; border-color: initial !important; background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: initial !important; background-position: initial initial !important; background-repeat: initial initial !important; "><a href="http://en.wikipedia.org/wiki/File:Schematic_of_cortical_areas_involved_with_pain_processing_and_fMRI.jpg" class="internal" title="Enlarge" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: initial !important; display: block; border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial !important; border-color: initial !important; background-position: initial initial !important; background-repeat: initial initial !important; "><img src="http://bits.wikimedia.org/skins-1.5/common/images/magnify-clip.png" width="15" height="11" alt="" style="border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial; border-color: initial; vertical-align: middle; display: block; border-width: initial !important; border-color: initial !important; background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: rgb(255, 255, 255); background-position: initial initial !important; background-repeat: initial initial !important; " /></a></div>Regions of the cerebral cortex associated with pain.</div></div></div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Specificity, the theory that pain is transmitted from specific pain receptors along dedicated pain fibers to a pain center in the brain, has withstood the challenge from pattern theory, though the "pain center" in the brain has become an elaborate neural network. Wilhelm Erb's (1874) early pattern theory hypothesis, that a pain signal can be generated by intense enough stimulation of <i>any</i> sensory receptor, has been soundly disproved.<sup id="cite_ref-Coakley_.26_Shelemay_56-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Coakley_.26_Shelemay-56" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>57<span>]</span></a></sup> <a href="http://en.wikipedia.org/wiki/A_delta_fiber" title="A delta fiber" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">A-delta</a> and <a href="http://en.wikipedia.org/wiki/C_fiber" title="C fiber" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">C</a> <a href="http://en.wikipedia.org/wiki/Peripheral_nervous_system" title="Peripheral nervous system" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">peripheral</a> nerve fibers carry information regarding the state of the body to the <a href="http://en.wikipedia.org/wiki/Dorsal_horn" title="Dorsal horn" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">dorsal horn</a> of the spinal cord.<sup id="cite_ref-Craig2003_57-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Craig2003-57" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>58<span>]</span></a></sup> Some of these A-delta and C fibers (<a href="http://en.wikipedia.org/wiki/Nociceptor" title="Nociceptor" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; "><i>nociceptors</i></a>) respond only to painfully intense stimuli, while others do not differentiate noxious from non-noxious stimuli.<sup id="cite_ref-Coakley_.26_Shelemay_56-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Coakley_.26_Shelemay-56" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>57<span>]</span></a></sup> A.D.Craig and colleagues have identified fibers dedicated to carrying A-delta fiber pain signals, and others dedicated to carrying C fiber pain signals up the spinal cord to the <a href="http://en.wikipedia.org/wiki/Thalamus" title="Thalamus" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">thalamus</a> in the brain.<sup id="cite_ref-58" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-58" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>59<span>]</span></a></sup> There is a specific pain pathway from nociceptor to brain. Pain-related activity in the thalamus spreads to the <a href="http://en.wikipedia.org/wiki/Insular_cortex" title="Insular cortex" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">insular cortex</a> (thought to embody, among other things, the feeling that distinguishes pain from other <a href="http://en.wikipedia.org/wiki/Homeostatic_emotion" title="Homeostatic emotion" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">homeostatic emotions</a> such as itch and nausea) and <a href="http://en.wikipedia.org/wiki/Anterior_cingulate_cortex" title="Anterior cingulate cortex" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">anterior cingulate cortex</a> (thought to embody, among other things, the motivational element of pain);<sup id="cite_ref-Craig2003_57-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Craig2003-57" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>58<span>]</span></a></sup>and pain that is distinctly located also activates the <a href="http://en.wikipedia.org/wiki/Primary_somatosensory_cortex" title="Primary somatosensory cortex" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">primary</a> and <a href="http://en.wikipedia.org/wiki/Secondary_somatosensory_cortex" title="Secondary somatosensory cortex" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">secondary</a> somatosensory cortices.<sup id="cite_ref-Romanelli_P.2C_Esposito_V._59-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Romanelli_P.2C_Esposito_V.-59" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>60<span>]</span></a></sup><sup id="cite_ref-Vanderah_TW._60-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Vanderah_TW.-60" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>61<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">The gate control theory has not fared well. Most of the dorsal horn interneurons identified by Melzack and Wall as inhibitory are in fact excitatory,<sup id="cite_ref-Coakley_.26_Shelemay_56-2" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Coakley_.26_Shelemay-56" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>57<span>]</span></a></sup> and Koji Inui and colleagues have recently shown that pain reduction due to non-noxious touch or vibration can result from activity within the cerebral cortex, with minimal contribution at the spinal level.<sup id="cite_ref-61" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-61" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>62<span>]</span></a></sup> Melzack and Casey's 1968 picture of the dimensions of pain is as influential today as ever, firmly framing theory and guiding research in the <a href="http://en.wikipedia.org/wiki/Brain#Functional_subsystems" title="Brain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">functional neuroanatomy</a> and psychology of pain.</p><h2 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0.6em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(170, 170, 170); font-size: 19px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=22" title="Edit section: Special cases" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Special_cases">Special cases</span></h2><h4 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 15px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=23" title="Edit section: Phantom pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Phantom_pain">Phantom pain</span></h4><div class="rellink relarticle mainarticle" style="font-style: italic; padding-left: 2em; margin-bottom: 0.5em; ">Main article: <a href="http://en.wikipedia.org/wiki/Phantom_pain" title="Phantom pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Phantom pain</a></div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; "><a href="http://en.wikipedia.org/wiki/Phantom_pain" title="Phantom pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Phantom pain</a> is the sensation of pain from a limb or organ that has been lost or from which a person no longer receives physical signals. <a href="http://en.wikipedia.org/wiki/Phantom_limb_pain" title="Phantom limb pain" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Phantom limb pain</a> is an experience almost universally reported by <a href="http://en.wikipedia.org/wiki/Amputee" title="Amputee" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">amputees</a> and <a href="http://en.wikipedia.org/wiki/Quadriplegia" title="Quadriplegia" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">quadriplegics</a>. Phantom pain is a type of <a href="http://en.wikipedia.org/wiki/Neuropathic_pain" title="Neuropathic pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">neuropathic pain</a>.</p><h4 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 15px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=24" title="Edit section: Pain asymbolia" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Pain_asymbolia">Pain asymbolia</span></h4><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Pain science acknowledges, in a puzzling challenge to IASP definition,<sup id="cite_ref-IASPterms_1-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-IASPterms-1" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>2<span>]</span></a></sup> that pain may be experienced as a sensation devoid of any unpleasantness: this happens in a syndrome called<a href="http://en.wikipedia.org/wiki/Pain_asymbolia" title="Pain asymbolia" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">pain asymbolia</a> or pain dissociation, caused by conditions like lobotomy, cingulotomy or morphine analgesia. Typically, such patients report that they have pain but are not bothered by it, they recognize the sensation of pain but are mostly or completely immune to suffering from it.<sup id="cite_ref-asymbolia_62-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-asymbolia-62" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>63<span>]</span></a></sup></p><h4 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 15px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=25" title="Edit section: Insensitivity to pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Insensitivity_to_pain">Insensitivity to pain</span></h4><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">The ability to experience pain is essential for protection from injury, and recognition of the presence of injury. Insensitivity to pain may occur in special circumstances, such as for an athlete in the heat of the action, or for an injured soldier happy to leave the battleground. This phenomenon is now explained by the <a href="http://en.wikipedia.org/wiki/Pain#Gate_Control" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">gate control theory</a>. However, insensitivity to pain may also be an acquired impairment following conditions such as <a href="http://en.wikipedia.org/wiki/Spinal_cord_injury" title="Spinal cord injury" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">spinal cord injury</a>, <a href="http://en.wikipedia.org/wiki/Diabetes_mellitus" title="Diabetes mellitus" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">diabetes mellitus</a>, or more rarely Hansen's Disease (<a href="http://en.wikipedia.org/wiki/Leprosy" title="Leprosy" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">leprosy</a>).<sup id="cite_ref-Brand_1997_63-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Brand_1997-63" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>64<span>]</span></a></sup> A few people can also suffer from <a href="http://en.wikipedia.org/wiki/Congenital_insensitivity_to_pain" title="Congenital insensitivity to pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">congenital insensitivity to pain</a>, or congenital analgesia, a rare <a href="http://en.wikipedia.org/wiki/Genetic_disorder" title="Genetic disorder" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">genetic defect</a> that puts these individuals at constant risk from the consequences of unrecognized injury or illness. Children with this condition suffer carelessly repeated damages to their tongue, eyes, bones, skin, muscles. They may attain adulthood, but they have a shortened life expectancy.</p><h4 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: bold; margin-top: 0px; margin-right: 0px; margin-bottom: 0.3em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: initial; border-bottom-style: none; border-bottom-color: initial; font-size: 15px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; font-weight: normal; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=26" title="Edit section: Psychogenic pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Psychogenic_pain">Psychogenic pain</span></h4><div class="rellink relarticle mainarticle" style="font-style: italic; padding-left: 2em; margin-bottom: 0.5em; ">Main article: <a href="http://en.wikipedia.org/wiki/Psychogenic_pain" title="Psychogenic pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Psychogenic pain</a></div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; "><a href="http://en.wikipedia.org/wiki/Psychogenic_pain" title="Psychogenic pain" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Psychogenic pain</a>, also called <i>psychalgia</i> or <i>somatoform pain</i>, is physical pain that is caused, increased, or prolonged by mental, emotional, or behavioral factors.<sup id="cite_ref-cleveland_64-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-cleveland-64" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>65<span>]</span></a></sup><sup id="cite_ref-65" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-65" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>66<span>]</span></a></sup> Psychogenic pain commonly manifests as headache, back pain, or stomach pain.<sup id="cite_ref-cleveland_64-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-cleveland-64" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>65<span>]</span></a></sup> Sufferers are often stigmatized, because both medical professionals and the general public tend to think that pain from a psychological source is not "real". However, specialists consider that it is no less actual or hurtful than pain from other sources.</p><h2 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0.6em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(170, 170, 170); font-size: 19px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=27" title="Edit section: Society and culture" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="Society_and_culture">Society and culture</span></h2><div class="thumb tright" style="margin-bottom: 0.8em; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; width: auto; clear: right; float: right; border-width: initial; border-color: initial; border-width: initial; border-color: initial; margin-top: 0.5em; margin-right: 0px; margin-left: 1.4em; background-color: white; "><div class="thumbinner" style="min-width: 100px; border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); padding-top: 3px !important; padding-right: 3px !important; padding-bottom: 3px !important; padding-left: 3px !important; background-color: rgb(249, 249, 249); font-size: 12px; text-align: center; overflow-x: hidden; overflow-y: hidden; width: 212px; "><a href="http://en.wikipedia.org/wiki/File:Catlin_Okipa.jpg" class="image" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; "><img alt="" src="http://upload.wikimedia.org/wikipedia/commons/thumb/d/de/Catlin_Okipa.jpg/210px-Catlin_Okipa.jpg" width="210" height="150" class="thumbimage" style="border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-width: initial; border-color: initial; vertical-align: middle; border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); background-color: rgb(255, 255, 255); " /></a><div class="thumbcaption" style="border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; text-align: left; line-height: 1.4em; padding-top: 3px !important; padding-right: 3px !important; padding-bottom: 3px !important; padding-left: 3px !important; font-size: 11px; "><div class="magnify" style="float: right; border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial !important; border-color: initial !important; background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: initial !important; background-position: initial initial !important; background-repeat: initial initial !important; "><a href="http://en.wikipedia.org/wiki/File:Catlin_Okipa.jpg" class="internal" title="Enlarge" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: initial !important; display: block; border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial !important; border-color: initial !important; background-position: initial initial !important; background-repeat: initial initial !important; "><img src="http://bits.wikimedia.org/skins-1.5/common/images/magnify-clip.png" width="15" height="11" alt="" style="border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial; border-color: initial; vertical-align: middle; display: block; border-width: initial !important; border-color: initial !important; background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: rgb(255, 255, 255); background-position: initial initial !important; background-repeat: initial initial !important; " /></a></div>The <a href="http://en.wikipedia.org/wiki/Mandan#Religion" title="Mandan" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">okipa</a> ceremony as witnessed by<a href="http://en.wikipedia.org/wiki/George_Catlin" title="George Catlin" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">George Catlin</a>, circa 1835.</div></div></div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Physical pain has been diversely understood or defined from antiquity to modern times.<sup id="cite_ref-66" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-66" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>67<span>]</span></a></sup> <a href="http://en.wikipedia.org/wiki/Pain_(philosophy)" title="Pain (philosophy)" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Philosophy of pain</a> is a branch of <a href="http://en.wikipedia.org/wiki/Philosophy_of_mind" title="Philosophy of mind" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">philosophy of mind</a>that deals essentially with physical pain. <a href="http://en.wikipedia.org/wiki/Type_physicalism" title="Type physicalism" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Identity theorists</a> assert that the mental state of pain is completely identical with some physiological state. <a href="http://en.wikipedia.org/wiki/Functionalism_(philosophy_of_mind)" title="Functionalism (philosophy of mind)" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Functionalists</a> consider pain only with regard to its causal relation to other mental states, sensory inputs, and behavioral outputs. Religious or secular traditions usually define the nature or meaning of physical pain in every society.<sup id="cite_ref-67" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-67" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>68<span>]</span></a></sup> Sometimes, extreme practices are highly regarded:<a href="http://en.wikipedia.org/wiki/Mortification_of_the_flesh" title="Mortification of the flesh" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">mortification of the flesh</a>, painful <a href="http://en.wikipedia.org/wiki/Rites_of_passage" title="Rites of passage" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">rites of passage</a>, walking on hot coals, etc. Variations in pain threshold or in pain tolerance occur between individuals for various reasons including genetics, cultural background, ethnicity and sex.</p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">Physical pain is an important political topic in relation to various issues, including distribution of resources for pain management, <a href="http://en.wikipedia.org/wiki/Drug_control" title="Drug control" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">drug control</a>,<a href="http://en.wikipedia.org/wiki/Animal_rights" title="Animal rights" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">animal rights</a>, <a href="http://en.wikipedia.org/wiki/Torture" title="Torture" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">torture</a>, <a href="http://en.wikipedia.org/wiki/Pain_compliance" title="Pain compliance" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">pain compliance</a> (see also <a href="http://en.wikipedia.org/wiki/Pain_beam" title="Pain beam" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">pain beam</a>, <a href="http://en.wikipedia.org/wiki/Pain_maker" title="Pain maker" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">pain maker</a>, <a href="http://en.wikipedia.org/wiki/Pain_ray" title="Pain ray" class="mw-redirect" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">pain ray</a>). <a href="http://en.wikipedia.org/wiki/Corporal_punishment" title="Corporal punishment" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Corporal punishment</a> is the deliberate infliction of pain intended to punish a person or change his behavior. More generally, it is rather as a part of pain in the broad sense, i.e., <a href="http://en.wikipedia.org/wiki/Suffering" title="Suffering" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">suffering</a>, that physical pain is dealt with in cultural, religious, philosophical, or social issues.</p><h2 style="color: black; background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; font-weight: normal; margin-top: 0px; margin-right: 0px; margin-bottom: 0.6em; margin-left: 0px; padding-top: 0.5em; padding-bottom: 0.17em; border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(170, 170, 170); font-size: 19px; background-position: initial initial; background-repeat: initial initial; "><span class="editsection" style="float: right; margin-left: 5px; font-size: 13px; ">[<a href="http://en.wikipedia.org/w/index.php?title=Pain&action=edit&section=28" title="Edit section: In animals" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">edit</a>]</span><span class="mw-headline" id="In_animals">In animals</span></h2><div class="rellink relarticle mainarticle" style="font-style: italic; padding-left: 2em; margin-bottom: 0.5em; ">Main article: <a href="http://en.wikipedia.org/wiki/Pain_in_animals" title="Pain in animals" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Pain in animals</a></div><div class="thumb tright" style="margin-bottom: 0.8em; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; width: auto; clear: right; float: right; border-width: initial; border-color: initial; border-width: initial; border-color: initial; margin-top: 0.5em; margin-right: 0px; margin-left: 1.4em; background-color: white; "><div class="thumbinner" style="min-width: 100px; border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); padding-top: 3px !important; padding-right: 3px !important; padding-bottom: 3px !important; padding-left: 3px !important; background-color: rgb(249, 249, 249); font-size: 12px; text-align: center; overflow-x: hidden; overflow-y: hidden; width: 222px; "><a href="http://en.wikipedia.org/wiki/File:Jan_Baptist_Weenix_-_Portrait_of_Ren%C3%A9_Descartes.jpg" class="image" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; "><img alt="" src="http://upload.wikimedia.org/wikipedia/commons/thumb/f/f2/Jan_Baptist_Weenix_-_Portrait_of_Ren%C3%A9_Descartes.jpg/220px-Jan_Baptist_Weenix_-_Portrait_of_Ren%C3%A9_Descartes.jpg" width="220" height="251" class="thumbimage" style="border-top-style: solid; border-right-style: solid; border-bottom-style: solid; border-left-style: solid; border-width: initial; border-color: initial; vertical-align: middle; border-top-width: 1px; border-right-width: 1px; border-bottom-width: 1px; border-left-width: 1px; border-top-color: rgb(204, 204, 204); border-right-color: rgb(204, 204, 204); border-bottom-color: rgb(204, 204, 204); border-left-color: rgb(204, 204, 204); background-color: rgb(255, 255, 255); " /></a><div class="thumbcaption" style="border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-width: initial; border-color: initial; text-align: left; line-height: 1.4em; padding-top: 3px !important; padding-right: 3px !important; padding-bottom: 3px !important; padding-left: 3px !important; font-size: 11px; "><div class="magnify" style="float: right; border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial !important; border-color: initial !important; background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: initial !important; background-position: initial initial !important; background-repeat: initial initial !important; "><a href="http://en.wikipedia.org/wiki/File:Jan_Baptist_Weenix_-_Portrait_of_Ren%C3%A9_Descartes.jpg" class="internal" title="Enlarge" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: initial !important; display: block; border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial !important; border-color: initial !important; background-position: initial initial !important; background-repeat: initial initial !important; "><img src="http://bits.wikimedia.org/skins-1.5/common/images/magnify-clip.png" width="15" height="11" alt="" style="border-top-style: none !important; border-right-style: none !important; border-bottom-style: none !important; border-left-style: none !important; border-width: initial; border-color: initial; vertical-align: middle; display: block; border-width: initial !important; border-color: initial !important; background-image: none !important; background-attachment: initial !important; background-origin: initial !important; background-clip: initial !important; background-color: rgb(255, 255, 255); background-position: initial initial !important; background-repeat: initial initial !important; " /></a></div>Portrait of René Descartes by Jan Baptist Weenix 1647-1649</div></div></div><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">The most reliable method for assessing pain in most humans is by asking a question: a person may report pain that cannot be detected by any known physiological measure. However, like infants (Latin <i>infans</i> meaning "unable to speak"), non-human animals cannot answer questions about whether they feel pain; thus the defining criterion for pain in humans cannot be applied to them. Philosophers and scientists have responded to this difficulty in a variety of ways. <a href="http://en.wikipedia.org/wiki/Ren%C3%A9_Descartes" title="René Descartes" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">René Descartes</a> for example argued that animals lack consciousness and therefore do not experience pain and suffering in the way that humans do.<sup id="cite_ref-Carbone149_68-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Carbone149-68" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>69<span>]</span></a></sup><sup id="cite_ref-nuffield45_69-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-nuffield45-69" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>70<span>]</span></a></sup> <a href="http://en.wikipedia.org/wiki/Bernard_Rollin" title="Bernard Rollin" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Bernard Rollin</a> of <a href="http://en.wikipedia.org/wiki/Colorado_State_University" title="Colorado State University" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Colorado State University</a>, the principal author of two U.S. federal laws regulating pain relief for animals,<sup id="cite_ref-70" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-70" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>71<span>]</span></a></sup> writes that researchers remained unsure into the 1980s as to whether animals experience pain, and that veterinarians trained in the U.S. before 1989 were simply taught to ignore animal pain.<sup id="cite_ref-Rollin117_71-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Rollin117-71" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>72<span>]</span></a></sup> In his interactions with scientists and other veterinarians, he was regularly asked to "prove" that animals are conscious, and to provide "scientifically acceptable" grounds for claiming that they feel pain.<sup id="cite_ref-Rollin117_71-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-Rollin117-71" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>72<span>]</span></a></sup> Carbone writes that the view that animals feel pain differently is now a minority view. Academic reviews of the topic are more equivocal, noting that although the argument that animals have at least simple conscious thoughts and feelings has strong support,<sup id="cite_ref-72" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-72" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>73<span>]</span></a></sup> some critics continue to question how reliably animal mental states can be determined.<sup id="cite_ref-nuffield45_69-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-nuffield45-69" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>70<span>]</span></a></sup><sup id="cite_ref-73" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-73" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>74<span>]</span></a></sup> The ability of invertebrate species of animals, such as insects, to feel pain and suffering is also unclear.<sup id="cite_ref-74" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-74" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>75<span>]</span></a></sup><sup id="cite_ref-75" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-75" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>76<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">The presence of pain in an animal cannot be known for certain, but it can be inferred through physical and behavioral reactions.<sup id="cite_ref-76" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-76" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>77<span>]</span></a></sup> Specialists currently believe that all vertebrates can feel pain, and that certain invertebrates, like the octopus, might too.<sup id="cite_ref-77" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-77" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>78<span>]</span></a></sup><sup id="cite_ref-78" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-78" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>79<span>]</span></a></sup> As for other animals, plants, or other entities, their ability to feel physical pain is at present a question beyond scientific reach, since no mechanism is known by which they could have such a feeling. In particular, there are no known nociceptors in groups such as plants, fungi, and most insects,<sup id="cite_ref-79" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-79" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>80<span>]</span></a></sup> except for instance in <a href="http://en.wikipedia.org/wiki/Drosophila_melanogaster" title="Drosophila melanogaster" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">fruit flies</a>.<sup id="cite_ref-80" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-80" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>81<span>]</span></a></sup></p><p style="margin-top: 0.4em; margin-right: 0px; margin-bottom: 0.5em; margin-left: 0px; line-height: 1.5em; ">In vertebrates, endogenous <a href="http://en.wikipedia.org/wiki/Opioid" title="Opioid" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">opioids</a> are neurochemicals that moderate pain by interacting with opiate receptors. Opioids and opiate receptors occur naturally in crustaceans and, although at present no certain conclusion can be drawn,<sup id="cite_ref-S.C3.B8mme_81-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-S.C3.B8mme-81" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>82<span>]</span></a></sup> their presence indicates that lobsters may be able to experience pain.<sup id="cite_ref-S.C3.B8mme_81-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-S.C3.B8mme-81" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>82<span>]</span></a></sup><sup id="cite_ref-afa_82-0" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-afa-82" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>83<span>]</span></a></sup> Opioids may mediate their pain in the same way as in vertebrates.<sup id="cite_ref-afa_82-1" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-afa-82" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>83<span>]</span></a></sup> <a href="http://en.wikipedia.org/wiki/Veterinary_medicine" title="Veterinary medicine" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; background-position: initial initial; background-repeat: initial initial; ">Veterinary medicine</a> uses, for actual or potential animal pain, the same analgesics and anesthetics as used in humans.<sup id="cite_ref-83" class="reference" style="line-height: 1em; font-weight: normal; font-style: normal; "><a href="http://en.wikipedia.org/wiki/Pain#cite_note-83" style="text-decoration: none; color: rgb(0, 43, 184); background-image: none; background-attachment: initial; background-origin: initial; background-clip: initial; background-color: initial; white-space: nowrap; background-position: initial initial; background-repeat: initial initial; "><span>[</span>84<span>]</span></a></sup></p></div></span>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-49822725251796303572010-04-22T07:33:00.000-07:002010-04-22T07:56:00.237-07:00PAIN MANAGEMENT<span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size:medium;"><br />The main causes of pain include medical conditions (such as cancer, arthritis and back problems), injuries and surgery. Sometimes, the cause of the pain can't be found or there are no available treatments for it. In other cases, the cause may be remedied, but the associated pain lingers on. Chronic pain is defined as pain that persists for longer than three months. At any given time, around one third of Australians are in pain. Management strategies include pain-killing medications, and complementary therapies (such as acupuncture and massage). Studies suggest that a person's outlook and the way they emotionally cope with chronic pain influence their quality of life. It has been shown that people who learn self-management skills lower their levels of felt pain. It is important to learn these skills, and to deal with the associated stress and depression in constructive ways.<br /><br /><b>The epidemiology of pain</b><br />A Brisbane study in 1986 found that certain groups are more likely to suffer chronic pain than others. The findings of this study were similar to research findings from other countries. Selected statistics include:<br /><br />The incidence of pain rises with advancing age.<br />Women are more likely to be in pain than men.<br />The most commonly reported pain is back pain.<br />The most severe pains include those of the back, head, neck and leg.<br />The pain is constant for around one fifth of people.<br />The cause is unknown in around one third of cases.<br />One fifth of cases were caused by work-related accidents.<br />Most people surveyed had suffered chronic pain for longer than three years.<br />Seven out of 10 people sought professional help.<br />The most common source of professional help was the family doctor (80 per cent).<br />Pain-killing medications<br />The type of medication you are prescribed depends on your pain. The issues you need to discuss with your health care professional include: the location, intensity and type of pain; which activities ease or exacerbate it; the impact your pain has on lifestyle factors, such as appetite and quality of sleep. Medications for chronic pain are best taken regularly. If your pain is well managed, you are less likely to take large doses of painkillers, and the risk of side effects is reduced.<br /><br /><b>The medications available for the management of chronic pain include:</b></span></span><div><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size:medium;"><b><br /></b>Aspirin and aspirin-like drugs<br />Paracetamol<br />Opioid drugs, such as codeine and morphine<br />Local anaesthetics.<br />Long term use of some medications can have side effects which affect a person's quality of life. They may also lose their ability to reduce pain. Some studies have shown that medication can undermine the value of developing self-management skills. This occurs because the person believes they are coping better with pain due to the medication, not because they may have learnt effective coping skills.<br /><br /><b>Complementary therapies</b><br />Numerous studies have found that certain complementary therapies are effective in pain management. Some of these therapies include:<br />Acupuncture - a component of traditional Chinese medicine. Acupuncture involves the insertion of slender needles into specific points on the skin.<br />Massage - better suited to soft tissue injuries and should be avoided if the pain originates in the joints.<br />Relaxation techniques - including meditation and yoga.<br />Transcutaneous electrical nerve stimulation (TENS) therapy - a minute electrical current is passed through the skin via electrodes, prompting a pain-killing response from the body.<br />Cognitive-behavioural therapy - this is a process of learning to change how you think and, in turn, how you feel and behave about pain. It is part of a process of self-management of chronic pain.<br />Coming to terms with chronic pain<br />Sometimes, chronic pain cannot be relieved. Suggestions on how to emotionally handle this difficult and distressing situation include the following:<br />If all medical avenues have been exhausted, don't raise false hopes by searching fruitlessly for a cure.<br />Accept that your pain may not go away and that flare-ups may occur. Talk yourself through these times.<br />Find out as much as you can about your condition so that you don't fret or worry unnecessarily about the pain. Fear makes cowards of us all!<br />Take steps to prevent or ease depression by any means that work for you, including talking to friends or professionals.<br />If painkillers can't ease the pain, don't increase the dose - take fewer or none at all, in consultation with your doctor.<br />Improve your physical fitness, eat healthy foods and ensure you get all the rest you need.<br />Don't allow the pain to curtail your life more than necessary - if you miss activities you used to do before the pain, try reintroducing those activities in a gently paced way. You may need to cut back on these activities if pain flare-ups occur, but it will be possible to increase slowly again as you did before.<br />Concentrate your efforts on finding fun and rewarding activities that don't exacerbate your pain.</span></span></div><div><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size:medium;"><br /><b>Seek advice on new coping strategies and skills from an occupational therapist.<br />Where to get help</b><br />Your doctor<br />Occupational therapist.<br />Things to remember<br />At any given time, around one third of Australians are in pain.<br />Management strategies for chronic pain include pain-killing medications, and complementary therapies (such as acupuncture and massage).<br />Studies suggest that a person's quality of life is influenced by their outlook, and by the way they emotionally cope with chronic pain.</span></span></div><div><span class="Apple-style-span" style="font-family:'trebuchet ms';"><span class="Apple-style-span" style="font-size:medium;"><br /><b>Seek advice on new coping strategies and skills from an occupational therapist.<br />You might also be interested in:</b><br />Acupuncture.<br />Cancer pain management.<br />Fibromyalgia.<br />Headache - treatment options.<br />Headache and medications.<br />Massage.<br />Pain-killing drugs.<br />Physiotherapy.</span></span></div>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-30197212515175932562010-04-22T04:19:00.000-07:002010-04-22T05:15:18.914-07:00Perawat Indonesia ( job Opportunities) Part 2Pemerintah INDONESIA sangat kurang tanggap dalam menangani permasalahan kesehatan, harusnya pemerintah sadar bahwa kesehatan adalah faktor yang paling penting dalam suatu negara. Hal yang paling penting yang mesti kita kembangkan dalam sektor kesehatan adalah pembangunan fasilitas kesehatang yang harus di tambah dengan prasarana yang berkualitas dan menjangkau daerah-daerah terpencil sehingga masyarakat bisa menikmati kesehatan dengan sempurna. Tentunya dengan bertambahnya fasilitas dan sarana itu bisa mengurangi angka pengangguran khususnya untuk perawat indonesia. <br /><br />Jumlah fasilitas kesehatan di Indonesia jelas tidak sebanding dengan jumlah penduduk indonesia yang mana saat ini kurang lebih "more less" 250 million bisa di bayangkan itu harusnya satu Rumah sakit wajib mengcover at least one suburb "satu area" misalnya jakarta punya banyak area seperti jakarta selatan, jakarta barat, dsb mungkin Jakarta kota besar jumlah fasilitas bisa memadai tapi lihat daerah lain seperti padang, Medan dll fasilitas kesehatan masih kurang memadai faktor inilah yang telah membuat perawat - perawat daerah pindah ke kota besar dengan alasan pekerjaan tapi kalau jumlah fasilitas kesehatan itu tersedia di daerah mereka meningkatnya urbanisasi itu jelas akan berkurang dan juga faktor kepadatan penduduk di kota besar seperti di Jakarta bisa di kurangi.<br />Recently, a number of nurses unemployed in Indonesia that is because of those factors<br />as I said before, <br />lack of health facilities in small area leading to increase of urbanisation to the CityDristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-30082821675663144532010-04-21T04:57:00.000-07:002010-04-22T04:42:37.968-07:00Perawat Indonesia (job opportunities) Part 1Perkembangan keperawatan di Indonesia saat saat ini terus melaju pesat seiring dengan zaman. Ribuan perawat indonesia lulus dari sekolah atau universitas setiap tahunnya tapi setelah mereka lulus ada yang kerja dengan langsung, gak berkerja atau bekerja sebagai TKS ( Tenaga Sukarelawan )dengan imbalan gaji yang jauh dari standard kebetuhan hidup. Sejauh mata memandang belum ada wadah yang mengikat untuk membantu menyalurkan perawat Indonesia untuk ketahap jenjang yang lebih, ada beberapa agent atau instansi yang menampung untuk menyalurkan itu juga balum mampu meng cover perawat indonesia yang belum berkerja yang saat ini mungkin mereka lagi mencari perkerjaan. Pemerintah pun belum mampu mengatasi permasalahan ini sebaliknya pemerintah terus membuka universitas - universitas baru yang tujuan untuk merekrut tenaga baru tanpa memperhatikan sisi negatifnya yang dampak itu akan meningkatnya angka pengangguran khususnya buat perawat itu sendiri.<br />phenomaena di lapangan yang kita lihat sekarang adalah kurangnya sarana dan prasarana dalam bidang kesehatan yang juga salah satu faktor penyebab angka pengganguran untuk perawat semakin meningkat setiap tahunnya, ini di sebabkan oleh jumlah sarana tidak sebanding dengan jumlah pekerja. Contoh di Jakarta jumlah RS masih bisa di hitung dengan jari tangan sedangkan lulusan perawat setiap tahunnya berkembang.<br />Pemerintah harusnya sadar bahwa tenaga kesehatan sebenarnya sangat di utamakan di dalam satu negara, contoh Australia baru saja punya program baru yang mana 60% dana pemerintah akan di alokasikan ke bidang kesehatan 6 billion dollar, can you imagine that?.Australia mengharapkan dalam waktu sebentar semua Australian bisa menikmati pelayanan kesehatan dengan gratis dan memuaskan juga peralatan kesehatan semuanya akan di up to date...to be continued......Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-82118281278279537482010-04-20T23:58:00.000-07:002010-04-21T00:00:26.959-07:00Indonesia Diminta Kirim Perawat ke JepangIndonesia Diminta Kirim Perawat ke Jepang<br />JAKARTA -- Kinerja perawat asal Indonesia di sejumlah lembaga kesehatan dan panti jompo di Jepang ternyata memikat pemerintah Negeri Sakura. Selama ini, pemerintah Jepang memberikan perhatian pada program pengiriman perawat asing ke negaranya, termasuk dari Indonesia. Karena itu, mereka meminta agar Indonesia kembali mengirimkan tenaga perawat lagi ke Jepang. <br /><br />"Permintaan itu disampaikan dalam pertemuan Menlu RI-Jepang yang antara lain membahas mengenai masalah ini," Ujar Konjen RI Osaka, Ibnu Hadi dalam keterangan resminya di Jakarta, Rabu 31 Maret. <br /><br />Ibnu mengatakan, kebutuhan Jepang akan perawat asing semakin besar, mengingat semakin meningkatnya jumlah penduduk Jepang yang berusia lanjut. Oleh karena itu, Pemerintah Jepang saat ini sedang mencari solusi mengenai ujian nasional keperawatan yang bagi para calon perawat asing terbukti sulit. <br /><br />Dia juga mengapresiasi hasil ujian nasional keperawatan pemerintah Jepang Februari lalu yang berhasil meloloskan dua perawat Indonesia dari wilayah Prefektur Nigata. Hal ini membuktikan bahwa perawat asal Indonesia, yang baru belajar bahasa Jepang sekitar 1,5 tahun, mampu menaklukan ujian lisensi keperawatan yang oleh orang Jepang sendiri dianggap sangat sulit. <br /><br />"Karena itu saya berharap agar perawat yang lain terus berusaha sehingga dapat mengikuti jejak rekan-rekan terdahulu yang berhasil lulus. Ujian lisensi keperawatan Jepang berikutnya akan dilaksanakan bulan Februari 2011," paparnya. <br /><br />Dalam beberapa kesempatan KBRI sendiri juga mengadakan sesi dialog, para perawat dan caregivers agar saling berbagi cerita mengenai pengalaman mereka. Dari masalah kontrak kerja dengan Rumah Sakit di Jakarta dan di Jepang, hak dan kewajiban mereka, waktu belajar untuk mengikuti ujian nasional, hingga proses adaptasi selama di Jepang. <br /><br />Menurut Ibnu, mereka yang hadir mengakui bahwa forum seperti ini telah memberikan kesempatan bagi mereka untuk berbagi optimisme sekaligus berbagi trik-trik cara belajar baik bahasa Jepang maupun substansi. <br /><br />Pengiriman tenaga perawat dan caregivers Indonesia ke Jepang dilaksanakan berdasarkan program Indonesia-Japan Economic Partnership Agreement (IJEPA). Dalam periode 2008-2009 telah didatangkan total 570 tenaga. "Kami harap kesempatan ini ditangkap oleh para perawat di tanah air dan segera diproses oleh pemerintah yang berwenang di Tanah Air," pungkasnya. (jpnn)Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-33754968864905048222010-04-20T23:56:00.000-07:002010-04-20T23:57:16.579-07:00Kedubes AS Sediakan Berbagai Visa Kerja Kamis<span style="font-weight:bold;">Kedubes AS Sediakan Berbagai Visa Kerja<br />Kamis, 15 April 2010 - 09:04 wib<blockquote></blockquote></span><br />TEXT SIZE : <br />Fajar Nugraha - Okezone<br /><br />Ilustrasi: Ist<br />JAKARTA - Pada presentasi mengenai permohonan visa bagi warga Indonesia di Kedutaan Besar Amerika Serikat (AS) di Jakarta, pihak Konsulat Jenderal AS menyatakan pihaknya menyediakan beberapa jenis visa kerja. Namun sayangnya visa kerja tersebut tidak seluruhnya tersedia bagi beberapa profesi.<br /><br />Wakil Konjen AS Robert Hawkins menyatakan jika pihaknya banyak mengeluarkan visa kerja. Namun untuk saat ini visa tersebut banyak sekali dikeluarkan untuk pelaut. Crew Visa Program (CVP) atau C1D dikeluarkan khusus untuk para pelaut Indonesia. Visa ini diajukan oleh agen-agen perkapalan yang memperkerjakan pelaut Indonesia, khususnya untuk kapal pesiar.<br /><br />Pihak Konjen AS paling tidak memberikan visa khusus untuk pelaut ini setiap tahunnya sekira 250 ribu visa. Selain itu ada juga visa H1 yang digunakan untuk pekerjaan spesial, seperti perawat. Sayangnya jarang sekali rumah sakit di Amerika menerima perawat Indonesia, hal ini disebabkan tidak lebih dari kendala bahasa. Demikian diberitakan kepada dihadapan para wartawan di Jakarta, Rabu (14/4/2010).<br /><br />AS sendiri tidak memiliki kesepakatan dengan Pemerintah Indonesia mengenai pengiriman tenaga kerja layaknya seperti Arab Saudi ataupun negara-negara lain menerima TKI. Kondisi keluarga di Amerika yang lebih bersifat kecil menjadi alasan mengapa TKI tidak dibutuhkan di negeri Paman Sam itu. <br /><br />Satu lagi jenis visa kerja yang tidak begitu dikenal oleh warga Indonesia, yakni Business Visa Program (BVP). BVP merupakan sebuah program di mana memungkinkan anggota-anggota yang terdaftar dalam program ini beserta suami/istri dan anaknya dapat datang untuk mengajukan permohonan visa tanpa perjanjian sebelumnya.<br /><br />Program ini juga dapat diajukan oleh perusahaan yang hendak mengirimkan karyawannya ke Amerika Serikat. Caranya pun mudah, hanya meminta pihak personalia dari pihak perusahaan mengajukan aplikasi langsung kepada pihak Kedubes AS tanpa membuat janji. Pelayanan ini dapat dilakukan setiap hari Rabu minggu pertama dan ketiga dalam tiap bulan, pada pukul 07.00 hingga 09.00 WIB.<br /><br />Proses pengajuan BVP ini juga berlangsung sama dengan visa seperti umumnya. Pelayanan atas BVP dapat diselesaikan selama dua hingga tiga hari, dan berlaku untuk semua pemohon visa selama lima tahunDristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-62381025245191053242010-04-17T05:37:00.000-07:002010-04-17T05:49:59.634-07:00CELLULITISCellulitis<br />From Wikipedia, the free encyclopedia<br />Not to be confused with cellulite.<br />Cellulitis<br />Classification and external resources<br /><br />Infected left shin<br />ICD-10 L03.<br />ICD-9 682.9<br />DiseasesDB 29806<br />eMedicine med/310 emerg/88 derm/464<br />MeSH D002481<br />Cellulitis is a diffuse inflammation[1] of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burns, insect bites, surgical wounds, or sites of intravenous catheter insertion. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body. The mainstay of therapy remains treatment with appropriate antibiotics.<br />Erysipelas is the term used for a more superficial infection of the dermis and upper subcutaneous layer that presents clinically with a well defined edge. Erysipelas and cellulitis often coexist, so it is often difficult to make a distinction between the two.<br />Cellulitis is unrelated (except etymologically) to cellulite, a cosmetic condition featuring dimpling of the skin.Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-16419113600707273012010-04-16T20:22:00.000-07:002010-04-16T20:27:54.091-07:00NURSING IN INDONESIAUniversitas Indonesia<br /><br />Motto veritas, probitas, iustitia<br />Established 1851 (as School for Javanese Doctor)<br />Type State University<br />Rector Prof. Der Soz Gumilar Rusliwa Somantri<br />Staff 4,814(Full-time Staff for Academic Staff on 2007/2008 Fiscal Year)<br />Students 41,555 students (2008/2009)(40% are graduate students)<br />Location Depok, West Java, Indonesia<br />Central Jakarta, Jakarta, Indonesia<br />Campus Both urban and rural<br />(Total Area 3,552,713 m²)<br />With 3 areas: Depok, Salemba, Pegangsaan Timur<br />Affiliations AUN, ASAIHL, APRU, ASEA UNINET[1], FUIW[2], SEAMEO, AUAP[3]<br />Website www.ui.ac.id<br />The earliest form of the logo of University of Indonesia was created in 1952 by Sumaxtono (born as Sumartono), a student from 1951 Art Department Class, Faculty of Engineering, which was at the time known as the Fakulteit Teknik Universiteit Indonesia, located in Bandung.<br /><br /><br />Makara UI Description.<br />The basic idea underlining the logo is the kala-makara, a symbol of the two sources of energy in nature. Kala is the energy from above (the power of the sun), while makara represents the energy from below (the power of the Earth) . The two powers are combined and stylized into a symbol that represents the function of the University of Indonesia as a source of knowledge and the works resulting from it which are disseminated wide and far.<br />The logo of the University of Indonesia carries the following interpretation: The tree, which includes the buds and the branches, represents science and its branches, implying as well that the buds will soon flourish and turn into new branches of science. The buds will continue to blossom as long as the main tree is alive. By this, Sumaxtono intended to state that branches of sciences will continuously grow according to the need and development of civilization.<br />Water pouring down from the makara signifies the works of science which are disseminated wide and far. Sumaxtono hereby implied that the University of Indonesia is a source of knowledge which produces intelligent graduates who are highly skilled and pious, have high morals and an open attitude, are responsive to the changes and advancement of science and technology, and are empathetic to the problems faced by the society. They are also the people who have the capacity to solve problems occurring wherever they are, following the academic principles.<br />The logo design and the meaning it carried were presented to Srihadi (a student from the 1952 class from the same department) in 1952. Prof. KRHT H. Srihadi Soedarsono Adhikoesoemo, M.A. who also created the logo of Bandung Technology Institute, was not sure who authenticated this logo or when. He was sure, however, that this logo was printed on the cover of the book titled Universiteit Indonesia, Fakulteit Teknik, Bandung: Rentjana Untuk Tahun Peladjaran 1952-1953 (University of Indonesia, Faculty of Engineering, Bandung: Course Plans for Academic Years 1952-1953), published by AID, Bandung, 120 pages, using the original design by Sumaxtono (without the pentagonal border).<br />[edit]History<br /><br /><br /><br />STOVIA medical school complex during the 1920s, the complex consists of buildings now known as the Faculty of Medicine of University of Indonesia (top) and Cipto Mangunkusumo Hospital (center).<br />The roots of the University of Indonesia (UI) date back to 1851. At that time, the colonial government of the Dutch East Indies decided to establish a school to train medical assistants. Such training lasted for two years, and the graduates were certified to provide simple and basic medical treatments. The degree conferred was Javanese Doctor, as the graduates were certified only to open their practice in the Dutch East Indies, especially Java. The program became more comprehensive, and by 1864 it was expanded to three years. By 1875, the program of study had reached 7 years in length and the graduates were entitled to the degree of Medical Doctor. The next step came in 1898, when the Dutch East Indies government established a completely new school to train medical doctors, named STOVIA (School tot Opleiding van Inlandsche Artsen). The prerequisite to enter STOVIA was roughly the equivalent of a junior high school diploma, but the school's education took 9 years, so it was a mix between high school and university education. Many STOVIA graduates later played important roles in Indonesia's national movement toward independence, as well in developing medical education in Indonesia.<br />In 1924, the colonial government again decided to open a new tertiary-level educational facility, the RHS (Rechts Hogeschool), to train civilian officers and servants. The RHS would later evolve into the Faculty of Law. In 1927, STOVIA's status was changed to that of a full tertiary-level institution and its name was changed to GHS (Geneeskundige Hogeschool). The GHS occupied the same main building and use the same teaching hospital as the current Faculty of Medicine. Many GHS alumni would later play roles in establishing the University of Indonesia.<br />After Indonesia gained independence, the Indonesian Institute for Higher Education (BPTRI) was established in Jakarta consisting of three faculties, namely Medicine and Pharmacy, Letters and Law. The institute produced its first 90 graduate students as medical doctors in the same year. When the Dutch colonial army occupied Jakarta in late 1945, the BPTRI moved to Klaten, Surakarta, Yogyakarta, Surabaya and Malang. In 1946, the Dutch colonial government established the Nood Universiteit or Emergency University at Jakarta. In 1947, the name was changed to Universiteit van Indonesie (UVI) or the University of Indonesia. Following the Indonesian National Revolution, the government established a state university in Jakarta in February 1950. The name was Universiteit Indonesia, comprising the BPTRI units and the former UVI, which was later changed into the University of Indonesia (UI).<br />By 1950, UI was a multi-campus university, with faculties in Jakarta (Medicine, Law, and Letters), Bogor (Agronomy and Veterinary Medicine), Bandung (Engineering, Mathematics and Natural Sciences), Surabaya (Medicine and Dentistry), and Makassar (Economics). The Surabaya campus became the University of Airlangga in 1954, and in the following year, the Makassar campus became the University of Hasanuddin. In 1959, the Bandung campus became the Bandung Institute of Technology. The School for Physical Education, which was also located in Bandung, became part of Padjadjaran University in 1960. In 1964, the Bogor campus became the Bogor Agricultural Institute and the Faculty of Education in Jakarta became the State University of Jakarta. By 1965, UI consisted of three campuses, all in Jakarta, namely the Salemba campus (Medicine, Dentistry, Economics, Engineering, Science and the Graduate School), the Rawamangun campus (Letters, Law, Social Science and Psychology) and the Pegangsaan campus (Public Health and parts of Medicine)<br />In 1987, several faculties from Salemba campus and Rawamangun campus moved to a newly built campus in the outskirts of Jakarta. The campus in southern Jakarta is known as the Depok campus, since it is situated in the city of Depok.Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0tag:blogger.com,1999:blog-6377598436955768767.post-22501686855418437672010-04-16T19:03:00.000-07:002010-04-22T07:31:07.631-07:00CCFwelcome to my blog<br />Heart failure (HF) is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs.[1] The phrase is often incorrectly used to describe other cardiac-related illnesses, such as myocardial infarction (heart attack) or cardiac arrest.<br />Common causes of heart failure include myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease and cardiomyopathy.[2] Heart failure can cause a large variety of symptoms such as shortness of breath (typically worse when lying flat, which is called orthopnea), coughing, ankle swelling and exercise intolerance. Heart failure is often undiagnosed due to a lack of a universally agreed definition and challenges in definitive diagnosis. Treatment commonly consists of lifestyle measures (such as decreased salt intake) and medications, and sometimes devices or even surgery.<br />Heart failure is a common, costly, disabling and deadly condition.[2] In developing countries, around 2% of adults suffer from heart failure, but in those over the age of 65, this increases to 6–10%.[2][3] Mostly due to costs of hospitalization, it is associated with a high health expenditure; costs have been estimated to amount to 2% of the total budget of the National Health Service in the United Kingdom, and more than $35 billion in the United States.[4][5] Heart failure is associated with significantly reduced physical and mental health, resulting in a markedly decreased quality of life.[6][7] With the exception of heart failure caused by reversible conditions, the condition usually worsens with time. Although some patients survive many years, progressive disease is associated with an overall annual mortality rate of 10%.[8]Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com1tag:blogger.com,1999:blog-6377598436955768767.post-20622521194064768402010-04-16T18:12:00.000-07:002010-04-16T20:26:11.522-07:00Welcome to My Nursing Blog<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqUVVKJ3OwBKiAd0_DQpzJbutriEICIskq6atIG74S846oKTDZeCjQCpux1t0XnJnHzNarMGWl8x4za10Go__stkcnCsIvRAKRD2FkkorrK0RH-3_UXo8WH_wzOKPLeI3HsIL6rk15hokX/s1600/modip.jpg"><img style="float:left; margin:0 10px 10px 0;cursor:pointer; cursor:hand;width: 258px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqUVVKJ3OwBKiAd0_DQpzJbutriEICIskq6atIG74S846oKTDZeCjQCpux1t0XnJnHzNarMGWl8x4za10Go__stkcnCsIvRAKRD2FkkorrK0RH-3_UXo8WH_wzOKPLeI3HsIL6rk15hokX/s320/modip.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5460908790902791618" /></a><br />Hallo Welcome to my Blog,<div>this is the first time i put my note on my blog so if you wanna go further to find out who i am just please leave your message on my blog ok</div><div><br /></div><div><br /></div>Dristanhttp://www.blogger.com/profile/15540819712177049710noreply@blogger.com0