withdrawal from pain

ida2

Senior Member
Persian - Iran
Hello,

What does “withdrawal from pain” mean in the context below?

If the physician intends only to palliate suffering, there is no warrant for increasing the dose of opioids or sedatives when the patient is comfortable. If patients are unconscious, physicians and nurses must assess whether patients are comfortable. Reasonable criteria for increasing the dose include restlessness, grimacing, withdrawal from pain, furrowed brow, hypertension, and tachycardia.

Source: Resolving Ethical Dilemmas: A Guide for Clinicians by Bernard Lo
 
  • manfy

    Senior Member
    German - Austria
    I think it means that if a body part reacts to intentionally inflicted pain, it is a sign that this person is not sufficiently sedated.
    Even though the person is unconscious, the body still reacts to stimuli if it hasn't been numbed with sedatives or pain killers. So the doctor might pinch you at some spots of your body and if that body part withdraws or reacts to that pain, he ups your opium dose.

    I'm not a doctor, so no guarantees! This is just a common sense assumption based on the context you provided.
     

    manfy

    Senior Member
    German - Austria
    I see you're not convinced by my answer. Fair enough!
    After re-reading and rethinking it, I still stand by it.
    Your sentence is talking about diagnostic methods/symptoms to assess whether an unconscious patient is in pain. Granted, the pinch test (i.e. infliction of external pain) does not show whether the patient is in pain, but it shows whether the person can feel pain. And if this person has any injuries, logic dictates that even the unconscious body will feel that pain. A higher dose of painkillers won't actually remove the pain but it will numb the senses enough so that the patient won't feel a thing.
     

    velisarius

    Senior Member
    British English (Sussex)
    Manfy's suggestion makes sense to me, in context. If the patient is unconscious, (s)he might seem to be comfortable, but isn't in a position to directly communicate any discomfort or pain (s)he's experiencing.
     

    Hermione Golightly

    Senior Member
    British English
    I agree with manfy. Being unconscious doesn't mean being painfree. Ways of knowing if the patient is in pain are listed. One of those is reacting to pain deliberately inflicted by moving away from the source. So a pinch on the arm would result in the patient moving the arm. I don't know how true this is.
     

    manfy

    Senior Member
    German - Austria
    So a pinch on the arm would result in the patient moving the arm. I don't know how true this is.
    :thumbsup:
    I suppose an unconscious person wouldn't be able to withdraw the arm the same way a conscious person would because that takes too many coordinated muscle movements. But some muscles certainly would react to the pain stimulus - it's an involuntary reflex and that's why it works with unconscious patients too.
    I trust that trained medical professionals will know where to pinch and what reaction to look for.
    The description of the symptom "withdrawal from pain" as a result of the diagnostic pinch test makes sense to me. (The term 'pinch test' is my own word creation, though. Probably they have a more professional-sounding fancy Latin word for it. :) )
     
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