Pain Management
Introduction
● Under recognized
● Misunderstood
● Inadequately tested
● Subjective
● No two people experience pain in the same way
Knowledge, Attitudes and Beliefs
● Be respectful
● Look over their pain history
● Do not degrade their experience
○ “Frequent flier”
Assumptions about patient pain
● Limits the ability to offer pain relief
● Accept the patients report of pain
● View experience through the patient's eyes
Factors Influencing Pain
● Physiological
○ Age
○ Fatigue
■ Can cause increase in perception of pain
■ Can decrease the coping abilities
○ Genes
■ Genetic info passed from parents can affect a person's sensitivity to pain
○ Neurological function
■ Neuropathy/neurosurgery can reduce the ability to feel the pain
■ Diabetes (feet), less
● Social
○ Previous experience
■ Pain = pain
■ Having previous episodes of pain without proper treatment can result in
fear and anxiety
○ Family and social network
■ Dependent upon others to help
○ Spiritual factors
■ Affect the way the patient views and copes with pain
● Psychological
○ Attention
■ Increased attention is associated with increased pain
■ Distraction is associated with a diminished pain response
●
● Massage
● Guided imagery
○ Anxiety and fear
■ Increased perception of pain
○ Coping style
■ Influences the ability to deal with the pain
Cultural factors
○ Meaning of pain
■ Part of life, deal with it > lack of treatment
○ Ethnicity
Critical thinking
● Attitudes and standards
● Creative planning
● Obtain acceptable outcomes
○ Pros and cons of different treatments
Nursing Process
● Assessment
○ COLDSPA
■ Characteristics
■ Onset
■ Location
■ Duration
■ Severity
■ Pattern
■ Associated factors
○ PQRSTU (box 44.5 in textbook)
■ Palliative/provoking
● What makes your pain worse/better?
■ Quality
● Describe your pain for me.
■ Relief measures/Region
● What do you take at home to gain pain relief?
● What helps your pain go away?
● Show me where you are hurting
■ Severity
● On a scale of 0 to 10, how bad is your pain right now?
● What is the worst pain you have had in the past 24 hours?
● What is the average pain you have had in the past 24 hours?
■ Timing
● Do you have pain all the time, only at certain times, or only on
certain days?
■ Unable to do
●
● What are you not able to do because of your pain?
● Who do you live with? How do they help you when you have pain?
○ ABCDE (box 44.6 in textbook)
■ Ask/assess pain regularly/systematically
■ Believe patient and family in their report of pain and what relieves it
■ Choose pain control options that are appropriate for patient, family, and
setting
■ Deliver interventions in a timely, logical, and coordinated fashion
■ Empower patient and their family
○ Pain scale
■ Numerical scale
● 0 to 10
■ Verbal descriptive scale
■ Visual analog scale
■ Wong-Baker faces pain scale
● Pediatric patients
● Non English speakers
○ Physical Examination
■ Pain can influence on activities of daily living (ADL)
● Need help showering, dressing, etc
○ Concomitant symptoms
■ Increases pain severity
○ Related Diagnoses
■ Difficulty coping
■ Fatigue
■ Impaired mobility
■ Impaired sleep
■ Social isolation
Implementation
○ Health promotion
■ Different types of pain relief measures
■ Use measures patient believes are appropriate
■ Open mind
■ Keep trying
■ May not be totally eliminated, but substantial improvement is realistic
○ Maintain wellness
○ Non Pharmacological pain relief
■ Distraction
■ Music
■ Relaxation and guided imagery
■ Herbals
■ Cutaneous stimulation
■ Cognitive and behavioral approach
■ Reducing pain perception and reception
○
Acute Care (hospital setting)
■ Pharmacological pain therapies
● Analgesics
○ Nonopioids
■ Tylenol
■ Advil
○ Opioids
■ Percocet
■ Morphin
■ Hydromorphone
■ Too much can cause decreased vital signs
○ Adjuvants/co-analgesics
■ Not designed for pain relief, but have some aspect
pain relief
● Patient controlled analgesia
● Topical and transdermal analgesics
● Local anesthesia
● Perineural local anesthetic infusion
● Epidural analgesia
Safety Guidelines for Nursing Skills
● Patient is the only person who should press the button to administer the pain medication
when PCA is used
● Monitor the patient for signs and symptoms of oversedation and respiratory depression
● Monitor for potential side effects of opioid analgesics