1 How does Borderline Personality Disorder Factor into Pharmacological Pain Management on an Inpatient Unit? Student Names Shoreline Community College NURS 221: Nursing Practice & Complex Heath Disturbances Emily Howerter MN, RN, CNE & Anna Sterner MN, RN, CNE February 22nd, 2022 1 2 Sansone, R. A., Sansone, L. A., & Tragesser, S. L. (2013). The Difficult Chronic Pain Patient: A Case of Borderline Personality Disorder? Primary Care Reports, 19(7), 93-104. https://ezproxy.shoreline.edu/login?url=https://search.ebscohost.com/login.aspx?direct=tr ue&db=c8h&AN=104186758&site=ehost-live [Put your search terms here] This article is a meta-analysis of multiple research experiments investigating pain tolerance in patients with BPD. One strength is it includes clinical implications to be considered by physicians when prescribing pain treatments, but also by nurses when caring for BPD/pain patients. While the article was written in 2013, a weakness is that much of the research analyzed is from mid 1990s due to lack of research done on this topic, especially on the outcomes of pain management techniques that the article presents. The data shows that while patients with BPD have higher tolerance to pain that is acute and self-inflicted, pain is simultaneously reported at higher intensities when it’s chronic and endogenous, which explains our case study patient’s intense requests for pain medication. It also shows that pain is reported at higher rates in the BPD population than in patients without BPD. The clinical implications of this include accurate assessment and diagnosis of BPD by the provider, and honest communication between nurse and patient regarding the fact that while pain will be reduced using medications, it may not be completely eliminated. Other implications include using non-pharmacological measures alongside medications such as physical therapy, lifestyle changes, etc. It also emphasized consideration of the prevalence of opiate misuse among the BPD population when administering narcotics. Finally, the patient’s pain may be improved with access to therapy such as dialectic behavioral therapy. The higher tolerance of acute pain also 2 3 places the patient at a higher risk for self-harm, which we observed in our case study patient, Susan. You, D. S., & Meagher, M. W. (2017). Association Between Borderline Personality Features and Temporal Summation of Second Pain: A Cross-Sectional Study. Behavioral Medicine, 43(3), 208–217. https://doi-org.ezproxy.shoreline.edu/10.1080/08964289.2017.1322935 [Put your search terms here] This article is about evidence-based research that explains the association between pain thresholds and patients with borderline personality disorder. After conducting studies, it was proved that people with BPD personality features have increased pain intensity than those without. While this article has strengths of identifying evidence-based practice on this claim, it has its limitations in such that these trials were performed on Texas A&M University college students with no real diagnosed symptoms of BPD. BPD is a type of personality disorder that causes dysregulations in personality such as affect and mood, identity problems, negative relationships, and self-harming/impulsivity. These factors greatly contribute to a person’s hypersensitivity of pain. From a nursing perspective, this gives nurses a more empathetic understanding about the kind of pain patients with BPD go through. It allows us to see that there is a biophysical element in their brain that makes the experience of acute pain different, which not only explains aggression or intense requests for pain management, but also differentiates pain experiences from other patients which serve as reasons for nurses to intervene in an effective manner to avoid behavioral outbursts. The targeted audience for this article is for healthcare professionals or students 3 4 treating patients with BPD and increased pain levels. In relation to Susan, her negative relationships with hospital staff, history of self-harm, and identity problems with being called Joseph instead of Susan all contribute to her diagnosis of BPD and with the dysregulation of her emotions from BPD, this triggers her intense levels of pain. 4
