1. Principles of Assessment What happens if the pain is not relieved?
Mount Auburn Hospital
“The Nurses Role in Improving Pain Management”
Julie O’Donnell, RN, BSN, BC
Definition of Pain
Principles of Assessment
What happens if the pain is not relieved?
Activites that Enhance Pain Management
"Pain is what the person says it is and exists whenever he or she says it does." (McCaffery, 1968)
Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, as described in terms of such damage". (The International Association for the Study of Pain)
Accept self report
Use the same pain scale over time
Assess when pain is both reported or suspected
Re-assess routinely
Consider the individual, the patient’s culture, values and beliefs
Neuropathic pain is a complex, chronic pain state that usually is accompanied by tissue injury.
With neuropathic pain, the nerve fibers themselves may be damaged, dysfunctional or injured.
Symptoms may include:
Shooting and burning pain
Tingling and numbness
Somatic pain:
-Somatic pain may feel like a throbbing pain
Examples: a cut to the finger, a stretching of a muscle
-Visceral pain is diffuse, poorly localized, and often referred. It is often described as generalized aching or squeezing.
Examples: organ pain
Consequence of unrelieved pain is future pain. Failure to unrelieved pain may lead to future chronic pain syndromes
Myths about pain:
-”Good” patients don’t report pain
- Pain is punishment
-Addiction is common
-Strong pain medicine should be saved for later
-The health care provider will know if I am in pain
-No pain, no gain
-Pain is normal part of aging
-Pain perception decreases with age
-If the vital signs are good the patient isn’t in pain
-If the patient is asleep they are free of pain
Effective treatments for neuropathic/chronic pain
Currently there is no proven treatment to prevent or cure neuropathic pain (neuropathy or never pain).
The primary goals of treatment are to reduce the pain as much as possible, balance the negative side effects of the treatment, and help patients manage any unresolved pain.
Interdisciplinary approach
Pain clinics
Show respect for other cultures
Promote a feeling of acceptance
Avoid stereotyping
Understand individuals goals and expectations
Use appropriate assessment tools
Call an interpreter if we need to or use the interpreter phone
All patients have a right to effective pain management.
Understanding the influences culture has on patients' pain experiences and attitudes regarding treatments will permit nurses to achieve better pain outcomes for all of them.
Use the nursing process
Gather pertinent objective and subjective data
Accept self report
Develop individual plans of care
Reassessment is key in order to evaluate and revise the plan
References:
Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: Relieving Pain in America, Prevention, Care, Education and Research. The National Academies Press, 2011.
Spanwick CC (editors) (2000). Pain management: an interdisciplinary approach. Churchill Livingstone, Edinburgh.