Pain Management Health Article

Preparation

Prior to beginning management, pain is thoroughly evaluated. Pain scales or questionnaires are used to attach an objective measure to a subjective experience. Objective measurements allow health care workers to better understand the pain being suffered by the patient. Evaluation also includes physical examinations and diagnostic tests to determine underlying causes. Some evaluations require assessments from several viewpoints, including neurology, psychiatry and psychology, and physical therapy. If pain is due to a medical procedure, management consists of anticipating the type and intensity of associated pain and managing it preemptively.

Nurses or physicians often take what is called a pain history. This will help to provide important information that can help health care providers to better manage the patient's pain. A typical pain history includes the following questions:

• Where is the pain located?
• On a scale of 1 to 10, with 1 indicating the least pain, how would the person rate the pain being experienced?
• What does the pain feel like?
• When did (or does) the pain start?
• How long has the person had it?
• Is the person sometimes free of pain?
• Does the person know of anything that triggers the pain, or makes it worse?
• Does the person have other symptoms (nausea, dizziness, blurred vision, etc.) during or after the pain?
• What pain medications or other measures has the person found to help in easing the pain?
• How does the pain affect the person's ability to carry on normal activities?
• What does it mean to the person that he or she is experiencing pain?

Aftercare

An assessment by nursing staff as well as other health care providers should be made to determine the effectiveness of the pain management interventions employed. There are objective, measurable signs and symptoms of pain that can be looked for. The goal of good pain management is the absence of these signs. Signs of acute pain include:

• rise in pulse and blood pressure
• more rapid breathing
• perspiring profusely, clammy skin
• taut muscles
• more tense appearance, fast speech, very alert
• unusually pale skin
• dilated pupils of the eye

Signs of chronic pain include:

• lower pulse and blood pressure
• changeable breathing pattern
• warm, dry skin
• nausea and vomiting
• slow speech in monotone
• inability, or difficulty in getting out of bed and doing activities
• constricted pupils of the eye

When these signs are absent and the patient appears to be comfortable, health care providers can consider their interventions to have been successful. It is also important to document interventions used, and which ones were successful.

Risks

Owing to toxicity over the long term, some drugs can only be used for acute pain or as adjuncts in chronic pain management. NSAIDs have the well-known side effect of causing gastrointestinal bleeding, and long-term use of acetaminophen has been linked to kidney and liver damage. Other drugs, especially narcotics, have serious side effects such as constipation, drowsiness, and nausea. Serious side effects can also accompany pharmacological therapies; mood swings, confusion, bone thinning, cataract formation, increased blood pressure, and other problems may discourage or prevent use of some analgesics.

Non-pharmacological therapies carry little or no risks. However, it is advised that individuals recovering from serious illness or injury consult with the health care providers or physical therapists before making use of adjunct therapies. Invasive procedures carry risks similar to other surgical procedures, such as infection, reaction to anesthesia, and iatrogenic (injury as a result of treatment) injury.

A traditional concern about narcotics use has been the risk of promoting addiction. As narcotic use continues over time, the body becomes accustomed to the drug and adjusts normal functions to accommodate to its presence. Therefore, to elicit the same level of action, it is necessary to increase dosage over time. As dosage increases, an individual may become physically dependent on narcotic drugs.

However, physical dependence is different from psychological addiction. Physical dependence is characterized by discomfort if drug administration suddenly stops, while psychological addiction is characterized by an overpowering craving for the drug for reasons other than pain relief. Psychological addiction is a very real and necessary concern in some instances, but it should not interfere with a genuine need for narcotic pain relief. However, caution must be taken with people who have a history of addictive behavior.

Normal results

Effective application of pain management techniques reduces or eliminates acute or chronic pain. This treatment can improve an individual's quality of life and aid in recovery from injury and disease.

BOOKS

Kozier, Barbara, Glenora Erb, Kathleen Blais, and Judith M. Wilkinson. Fundamentals of Nursing, Concepts, Process and Practice, 5th edition. Redwood City, CA: Addison-Wesley, 1995.

Salerno, Evelyn, and Joyce S. Willens, eds. Pain Management Handbook: An Interdisciplinary Approach. St. Louis: Mosby, 1996.