One frequent causative factor in acute pain is trauma. A traumatic event can be work or leisure-related. It can be as minor as an abrasion as the result of a fall, or it can affect multiple systems, such as trauma from a major auto accident. Severity of pain is not necessarily correlated to the type or severity of the traumatic event. Superficial injuries that occur as the result of trauma are frequently associated with severe pain because of the large number of nociceptors present in superficial tissues. First- and second-degree burns are far more painful for the client than a more severe and destructive third-degree burn, because the third-degree burn or full-thickness injury destroys many of the nociceptors that would send pain messages to the central nervous system. Visceral pain can also result from trauma, including trauma as the result of violence. Somatic pain is frequently reported, such as in a fracture or a sprain. Somatic pain is often associated with sports and physical activity.

Medical reasons for acute pain in adults most commonly include cardiac and gastric disorders. In these instances, pain acts as a signal that there is impending or actual damage to the system. Pain related to a medical condition ranges from minor to severe, with no correlation to severity of disease or damage. It is very important for the healthcare provider to remember that pain is a subjective entity. One client may be incapacitated by pain related to gastrointestinal flu because the pain is perceived as severe, while a different client may continue to function in normal everyday activities through an acute inflammation of the appendix resulting in rupture. Although people often relate cancer to pain, pain is not commonly an early warning sign of cancer; rather, it is more commonly a later symptom of advanced disease.

Pregnancy and childbirth are responsible for acute pain, but this will not be addressed further in this chapter. Hormonal changes in females can be correlated with acute episodes of pain, including menstrual pain as well as midcycle pain associated with ovulation.

Multiple examples of acute pain exist in the adult population. Headaches are common in this client population. Headaches may be related to tension, hormonal shifts, and migraine. Sinus inflammation or seasonal allergies are implicated in episodes of acute headache. Headache pain is also described in certain individuals with a history of multiple or cluster headaches as acute episodes of a chronic condition. Dental pain is another acute complaint in this group. It may precede or be the result of dental procedures.

The healthcare provider has the opportunity to care for the adult client with acute pain in a wide variety of settings. Clients experiencing surgical pain are seen in inpatient and outpatient facilities, including ambulatory surgical clinics, private offices, and dental offices. Those with medical conditions are seen over the same wide variety of care settings. Long-term care facilities provide services for these clients as well. Most commonly, the adult client with acute pain is ambulatory and at least partly involved in self-care, taking active efforts toward pain relief. Healthcare access is sought when pain becomes a barrier to activities of daily living (ADLs). It is important to plan care and institute management with the input of each individual client, including him or her in providing for pain relief.

Mild to moderate pain may be relieved with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or other anti-inflammatory agents such as salicylates. These medications in common dosages can be administered on an as-needed (PRN) or around-the-clock basis. Using medication on an as-needed protocol sometimes results in increased severity of pain and reduction in relief, because the medication is not used frequently enough or is not used until the pain becomes quite severe. Complications or factors that may make pain worse, such as anxiety or muscular tension, may increase when there are long intervals between doses of medication used on a PRN basis, reducing the effectiveness of simple relief measures. Acute pain of more than a transitory nature may be relieved more effectively by using a NSAID on a regular dosage schedule, rather than waiting to re-experience pain before taking more medication.

Acute pain that is not adequately relieved by these medications on a scheduled dosage protocol, or acute pain that is expected to be more severe, such as post surgical pain, can be treated with the addition of a narcotic or opioid. Choice of narcotic will include information about severity of pain, as well as client history of medication use and allergies. Codeine or oxycodone are common choices for less severe pain; morphine or meperidine (Demerol) may be used for pain that is more severe or not well relieved by codeine or a codeine derivative. Routes of administration for narcotics are also considered. Oral medication is appropriate for the client who is able to tolerate food or fluids. Intravenous medication is useful when the client must be maintained NPO (nothing by mouth), cannot tolerate oral food or fluids, or if extremely rapid relief is vital. Intravenous medications are cleared from the body much more rapidly than other routes, so administration must be more frequent to maintain adequate pain relief. Intramuscular, subcutaneous, or rectal routes are other alternatives. Transcutaneous administration is less commonly used for clients with acute pain. In clients who can tolerate oral medication, the addition of an NSAID to the narcotic regimen
will increase efficacy. Oral preparations of codeine and oxycodone are manufactured in a form already in combination with acetaminophen (e.g., Tylenol #2, Tylenol #3, or Tylenol #4, and Percocet). One drawback of these combination tablets is that doses can only be titrated as high as the ceiling dose for acetaminophen. If further amounts of narcotic are necessary, plain codeine or oxycodone should be used. Overdoses of acetaminophen can result in liver damage.

Routes of administration may directly affect self-administration in the adult client. Ease of administration, as well as the client’s ability to accept the route, are important to consider when planning care. Self-injection or relying on a family member to administer injections may be unacceptable. Many clients object to rectal administration as well, and family members often consider it undignified or embarrassing to administer rectal medications (e.g., suppositories). Timed-release oral medications, which restrict dosing to two or three times per day, decrease client burden and increase client adherence with multiple-dose schedules. Ascertaining that the client is comfortable with, understands, and is able to accomplish administration via a prescribed route is essential to client acceptance of a pain management plan.