Pain Management
Considered the fifth vital sign, pain is defined as the sensory and emotional experience associated with actual or potential tissue damage. It includes not only the perception of an uncomfortable stimulus, but also the response to that perception.
The patient’s self-report of pain is the most reliable indicator of the existence of pain. When a patient feels severe pain, he seeks medical help because he believes the pain signals a serious problem. This perception produces anxiety, which, in turn, increases the pain. To assess and manage pain properly, the nurse must
depend on both the patient’s subjective description and objective tools.
depend on both the patient’s subjective description and objective tools.
According to The Joint Commission, health care facilities are required to develop policies and procedures supporting the appropriate use of analgesics and other pain control therapies.1
Pain should be assessed at admission and reassessed at regular intervals. Pain assessment should include personal, cultural, spiritual, and ethnic beliefs. Patients and families should be educated about their role in pain management and informed about potential limitations and adverse effects of pain treatment.
Interventions used to manage pain include analgesics, emotional support, comfort measures, and complementary and alternative therapies such as cognitive techniques to distract the patient. Patients with severe pain typically require treatment with an opioid analgesic; such patients may also need invasive measures, such as epidural analgesia or patient-controlled analgesia (PCA).
Equipment
Pain assessment tool or scale ▪ oral hygiene supplies ▪ water ▪ non-opioid analgesic (such as aspirin or acetaminophen) ▪ Optional: PCA device; mild opioid (such as oxycodone or codeine); strong opioid (such as morphine or hydromorphone).
Implementation
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
Explain to the patient how pain medications work together with other pain management therapies to provide relief. Also explain that management aims to keep pain at a low level to permit optimal bodily function.6
Assess the patient’s pain by using a pain assessment tool or scale or by asking key questions and noting his response to the pain.1 For instance, ask him to describe its duration, severity, and location. Look for physiologic or behavioral clues to the pain’s severity.7 (See How to assess pain.)
Develop nursing diagnoses. Appropriate nursing diagnostic categories include acute or chronic pain, anxiety, activity intolerance, fear, risk for injury, deficient knowledge, and powerlessness.
Work with the patient to develop a nursing care plan using interventions appropriate to the patient’s lifestyle. These may include prescribed medications, emotional support, comfort measures, complementary and alternative therapies such as cognitive techniques, and education about pain and its management. Emphasize the importance of maintaining good bowel habits, respiratory functions, and mobility because pain may exacerbate any problems in these areas.
Implement your care plan. Because individuals respond to pain differently, you’ll find that what works for one person may not work for another.
Giving Medications
If the patient is allowed oral intake, begin with a nonopioid analgesic, such as acetaminophen or aspirin, every 4 to 6 hours as ordered.8
If the patient needs more relief than a nonopioid analgesic provides, you may give a mild opioid (such as oxycodone or codeine) as ordered.8
If the patient needs still more pain relief, you may administer a strong opioid (such as morphine or hydromorphone) as prescribed. Administer oral medications if possible.8 Check the appropriate drug information for each medication given.
If ordered, teach the patient how to use a PCA device. Such a device can help the patient manage his pain and decrease his anxiety. (See “Patient-controlled analgesia,” page 557.)
Assess pain 30 minutes after parenteral medication administration; assess pain 60 minutes after oral medication administration. If the patient is still in pain, reassess him and alter your care plan as appropriate.9
How to Assess Pain
To assess pain properly, you’ll need to consider the patient’s description and your observations of the patient’s physical and behavioral responses. Start by asking this series of key questions (bearing in mind that the patient’s responses will be shaped by his prior experiences, self-image, and beliefs about his condition):
Where’s the pain located? How long does it last? How often does it occur?
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