What Is Pain ?

Pain is an unpleasant sensory and emotional experienceassociated with actual or potential tissue damage, ordescribed in terms such as damage.

*International Association for the Study of Pain

Adult Pain Management • Older adults often have chronic and acute pain at the same time.• May use “ache” or “sore” instead of pain.

• Feel pain as intensely as younger adults.• May take a variety of drugs that could interact with pain management.• Desire to be a “good” patient and hesitate to report pain.

• Under report because they have learned to live with pain.

Developmental Differences in Pain Expressions

Infants:• Exhibit body rigidity or thrashing, may include arc• Exhibit facial expression of pain (brows lowered altogether, eyes tightly closed, mouth open and squared)• Cry intensely/loud• Be inconsolable• Draw knees to chest• Exhibit hypersensitivity or irritability• Have poor oral intake• Be unable to sleep

Expressions of Pain

Toddlers:• Be verbally aggressive, cry intensely• Exhibit regressive behavior or withdraw• Exhibit physical resistance by pushing painful stimuli away after applied• Guard painful area of body• Be unable to sleep

Expressions of Pain

Pre-School/Young Children:

• Verbalize intensity of pain• Exhibit thrashing of arms and legs• See pain as punishment• Be uncooperative• Cling to parents, nurse, or significant other• Request emotional support ( hugs, kisses)

Expressions of Pain

Adolescents:• Localize and verbalize pain• Deny pain in presence of peers• Have changes in sleep patterns or appetite• Be influenced by cultural beliefs• Display regressive behavior in presence of family• Exhibit muscle tension and body control• Be unable to sleep

Be aware of your patient’s attitudes about pain management

Remember each patient is different. It’s important to know if a patient is:

• Afraid

Do you fear that pain medicine will cause addiction ?

Do you worry about possible side effects of medication than the pain itself ?

Integrated ApproachTotal Pain Components• Somatic (anatomical/physiological) Source• Socioeconomic/cultural Factors: ask your patient• Emotional/Spiritual Factors: ask your patient• Meaning of pain to patient: ask your patient

Effective Pain Management• Must affect all components of Pain• Traditional Medical Treatment• Complementary Therapies

• Improve function• Decrease medication use • Decrease fear of treatment• Improve morale and compliance • Enhance medication’s analgesic effects

Complementary Therapies

Success FactorsAffects all components of Pain Congruent w/ the patient’s beliefs Not medically contraindicated (i.e.heat/tumors)

ExamplesTENS, electrical stimulationPsychotherapy, counselingBiofeedback TherapyPhysical TherapyMusic TherapyMassageExercise Imagery

Be aware of patient’s attitude about managing pain

• Misinformed

Ask your patient:

Do you believe that pain medicine

doesn’t really control pain ?

Do you think it is important to save your

medication in case your pain gets worse ?

Be aware of your patients attitudes about

pain management

Trying to be “strong”. Find out which patients feel:• A “good” pt. should not talk about his or her

pain• Enduring pain builds character• Pain is simply part of life

Your Role in Pain Management

The Impact of Pain

• Under treatment of pain is common in all types of settings.

• Many healthcare providers & consumers used to think that pain was just accepted & unavoidable part of healthcare.

• Pain wasn’t viewed as harmful or hazardous, just a nuisance.

Impact of Pain

• Pain can dramatically affect the patient’s physical & psychological health.

• Pain causes enormous stress for the pt.’s entire family.

• The economic costs of pain are tremendous.

It is estimated that $100 billion are spent each year in health care & lost work time related to pain.

Undertreatment of Pain

• Inadequate pain treatment is a serious issue.

• The University Hospitals meet or exceed the JCAHO standards designed to improve pain management in

accredited facilities.

Pain Management Standards

• Patients have the right to appropriate assessment• Patients will be treated for pain or referred for treatment• Pain is to be assessed and regularly reassessed• Patients will be taught the importance of effective pain management and their specific role in pain management• Patients will be taught that pain management is a part of treatment• Patients will be involved in making care decisions• Routine and p.r.n. analgesics are to be administered as needed

Untreated Pain

• Patients whose pain is not well controlled tend to have a higher risk of complications, such as pneumonia & blood clots.

• Unrelieved pain may prevent the patient from carrying out normal daily activities & can result in fatigue, depression & anger.

Common responses of patients to pain may worsen the problem of under-treatment

Many patients do not express their pain , for a variety of reasons:

• The belief that pain is an expected part of their condition, or the aging process (it is not).• Fear of becoming “addicted”to drugs.• The belief that they will “bother” the staff or be thought of as a complainer.• Fear that pain means they will soon die or become disabled.• Dementia or confusion may prevent a patient from being able to communicate clearly.

Pain can be treated with a combination of medication & other therapies.

• Gentle massage - around the affected area or on another body part.

• Warm or cold applications - including ice packs, warm soaks or baths

• Positioning - help the pt. to find a more comfortable position, padded with pillows or extra blankets.

• Distractions - TV,cards or music.

Pain Medications

Non-Narcotic Analgesics Aspirin , Tylenol , NSAIDS:• Can be highly effective but reaches limits on maximum effects (“ceiling effect”)• Can be given concurrently with narcotics for additive analgesic effects

Side Effects:• Prolonged bleeding time• GI effects• GI effects more common in the elderly from NSAIDS• Decreased renal blood flow & fluid retention• Liver injury if over used

Narcotic analgesics

• Opioids have analgesic activity that is mainly mediated in the CNS• Typically used to manage severe acute pain and chronic pain that is cancer-related• No ceiling effect• No ceiling dose• Duration of analgesia varies from drug to drug 30 mg. Of Morphine is the “standard” for comparison Demerol• Caution in elderly or patients with renal insufficiency• Poorly absorbed through GI tract. Oral dose = 1/2 effectiveness of parenteral • Rarely used

Demerol is a Dinosaur

Alternatives to Demerol

• Remind the physician of the hospital’s initiative to reduce the use of Demerol if it is more than just a one time order.

• Ask physician if there is a another medication we can use in place of Demerol.

• Be a patient advocate. Ask the patient what has relieved their pain in the past.

• Try alternatives to pain medication as discussed earlier.

You’re Important

Unrelieved pain has devastating effects on your patients.By being watchful for possible signs of pain & helping the pt. to receive quick & effective treatment , you have greatly improved that patient’s health & quality of life.

You’re The

Best

You Can Make a Difference