This is a process of managing chronic pain by the nurse/midwife using nonpharmacological and pharmacological interventions to promote quality of life. Chronic pain persists for over three to six months and for patients who are able to speak, self-report based on numerical, verbal or graphical rating scales ensures adequate management.
Aims
· Effectively assess chronic pain in patients who can describe their pain experience
· Implement interventions that will ensure holistic management of pain to a verbal rating score of 0-3
· Relieve the patient of chronic pain, discomfort and suffering
· Promote the dignity of the patient
· Promote early ambulation and discharge of patient
· Reduce pain with minimal adverse effect
· Prevent abuse and addiction
· Counsel patient on adverse effects of pain relieving medications
· Prevent medication resistance
Types
· Nonpharmacological
· Pharmacological
Principles of Pain Management
1. Pain assessment is part of vital signs
2. Provide patient and family with adequate information and education on pain management
3. Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
4. Treat each patient as an individual and involve the patient and family in the pain management
5. Employ evidence-based contemporary recommendations for pain management such as:
· Pre-emptive analgesia (analgesic given before a painful stimulus)
· Multi-modal analgesia (using two or more forms of analgesic concurrently)
· Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
· Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management
6. Evaluate the pain management and review decisions per assessment findings
7. Investigate allergies to pain medications and other co-morbidities
8. Employ effective teamwork with doctors and other health team members when managing pain
9. There should be hospital protocol for pain management
10. There should be input and monitoring from hospital management and departmental leadership to achieve effective pain management
11. Guard against dependence or addiction
Requirements
a. Patient Treatment chart (Electronic or Manual)
b. A tray containing the following
· Spoon
· A cup
· A saucer
· A jug/bottle/sachet of water
· A pair of scissors
· Tissue paper/napkin
· Prescribed pain medication and other adjuvant
· Pulse oximeter
c. Neurologic examination tray
d. Ice pack
e. Hot water bottle
Steps
1. Establish rapport with patient to facilitate openness in communication
2. Perform the five moments of hand hygiene
3. Obtain history of the pain as follows:
a. Ask patient about the onset of the pain to confirm chronicity noting if there was a sudden or gradual onset
b. Explore the quality of pain to determine if the pain is sharp, burning, tingling, gnawing or dull
c. Ask patient to describe the location of the pain and whether it is generalised or localised and illustrate this on the *body map if applicable
d. Ask about the severity of the pain on the scale of 0-10 or using the colour recognition from white-black
e. Find out whether pain is intermittent or continuous
f. Determine the factors that precipitate, aggravate or relieve the pain
g. Explore any associated symptoms such as weakness, anxiety, depression, sleep pattern changes, appetite and weight loss
h. Find out about the effect of the pain on functional abilities
i. Ask about previous treatment and therapies used to manage the pain
j. Explore the influence of patient’s perception, experiences and cultural context on pain expression
4. Conduct a physical examination to validate pain report
a. Inspect general mood, gait, mannerism, coordination, interpersonal interaction of the patient
b. Observe for use of assistive device, guarding behaviour and restlessness
c. Check for mental orientation to time, place, person and ability to name objects or recall objects in 1 minute and after 5minutes
d. Observe location/site of pain noting any swellings, scaring, discolouration, lesions, ulceration, atrophy or hypertrophy and compare with other regions of the body
e. Palpate lymph nodes for swelling, lesions or masses - If masses are present check for pulsation
f. Palpate for tenderness over areas where patient reports pain (conduct a systematic regional palpation if pain is generalised)
g. Check patients pulse noting rhythm, amplitude, equality and rate
h. Percuss for collection of fluid, air or rigidity in regions or structure where patient reports pain
i. Conduct an active or passive range of motion assessment according to the patient’s activity tolerance level (flexion, abduction, adduction, external and internal rotation) and observe for patient’s responses suggesting pain
j. Asses for increase or decrease in muscle tone as observed with level of resistance during range of motion assessment
k. Check for sensory reaction by pinching patient, pricking with needle and passing cotton wool balls gently over specific spots
l. Check for the sense of smell by asking patient to inhale pungent substance such spice or perfume
m. Assess for Achilles, patellar, bicep and triceps reflexes while observing patient’s reaction that suggest decrease or increase pain
5. Discuss with patient the need to keep a record of the pain and the strategies best suitable for dealing with the pain
6. Adopt the most appropriate nonpharmacological intervention that addresses pain report
a. Massage areas of pain to facilitate release of endorphins to decrease pain transmission
b. Teach patient relaxation techniques including deep breathing exercise, music therapy to allow for refocusing of energy on positive aspect of life
c. Apply cold compress for 20 to 30 minutes/hour to relieve pain associated with inflammation
d. Use heat application if increasing blood supply to the area of pain will decrease pain reflexes. Do not exceed 20minutes and take precautions to prevent burns or scalds
e. Administer prescribed medications according to WHO analgesic ladder and monitor for adverse reactions
f. For mild pain; give non-opioid analgesics such as paracetamol, ibuprofen or aspirin
g. Manage moderate chronic pain with weak opioid such as codeine, tramadol or low dose morphine
h. Manage severe pain with strong opioid such as morphine, fentanyl, oxycodone and hydromorphine
i. For breakthrough pain, give an extra dose of medication as prescribed
7. Administer adjuvants therapy as prescribed
a. Educate patient on side effects of medication and what to do
b. Be sensitive to patients report of pain and act promptly
c. Involve family in pain management goal setting and intervention
d. Connect patient with significant support groups
e. Dispose off, decontaminate and clean items as necessary
f. Document your assessment findings and management strategies
0 Comments