Pain Management Notes

Pain

Significance of Pain

• Pain is the most common reason individuals seek medical attention.

• It often necessitates medication.

• It is a major cause of disability.

• The adequate assessment and treatment of pain is considered a human right.

• The patient's self-report is the most reliable indicator of their pain.

Multidimensional Symptom

Pain is a multidimensional symptom encompassing:

• Physical aspects.

• Psychological aspects.

• Emotional aspects.

• Social aspects.

• Spiritual aspects.

Types of Pain

Nurses should be able to differentiate between different types of pain:

• Chronic Pain: Lasting more than 3 months.

• Acute Pain: Sudden onset, linked to a specific event, and expected to dissipate over time with routine healing.

• Nociceptive Pain: Normal pain response.

• Neuropathic Pain: Can involve:

  • Deafferentation

  • Pathologic conditions

  • Sympathetic involvement

  • Somatic sources

  • Visceral sources

  • Neuralgia

Pain Assessment

Nurses should assess the following characteristics of pain:

• Location

• Intensity

• Frequency

• Duration

• Factors that make it better or worse

Pain Scales

Nurses can utilize various pain scales, including:

• Numeric Rating Scale

• Faces Pain Scale

• Wong-Baker Faces Pain Scale

• Verbal Descriptor Scale

Advocacy for Vulnerable Populations

When advocating for vulnerable populations experiencing pain:

• Attempt to obtain self-report whenever possible.

• Consider underlying pathology or procedures that may be causing pain.

• Observe behavior for nonverbal cues of pain.

• Evaluate physiological indicators of pain.

• Conduct an analgesic trial to assess pain relief.

Populations at Risk for Inadequate Pain Management

Populations particularly at risk include:

• Infants and Children

• Older Adults

• Factors such as sex, race, and ethnicity can influence pain experience and management.

• Socioeconomic factors like income, education and geographic location play a role.

• Those with communication barriers may face challenges in reporting pain.

• Individuals with cognitive or developmental differences.

• People with Mental Health conditions.

Collaborative Interventions: Pharmacologic Management

Pharmacologic management of pain involves three main analgesic groups:

• Nonopioid Analgesics

  • Acetaminophen

  • Nonselective NSAIDs (e.g., ibuprofen, naproxen, ketorolac)

  • COX-2 selective NSAIDs (e.g., celecoxib)

• Opioid Analgesics

  • Morphine

  • Fentanyl

  • Hydromorphone

  • Oxycodone

• Adjuvant Analgesics

  • Local anesthetics (e.g., bupivacaine, ropivacaine, lidocaine)

  • Anticonvulsants (e.g., gabapentin, pregabalin)

  • Antidepressants (e.g., desipramine, nortriptyline, duloxetine)

Exemplars of Pain Conditions

• Osteoarthritis

• Trigeminal Neuralgia

• Phantom Pain