Pain management

Pain Assessment and Management

Learning Outcomes

  • Demonstrate a comprehensive understanding of the main concepts related to pain

  • Apply the biopsychosocial model of pain to nursing practice

  • Identify the importance of providing person-centred care by adopting a biopsychosocial approach when caring for patients with pain

  • Perform a comprehensive patient assessment and advocate for appropriate care by accepting and acting on the patient’s report of pain

  • Explain the pharmacology of the three analgesic groups in pain management and the concept of multimodal analgesia

  • Develop nurse-initiated and collaborative interventions for pain management

  • Describe the role of the nurse in providing safe and effective pain management for patients receiving patient-controlled analgesia, epidural or intrathecal analgesia, or peripheral nerve blocks

  • Describe non-pharmacological interventions for pain

What is pain?

  • "An unpleasant sensory and emotional experience associated with actual or potential tissue damage"

  • "Pain is whatever the experiencing person says it is, existing whenever he or she says it does"

Types of pain

  • Acute pain

    • Directs immediate attention

    • Short duration and resolves with healing

    • Responds with analgesics

    • Rapid rehabilitation

    • Mostly nociceptive etiology

    • Simple management with multimodal approach

    • Poorly controlled pain can lead to adverse outcomes

    • Rehabilitation can be delayed

    • Prolonged hospitalization

  • Chronic pain (Non-cancer)

    • Persists for months beyond healing time

    • Poor response to conventional analgesics

    • Disability, diminished social roles, poor quality of life

    • Anxiety and depression are common features

    • Can occur after injury or surgery, with chronic disease and disability

    • Associated with features of neuropathic pain

    • Radiates from origin of injury

  • Other forms of pain

    • Cancer

    • Nociceptive

    • Neuropathic

    • Nociplastic pain

    • Mixed

Pain theories

  • Pain theory

    • Renē Descartes, 17th-century philosopher

    • Direct relationship between tissue damage and perceived pain

  • Biomedical model of pain

    • Devised 19th and early 20th century

    • Assessment and treatment focused on underlying tissue damage or injury

    • Psychological and social factors seen as secondary role and response to pain

  • Gate control theory of pain

    • Devised by Melzack and Wall

    • 'Open' and 'Close' gates in the spinal cord to inhibit transmission of noxious signals to the brain

    • Psychological factors play a role in pain perception

    • Three brain systems and response to pain

      • Sensory-discriminative refers to sensory location, intensity, and quality of pain

      • Motivational-affective refers to the emotional response to pain

      • Cognitive-evaluative involves the appraisal of pain in terms of attention, meaning, and past experience

Biopsychosocial model of pain

  • Environment

  • Pain behavior (disability)

  • Psychological distress (suffering)

  • Attitudes and beliefs

  • Pain perception

  • Nociception

Physiology of pain

  • Acute pain is mediated by the nociceptive system

  • Four physiological processes involved:

    • Transduction

    • Transmission

    • Perception

    • Modulation

Misconceptions: barriers to the assessment and treatment of pain

  • The best judges of the existence and severity of patients' pain are the medical staff and nurses caring for the patients

  • Clinicians should use their personal opinions and beliefs about the truthfulness of patients to determine patients' true pain status

  • It is essential to establish the patients' self-reports of pain as the standard for pain assessment

  • Comparable noxious stimuli produce comparable pain in different people

  • Patients should not receive analgesics until the cause of pain is diagnosed

  • Visible signs, either physiological or behavioral, accompany pain

  • Lack of pain expression does not necessarily mean lack of pain

  • Cognitively impaired older patients are unable to use pain-rating scales

  • Cognitively impaired patients, especially those who are unable to self-report, do not experience as much pain as those who are cognitively intact

  • Critically ill patients, especially those who appear to be unconscious or have received a neuromuscular blocking agent, do not feel pain and do not recall painful episodes in intensive care units (ICUs)

  • Persons with intellectual disabilities (IDs) or mental retardation are either insensitive to pain or have greater tolerance for it

Gathering information

  • Foundation of pain assessment: accepting the patient’s report of pain

  • Performing a pain assessment

Starship Child Health Pain assessment and management algorithm

  • Choose appropriate pain scale for age and development level

  • Consider location, duration, onset, behavioral signs, physiological signs, contextual factors, cause of the pain

  • Document intervention (pharmacological & non-pharmacological)

  • Re-assess

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  • Pain assessment tools:

    • FLACC scale

    • Behavioral Observation Pain Rating Scale

  • Categories and scoring of pain assessment tools:

    • Face: No particular expression or occasional grimace (0), frequent to constant frown, withdrawn clenched jaw, quivering chin (1), disinterested expression or smile; or frown (2)

    • Legs: No position or uneasy, restless, tense (0), kicking, or legs drawn up or relaxed (1)

    • Activity: Lying quietly, normal position, back and forth, tense moves easily (0), squirming, shifting, arched, rigid, or jerking (1)

    • Cry: No crying or moans or whimpers (0), crying steadily, screams or sobs, frequent complaints (1)

    • Consolability: Content, relaxed (0), reassured by occasional touching, hugging, or comfort or talking to (1), difficult to console (2)

  • Each category is scored from 0-2, resulting in a total score between 0 and 10.

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  • O L D C A R S T pain assessment:

    • Onset: When did the pain begin?

    • Location: Where is the pain? Can the patient point to the location?

    • Duration: How long does the pain last? Is it persistent or intermittent?

    • Characteristics: Describe the pain (e.g., crushing, stabbing, indigestion-like, dull, or ache)

    • Associating factors: What other symptoms are associated with the pain (e.g., nausea, vomiting, weakness, fatigue, breathlessness, syncope, feeling cold and clammy)?

    • Radiating/relieving factors: Does the pain radiate? Does it stop and start? What relieves the pain?

    • Treatment: Has the patient taken medication for the pain? Used a heat pack?

    • Severity: How bad is the pain on a scale of 1-10?

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  • Potential problems with managing pain:

    • Example clinical situations and decision-making relating to pain:

      • Post-anaesthesia: Patient reports severe pain but appears sedated and comfortable based on observations. PACU nurse carries out a thorough physical assessment and discovers a wound haemorrhage, surgical team is engaged to return to the operating suite.

      • Post-delivery: Woman who delivered her baby by caesarean requests ibuprofen for pain. Nurse discovers she has preeclampsia and collaborates to cease the drug as it may affect kidney function.

      • Medical ward: Patient admitted for respiratory distress complains of nausea, insomnia, abdominal cramping, and sweating. Nurse undertakes a health history and discovers the patient is withdrawing from opioids because the usual oral oxycodone dose for cancer pain has not been prescribed since admission 4 days ago.

      • Surgical ward: Patient's pain score is 7/10 at rest after a total abdominal hysterectomy. Decision is made that the pain management plan is inadequate. RN calls the acute pain service and the nurse practitioner orders patient-controlled analgesia.

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  • Pain management - multimodal approach:

    • Various approaches to pain management:

      • Paracetamol

      • NSAIDs

      • Opioids

      • Tramadol

      • Alpha2 agonists

      • Ketamine

      • Local anesthetics

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  • World Health Organization's Pain Multi-modal Relief Ladder:

    • Analgesic options based on pain severity:

      • Free from cancer pain

      • Opioid for moderate to severe pain

      • Nonopioid +/- Adjuvant

      • Pain persisting or increasing

      • Analgesic Drug Concentration

      • Opioid for mild to moderate pain +/- Nonopioid

      • Pain persisting or increasing

      • Nonopioid +/- Adjuvant

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  • Pharmacology of analgesics:

    • Principles for administering analgesics:

      • Know the patient's previous responses

      • Administer medications based on clinical reasoning

      • Know the accurate dosage

      • Assess the right time and interval for administration

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  • Risks for administering various analgesics:

    • Definitions and application of key pharmacological terms:

      • Pharmacodynamics: What the drug does to the body and events caused by the interaction of a drug with a receptor (e.g., opioids may cause respiratory depression, sedation, nausea, pruritus, and constipation)

      • Pharmacokinetics: What the body does to the drug and concerns relating to drug absorption, metabolism, distribution, and elimination (e.g., intravenous injection of morphine peaks in 15-20 minutes in plasma)

    • Half-life: The time it takes for plasma concentration of a drug to decrease by 50% (e.g., half-life of morphine is 2-3 hours)

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  • Different approaches to pain management:

    • Non-opioid analgesics

    • Opioids

    • Patient-controlled analgesia (PCA)

    • Continuous subcut infusion devices

    • Prevention and management of opioid-induced effects

    • Adjuvants

    • Local anesthesia and peripheral nerve blocks

    • Epidural and intrathecal analgesia

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  • Analgesics:

    • Opioids:

      • Act on the central nervous system to reduce pain

      • Produce analgesia, sedation, respiratory depression, nausea, and constipation

      • Not recommended for renal impairment

    • Patient-controlled analgesia (PCA):

      • Intravenous administration

      • Patient controls administration

      • Regular monitoring of patient

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  • Prevention and management of opioid-induced effects:

    • Common side effects of opioids:

      • Constipation

      • Nausea and vomiting

      • Sedation

      • Itching (pruritus)

    • Ensure lowest effective dose of opioid is administered

    • Regular monitoring of vital signs, sedation score, and asking the patient

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  • Adjuvants:

    • Medications prescribed with analgesics:

      • Ketamine: Blocks sensory receptors

      • Clonidine: Agonist with morphine to produce analgesia

      • Anti-depressants: Enhances serotonin levels, used for chronic pain (e.g., neuropathic pain)

      • Anti-convulsants: Decrease firing of neurons, used if anti-depressants are ineffective or contraindicated

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  • Non-pharmacological strategies:

    • Should be used in conjunction with analgesia, especially if anxiety or fear is present

    • Strategies include:

      • Asking the patient about fears and worries

      • Positional changes

      • Heat packs

      • Massage

      • Distraction and relaxation techniques (e.g., music, videos)

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  • Treating acute pain:

    • Assessment of pain:

      • Pain scores

      • Functional pain score (3 or more = action)

      • Review within a short period at the expected peak effect of the drug

    • Pharmacological or non-pharmacological intervention

    • Check for side effects

    • Treatment cycle: Assess, intervene, review

    • Use pharmacological or non-pharmacological interventions based on pain level

    • Regular monitoring of patient

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Key concepts

  • Pain is subjective and exists when the experiencing person says it does.

  • The patient's assessment of pain and its effectiveness is crucial.

  • Communication with the patient is essential for determining the outcomes of care.

  • Taking a biopsychosocial, patient-centered perspective is important.

  • Four key processes in normal pain processing: transduction, transmission, perception, and modulation.

  • Psychosocial factors influencing acute pain experience include fear, anxiety, depression, perceived control, pain catastrophizing, and social support.

  • Healthcare professionals have a responsibility to accept and act on what the patient says about their pain.

  • Routine pain assessment should include various aspects such as intensity, quality, onset, duration, location, aggravating and relieving factors, associated symptoms, and impact on functioning.

  • Acute postoperative pain intensity should be assessed at rest and on movement to determine adequacy of pain control.

  • Analgesia is the cornerstone of acute pain management, and nurses should have knowledge of different types of analgesics.

  • Multimodal analgesia combining different drugs is recommended for effective pain relief with fewer side effects.

  • The nursing role is critical for patient safety, including pain assessment, treatment advice, administration, monitoring, and support.

  • Non-drug therapies can be used in conjunction with analgesia to enhance effectiveness and patient coping.

  • Accurate and thorough documentation is important for effective communication and reporting.

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  • Nurses' knowledge and attitudes about pain can impact patient satisfaction.

  • Financial toxicity and symptom burden in cancer survivors are related.

  • Opioid-induced respiratory depression can be prevented and reversed.

  • Chronic pain management requires a biopsychosocial approach.

  • Pain intensity on the first day after surgery varies across different procedures.

  • Various resources and studies provide information on pain management.

  • Pain assessment scales and procedures are available for adults.

  • Adjuvant and miscellaneous drugs are used in pain management.

  • Psychopharmacologic and psychotherapeutic approaches are used for pain management.

  • Acute pain management requires a psychosocial perspective.

  • Various books and publications provide information on pain management.

  • Nurse practitioners can lead pain management after caesarean section.

  • The Pain Catastrophizing Scale is a validated tool for assessing pain.

  • Therapeutic Guidelines provide information on analgesics.

  • The biopsychosocial model of pain is important in understanding pain.

  • Various studies and resources provide