Pain is the number one reason people seek health care, yet very little emphasis is placed on pain management in our nursing training. In this and future articles we will review some of the basics of pain management and treatment so that we as nurses, regardless of our area of practice, can better serve our patients.
We have all been trained to have our patients rate their pain on a scale of 0 to 10. Then based on their response we administer pain medications and, after ample time has passed for the medication to work, have the patient rate their pain again. We record this in the patient’s record, let the doctor know if the pain is not better, and call this pain management. We, as nurses, can do much better. Here are some rules to live by…
Ask every patient about pain. Many patients will not bring it up because they think it is "normal" or "just a sign of old age". They may feel like it is something they just have to live with or may be fearful of "pain medicine". We as nurses have a wonderful opportunity to educate our patients that they do not have to live with pain. Even if the patient is smiling and does not appear distressed, ask. Being able to visually tell if someone is in pain is the least reliable way to assess for the presence of pain.
Use other words besides "pain" when assessing the patient. Sometimes a patient will not describe an unpleasant sensation as pain. Use other words, such as "discomfort" or "aches" or "numbness/tingling" as many patients will respond positively to those words. While doing an inservice for an elderly group of patients I asked for a show of hands as to how many people had pain. Only a few raised their hands, but when I restated the question to "how many of you are uncomfortable or have aches?" over half the room raised their hands.
Ask the patient to describe his pain. How a patient describes his pain tell us a lot about the pain itself and how best to treat it. You may need to give the patients some words to choose from such as: ache, burning, shooting, sharp, dull, tingling, heavy, crushing. It may be that the patient has pain in more than one location and those pains feel very different. Document and report each pain separately.
v Ask the patient what makes the pain better and what makes it worse. Identifying this aspect of the patient’s pain can help with the selection of treatments.
v Identify if the pain is constant or intermittent. Again this is helpful in identifying the correct interventions for the patient.
v Remember that many patients have different kinds of pain. Many patients, especially our elderly, may have different types of pain. They may have arthritic joint or bone pain, neuropathic pain from injuries or disease processes, spasmodic pain, and visceral or soft tissue pain. Each of these pains is treated differently. Some respond well to traditional narcotic pain medications and some do not respond to those at all. Some respond to antidepressants or anti-epileptic drugs or muscle relaxants. Each pain may need to be treated differently.
v Nonverbal patients may need extra attention. It is difficult to identify pain in nonverbal patients because they can not respond to our questions. We must use our skills as nurses to identify those patients who may be having pain. Look for obvious signs such as facial grimacing, moaning, or crying but also look for more subtle signs like restlessness, agitation, combativeness, or anger. I had one dementia patient one time who would suck her thumb whenever she was in pain. When pain meds were given the sucking stopped. We should observe our nonverbal patients for at least 5 minutes for signs and symptoms of pain before saying they have none.
Using these assessment tools and documenting and reporting them to the patient’s physician can greatly improve the patient’s overall quality of life. Isn’t it great when we can use our nursing skills to impacts lives like that!!!
Andrea Arnold, RN-BC, is a board certified pain management nurse who graduated from the University of Oklahoma in 1987 with her BSN. She has worked in Southwest Medical Center’s ICU; VA Hospital’s ICU, Post- Surgical Floor and Oncology/Med-Surg; and currently works at Good Shepherd Hospice where she has found her niche in hospice and pain management.