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Pain Management – An Introduction

Pain Management – An Introduction. Thea Addison, Vicki Yates Acute Pain Nurse Specialists Derby Hospitals NHS Foundation Trust. Aims of the Session. The Pain Team & their Role Define pain Emphasise the different pain pathways Types of pain Assessment of pain & pain tools

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Pain Management – An Introduction

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  1. Pain Management – An Introduction Thea Addison, Vicki Yates Acute Pain Nurse Specialists Derby Hospitals NHS Foundation Trust

  2. Aims of the Session • The Pain Team & their Role • Define pain • Emphasise the different pain pathways • Types of pain • Assessment of pain & pain tools • Barriers to pain assessment • Simple interventions

  3. Role of the Acute Pain Team • Overall responsibility for Acute Pain Management throughout the trust • Expert clinical and educational pain management resource • Service initially set up for post-op pain management • Now - Complex diverse pain problems In-patient Pain Team - A more accurate title? Clinical / Education / Audit / Research

  4. Links with • Outreach Team • Palliative Care Team • Ward based link nurses • School of Nursing • Clinical facilitators + educators • Other nurse specialists • Regional and National Specialists in Pain

  5. Definition of Pain ‘Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does’ McCaffrey(1968)

  6. Definition of Pain ‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is always subjective……always unpleasant and therefore also an emotional experience.’ International Association for the Study Pain (1979)

  7. Why Treat Pain? • Humanitarian Reasons • Clinical Effects of Pain • Reduces Stress Response • Patient Satisfaction • Promote Early Discharge

  8. How Do We Feel Pain? Two Major Types of Pain • Nociceptive: pain due to tissue damage • Neuropathic:paindue to injury ofnerve pathway - painful sensations are carried from the site of injury to the brain - treatment will depend on type of pain

  9. Acute Pain • Helps diagnose illness by acting as a warning mechanism - therefore is a symptom • From trauma often imposes limitations, which can prevent aggravation of an injury • In post-operative period serves no useful purpose and can be detrimental to the recovery of the patient • Recent studies/surveys indicate that pain control still remains an inconsistent affair

  10. Chronic Pain Untreated Acute Pain can become Chronic Pain

  11. Chronic Pain • Pain that persists beyond the expected healing time • Not simply a prolonged duration of acute pain. • Biological changes in central nervous system. • Adaptation of autonomic nervous system. • Complex Pain that is prolonged in nature, due to known reasons or absence of evident tissue damage. • Complex interplay of biological & psychological factors. • 7.5 million pain sufferers in UK

  12. Cancer Pain • Cancer is a dynamic disorder and patients may experience Acute as well as Chronic pain due to further tissue damage • Pain of varied duration/commonly progressive • Pain may be associated with symptoms which signal deterioration eg weight loss, anorexia, physical dependence, lack of sleep • Realization of dying may result in “overwhelming pain” that is difficult to describe and to assess

  13. ACUTE Transient Warning mechanism Usually decreases at around 48hrs Start at top of medication ladder CHRONIC Persistent No useful purpose Tends to increase as time goes on Starts at bottom of medicationladder

  14. Pain Assessment Advantages • Provides patients with an opportunity to express their pain • Conveys genuine interest & concern about their pain • Gives patients an active role in their pain management • Can provide documented evidence of the efficacy or failure of drugs / treatments

  15. Pain Assessment When • Initially to understand the pain & develop a care plan • Immediately following surgery / procedures • Prior to & following administration of analgesia / treatments • At a report in change of description, location or intensity of pain • Deep breathing / coughing / moving limb etc

  16. Pain Assessment – What You Need to Know • Location • Description • Duration • Pain Intensity • ? Related to admission • Influencing factors • Deep breathing / coughing / moving limb etc • Drug history

  17. Pain Assessment Tools Pain Intensity Scales • Visual Analogue Scales (VAS) • Numeric Scales • Verbal Rating Scale (VRS) • Body charts

  18. Pain Assessment Tools Visual Analogues Scale No The worst Pain pain imaginable Numerical Rating Scale 0 1 2 3

  19. Verbal Rating Scales 0 = No pain 1-3 = Mild pain 4-6 = Moderate pain 7-10= Severe pain Acute Pain Chart 0 = No pain 1 = Mild pain 2 = Moderate pain 3 = Severepain Pain Assessment Tools

  20. Throbbing Cutting Burning Stinging Aching Tiring Blinding Intense Penetrating Nagging Shooting Gnawing Searing Tender Dull What makes pain better? Frightful Annoying Unbearable Radiating Nauseating Stabbing Crushing Smarting Hurting Splitting Vicious Spreading Piercing Torturing Descriptive Words for Pain

  21. Factors Influencing Coping • Age / gender • Culture / Social beliefs • Emotions, eg fear, anxiety, anger, sadness & depression • Fatigue, sleeplessness • Past experiences • Expectations • Communication & information

  22. PAIN IS THE 5TH VITAL SIGN Patient assessment is the first stage in managing pain well!

  23. Body Language- posture, lying still, rolling around, rocking, withdrawn Facial Expressions-crying, grimacing, frowning Disrupted sleep pattern Note! Patients with long standing pain may tell you they have severe pain but not display any of these signs! Non-Verbal Signs

  24. Mentally / cognitively impaired patients Sensory impaired patients Unconscious patients Neonates / children Assessing Pain in Patients Unable to Communicate

  25. Assessing Pain in Patients Unable to Communicate How • Patients self-report if possible / carers report • Observation of behaviour incl. posture, movement • Comparing current with usual behaviour • Abnormal change in behaviour eg aggression / agitation • Patients interactions with others • Check for full bladder / colic caused by constipation • Sleep and diet

  26. The Cognitively Impaired Patient • Some patients who are confused in time and place will still be able to report and describe pain! • Once patient becomes very vague, confused or unconscious, signs which signal pain should be looked for eg • Restlessness or agitation • crying out or groaning • Withdrawing, localizing or guarding • Rocking, immobility or rubbing the area

  27. Impact of Pain • Clinical: BP, Pulse, Resps, sweating • Functional: reduced mobility & associated problems • Emotional: the meaning of pain – effects, anxiety, depression • Social/occupational: role, finance, family, sexuality

  28. Barriers to Pain Assessment Healthcare Professionals • Attitudes • Skills • Knowledge / misconceptions • Failure to routinely assess & document • Legal aspects of drug administration • Drug round times

  29. Barriers to Pain Assessment Patients • Want to be a ‘good patient’ • Language or cultural barrier • Fear of addiction/unwanted side effects /misconceptions • Value of suffering - no pain / no gain • Expectations and goals • Reluctance to report or use word “pain” • Litigation

  30. Barriers to Pain Assessment Healthcare System • A low priority given to pain care • Restrictive regulation of controlled substances • Lack of access to pain specialists • Resources & workload

  31. Failure to Manage Pain Well • Inadequate assessment • Failure to evaluate interventions • Failure to reassess

  32. Simple Interventions Comfort Measures • Therapeutic environment • Patients bodily comfort • Relaxation • Massage / touch • Guided Imagery • Diversional activities • Confidence building

  33. Simple Interventions Preventative Measures • Positioning • Carefully support painful area • Attention to Dressings • Provide pressure relieving mattress • Hot/cold packs • Ensure medications and adequate hydration is given • Encourage and assist with exercise

  34. Simple Intervention Recognise the power of suggestion and Patient Partnership! • Listen to the patient • Support the patient • Reassure the patient NBBe aware of your own limitations and ask for support!

  35. Benefits of Treating Pain • Humanitarian - quality of life • Aids recovery • Reduces complications • Improves patient & carers satisfaction • Healthcare outcomes - can prevent readmission  hospital stay

  36. Ineffective Pain Control If not achieved the “5 D’s” can occur! • DISCOMFORT • DISABILITY • DISSATISFACTION • DISEASE • DEATH -COMPLAINT / LITIGATION

  37. Summary • Pain is an individual experience • Listen to your patient • Effective assessment and documentation • Non-pharmacological management • Evaluation/ Documentation

  38. Useful websites • www.painsociety.org • www.ampainsociety.org • www.pain-talk.co.uk • www.iasp-pain.org/ • www.anzca.edu.au • www.medicine.ox.au.uk/bandolier • www.medicines.org.uk • www.painradar.co.uk

  39. References • McCaffery, M. (1968) Nursing Practice theories related to cognition, bodily pain, and man-environment interactions.

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