Pain Management
Pain management is the alleviation of pain or reduction in pain to level
of comfort that is acceptable to the patients. Effective management of long
term pain, however, frequently requires the coordinated efforts of the
management team.
The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists,
occupational therapists, and nurse practitioners
It includes two basic types of nursing
interventions:
ü
Pharmacologic
intervention.
ü
Non-pharmacologic
intervention.
I.
Pharmacologic Interventions
Using pharmacological method to control pain
requires attention to four "Rights" right drug right does right rout
and right time. There are two primary groups of pain medications: non opioid
and opioid. A third group of drugs called adjuvant or analgesics, address
symptoms that often accompany pain, such as insomnia, anxiety, muscle spasm,
anorexia, and depression.
(A) Non opioid Analgesics
Non opioid analgesics relieve pain by acting on
peripheral nerve endings at the injury site to decrease the level of
inflammatory mediators. This group of analgesics includes drugs such as
acetaminophen (Tylenol) and non steroidal anti-inflammatory-drugs (NSAIDs) such
as acetylsalicylic acid (aspirin) and ibuprofen (Motrin). The specific actions
and dosages of these analgesics vary. Generally speaking, however, they have
analgesic, antipyretic, and anti-inflammatory effects and are useful for mild
to moderate pain With the exception of acetaminophen, most non opioid are
potent anti-inflammatory agents. These drugs are especially effective when the
primary cause of pain is inflammation, as occurs in rheumatoid arthritis and
bone cancer.
(B) Opioid Analgesics
Opioid (narcotic, CNS-acting) analgesics are
derivatives of opium and include such
drugs as morphine, codeine, and methadone. These Opioid works at the level of
the central nervous system, decreasing the perception of pain. The primary action
of opioid (narcotics) is to alleviate moderate to severe pain. Many of the
unwanted effects of this class of drugs are related to their actions on systems
of the body other than the CNS, causing such effects as constipation and
respiratory depression drug tolerance, chemical dependency, and addiction may occur
II.
Non pharmacologic Interventions
There are many non pharmacologic
interventions to give pain relief, especially when used in conjunction with
pharmacologic measures. Described as physical and cognitive-behavioral
interventions, many of these approaches are non invasive, low-risk,
inexpensive, easily performed and taught, and within the scope of nursing
practice.
1) Comfort measures:
Such as clean, smooth sheets, soft, supportive
pillows, warm blankets, and a soothing environment have been used by nurses
through out history to relieve pain and suffering.
2) Position change and movement:
We are well-known pain-relieving interventions.
Moving the body, even a small amount, relieves muscle spasm and provides a
degree of pain relief
3) Massage:
Relieves muscle spasm, improves circulation, and
provides cutaneous stimulation. While there are many different massage
techniques, they all involve rubbing the skin in various patterns and degrees
of pressure.
4) Applications of hot and cold:
Are effective pain-relieving measures when used
appropriately, hot decreases muscle spasm and increases blood flow to an area.
Cold decrease blood flow, edema, and inflammation and may decrease muscle spasm
and pain
5) Transcutaneous electrical nerve stimulation (TENS):
Provides a continuous, mild electric current via 2
to 4 electrodes placed on the skin near a painful site. The stimulator is a
small, battery operated devise worn by the patient. Experienced as a tingling
sensation, TENS works by stimulating large nerve fibers to close the
"gate" in the spinal cord. It also may stimulate endorphin
production. TENS may be used for acute postoperative pain or for chronic
conditions, such as low back pain, phantom limb pain, and neuralgia.
6) Distraction:
Distraction can be helpful particularly for babies,
by using colorful, moving objects. Singing songs, telling stories or looking at
books or videos can distract preschoolers. Older patients find watching TV or
listening to music helpful. Distraction should not be a substitute for
explaining what to expect.
7)
Touch:
Nurses, when using touch, are usually trying to
convey understanding, support, warmth, concern, and closeness to the patient.
Touching not only contributes to the patient’s sense of well-being, but also
promotes physical recovery from disease.
8) Imagination:
Guiding a patient through an imaginary mental image of sights, sounds, tastes,
smells, and feelings can often help shift attention away from the pain.
9)
Relaxation:
Patient can be guided through relaxation exercises
such as deep breathing and Stretching to reduce discomfort. Relaxation
exercises are useful ways to reduce anxiety, decrease muscle tension, and lower
blood pressure and heart rate. They induce a state of altered consciousness and
give patient a sense of control and peace of mind. Meditation, Zen, yoga, and
other such interventions may effectively relieve pain. One such exercise
involves controlled breathing.
10) Acupuncture
Is based on the belief that life
forces or energy move through the body in specific paths. These paths are
called meridians. With acupuncture, a needle is put into the meridian that runs
to the area where you have pain. This needle blocks the meridian which stops or
decreases the pain.
11) Aromatherapy:
Is a way of using good smells to
help you relax and decrease pain? Candles, massage oils, scented bubble baths
and even baking cookies are all ways that smells are used. Scientists are
learning that good smells may change your mood and help you relax. It may also
help your brain makes special chemicals like endorphins .Endorphins are a
natural body chemical like morphine that decrease pain..
12) Laughter:
It has been said that "10
minutes of belly laughter gives 2 hours of pain-free sleep!" Laughter
helps you breathe deeper and your stomach digest (break down) food. It lowers
blood pressure and may cause your brain to make endorphins. Laughter can also
help change your moods. It helps you relax and let go of stress, anger, fear,
depression, and hopelessness. These are all parts of chronic pain
13) Music:
Music increases blood flow to the brain and helps
you take in more air. Scientists are learning that it increases energy and
helps change your mood. Music also may cause your brain to make special
chemicals like endorphins. People who use music often say it decreases their
need of medicines for pain and anxiety.
Nursing role in pain management
v The role of the nurse
in assessment and management of pain varies according to :
§ Type of pain being
cared e.g. age, sex, educational level, diagnosis, expected prognosis, medical
management.
§ Setting in which care
is delivered.
§ Educational
background and experience of individual nurse.
v In acute care setting
, the nurse occupies a central position in :
§ Assessing the
individual with pain.
§ Administering
prescribed selected pain management modalities.
§ Monitoring the
condition of person in pain.
v for those individual
s experiencing chronic pain who are being discharged from hospital , nurses are
to :
§ Assess the congruence
between person׳s condition and needs for care.
§ Link between the
person's needs and the community resources.
§ Maintain the ongoing
communication between the patient, family and other care providers.
v Nurses should start
intervention before the level of pain becomes unbearable.
v Because pain is a
subjective experience nurses should maintain good communication pattern with
their patients.
v The nurse should respect and does not ignore
patient's complain.
v Nurses should teach
the patient and his family about pain and its management and scheduling
medications in relation to patient׳s need
v Moreover, nurses
should teach the patient and his family how to use the complementary pain
relief methods in combination with medication to achieve effective relief.
v All persons who are
experiencing pain are ought to be attended by the nurse who aims to relief
their pain to the greatest possible extent.
v Fear of addiction to
pain relief medications should not be a barrier in pain management.
v All people have the
right to have their pain relived even with use of opioid, and even if they have
a history of substance abuse.
v Nurses should
continue pain management even if persons become unresponsive.
v Nurses should
encourage continuity of care within and across health care setting for the
achievement of effective pain management.
v An interdisciplinary
approach to pain management should be reinforced by nurse advocacy for their
patients.
v Sedation is an
acceptable mean of pain management when all other reasonable have failed.
v The nurse should assist in treatment
modalities such as :
·
Range of motion exercises.
·
Position change.
·
Comfort measures.
·
Application of hot or cold
packs.
·
Hydro therapy.
·
Paraffin wax therapy.
·
Cold laser.
·
Music therapy.
·
Peer support group.
·
Relaxation techniques.
·
Imagery , distractions
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