Pain: Understanding and Management

Pain is defined as “An unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage”. Many patients in the hospital and community settings experience pain, some more than others. It is expected that every nurse practitioner has the capability to evaluate and manage pain. This article is for nursing students, currently practicing nurses and aspiring nurses. It is also useful reading for individuals caring for a loved one. The author realizes that it may not be possible to apply all of the techniques mentioned here to all situations.

In this article the author will cover the following topics

1. Student objectives
2. Lecturer objectives
3. Experiencing and defining pain
4. Pathology of pain
5. Application of general principles for pain management
6. Interventions for appropriate pain management

Student Objectives

Nursing Students who do this unit will be required to be able to demonstrate the following competencies in accordance with the ANMC guidelines.

1. Demonstrate knowledge about how pain is caused, perceived, transmitted and felt by the patient. This must be done in context of current understanding of the micro and macro anatomy, physiology, habitat, cultural and social factors.
2. Students must be able to discuss the definition of pain and the current theories of pain
3. Students must be able to distinguish acute pain and chronic pain. They must be able to apply some of the principles of pain management in the acute and chronic setting.
4. Nursing students must be able to use evidence-based pain assessment tools. They should be able to include sensory, cognitive, behavioral, cultural and spiritual aspects of the patient's belief system to assist in the management of pain.'.
5. Students should be able to identify barriers to effective pain management. Some of these barriers are related to professional boundaries, others are system related, some are patient related. The last groups of barriers are family and community related.
6. Students will acquire the skills which are necessary to recognize patients who are receiving inadequate pain relief. Hopefully they will be able to intervene appropriately.
7. Students will be able to evaluate pain assessment tools which are most suitable for the given clinical environment. During the evaluation students should take into account cultural and social variations such as language, cognitive ability of the patient, patient's age, disability and other factors.
8. Students should be able to competently administer and manage common adverse effects of pain medications
9. Students have been taught to administer medications in other courses. It is therefore expected that students can competently administer prescribed analgesia via the many approved routes of administration.
10. Students will be able to identify and manage side effects of treatment which are routine for their clinical area.
11. Students will be able to identify signs and symptoms of physical dependence (addiction), tolerance and pseudo-addiction
12. Students will be able to assess the patient's needs for physical and psychological support. These include making the patient physically comfortable by appropriate positioning and appropriate use of distraction techniques.
13. Students will be able to discuss a range of options for pain management and be able to initiate appropriate referral
14. Students will be able to collaborate with other nurses and non-nurses of the interdisciplinary team who may include patients and family members. Achievable goal setting by care givers should produce a win win situation.
15. All students should understand and be able to demonstrate the importance of accurate record keeping. They should be able to abide by local professional and clinical standards.
16. Students should be able to communicate with other members of the interdisciplinary team within ethical and professional standards
17. Students should be aware that they must practice within their professional boundaries, human rights and always take into account the “the risk to benefit ratio”
18. All nurses and students are expected to critically reflect on their practice with a view to improving pain management for the ill
19. All students are expected to be informed of new developments in their chosen fields including pain management techniques
20. Evidence based nursing is the current trend and students should be aware of this.

Lecturer's objectives

1. Lecturer will outline the extent of this problem in the Hospital, home and community.
2. Lecturer will discuss the impacts of unrelieved pain on the recovery process.
3. Lecturer will explain how to identify and manage pain due to surgery and or illness.
4. The class will discuss the effects of persistent pain which may be due to cancer and/or chronic illnesses in the context of (i) the patient: physical implications, psychosocial factors, spiritual ramifications, vocational effects, and socioeconomic consequences. (ii) the patient's family: altered roles, relationship difficulties, psychological impacts and socioeconomic and (iii) the Society: cost to society: lost production.E. Influences which are barriers to pain assessment & management: patient, family, caring professionals, beliefs and attitudes, intitutions, access and costs of pain relief.
5. Patient's life span considerations will be discussed. Some studies show that when pain is relieved than the patient's life span is reduced. Other studies show that pain relief improves quality and quantity of life.
6. Socio political issues which affect pain management eg. Smoking marijuana ? economic vs legal issues.
7. Legal and Political considerations eg. Marijuana smoking and pain relief.
8. Transference and counter transference issues: Barriers to optimal care for patient. Nurses must be aware of this.
9. Lecturer will discuss the different types of pain, causes, classification and management of pain. Class will be asked to answer questions during teaching session.