Dealing with Pain – Things to know about Pain

Basic Steps to Pain Assessment

When assessing pain, know the chronology of the pain, whether it is frequent, constant, or intermittent. Identify the character of the pain. Where it is, what is its quality (dull, stabbing, aching). Know the intensity of the pain. What makes it better or worse, if anything? How does the pain affect a person’s lifestyle?

Take Pain Assessment Seriously

The most common reason that pain is undertreated in older adults is failure to assess it. Older persons often have multiple persistent pain problems that must be considered in evaluation of new and ongoing pain conditions. Alternative strategies are important when assessing pain in older persons who cannot communicate their pain. Subtle pain behaviors or changes in routine/activities may be indicators of the presence of pain in those with severe cognitive impairment.

Pain Can Always Be Managed

There are some types of pain that require “multi-modality” (combined approaches) to pain relief. Recent advances in analgesia ensure that all pain can be relieved by using commonly available medications and/or a combination of approaches that may include chemotherapy, radiation therapy, nerve block, physical therapies, and whatever else is appropriate.

Patients Can Almost Always Remain Alert and Awake

Most people with severe pain have been unable to sleep because of their pain. Opioid analgesics can produce initial sedation (usually about 24 hours) that allows patients to catch up on their lost sleep. With continuing doses of medication they are able to carry on normal mental activities. Sedation often occurs because of other drugs, such as anti-anxiety agents and tranquilizers that have been prescribed for other reasons. Intentional palliative sedation is used infrequently, and only in cases where pain cannot be managed otherwise.

Address Pain Immediately

If pain is not relieved by the lesser strength analgesics, then it is best to change to a stronger analgesic to bring the pain under continuing (24-hour) control. Pain that is only partially or occasionally controlled tends to increase in severity.

Understand Opioids

When morphine and other opioid analgesics are prescribed for the management of pain, the dose is sometimes raised to be sure that pain is well-controlled 24 hours a day, 7 days a week. Opioids given to relieve pain generally do not lead to the development of dependence. As a disease, like cancer, progresses, more opioids may be needed to control the pain on a continuing basis. When prescribed on a regular basis in a dose sufficient to relieve pain, there is no empirically-based evidence that opioids lead to addiction.

Pain Does Not Enhance Character

This myth developed in the years before clinicians learned to provide excellent pain management, but is not appropriate today. Suffering does not enhance character or earn people a higher place in the life hereafter; it can lead to a miserable life and needless anguish in all who see helpless dying people suffer.

Understand Pseudo-addiction

This term is used to describe patient behaviors when pain is undertreated. Patients with undertreated pain may become focused on the next dose and may seem to be inappropriately “drug seeking.” The patient may become involved in deception or seek illicit drugs for pain relief. Pseudo-addiction resolves itself when pain is adequately treated, but may result in a patient wrongly being labeled an addict.

Your Own Attitudes and Beliefs

Each person has his or her own beliefs about pain and pain behaviors. How do your attitudes and beliefs about pain influence your response to individuals from other cultures? For example, do you admire those who stoically bear pain without complaint? Do you hold any attitudes or suspicions that persons from certain groups or social classes might abuse pain medications? Begin by being aware of your own biases and beliefs.

Develop a Relationship with Your Patients

Effective pain assessment is more likely to occur in an atmosphere in which patients trust health professionals and believe that their concerns and perspectives are being listened to, validated, and valued. Remember that people who have experienced social discrimination and prejudice in the past may need more time to develop trust.

Assess Patients’ Cultural Beliefs and Practices Regarding Pain

Be open to learning about other cultures. The question “What do I need to understand about your cultural background to effectively treat you?” not only provides information about the patient’s culture; it also communicates an attitude of respect and concern. Assessing a patient’s beliefs and practices allows you to determine whether any barriers exist that might inhibit effective pain management.

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