According to IASP, pain can be defined as “an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage”. Choosing the ideal pain management nursing interventions for a patient in pain depends on the accuracy in which pain assessment is carried out, correct diagnosis and adequate nursing care plan.
Pain Classification
Pain can be classified as ‘acute’ or ‘chronic’.
Acute pain acts as a warning, signalling that you’ve been hurt. It is typically mild and short-lasting, or severe, lasting for a few weeks or months, disappearing when the underlying cause of pain is treated (eg. surgical wounds, broken bones and childbirth). Acute pain is the result of noxious stimuli that activate nociceptors.
On the other hand, chronic pain can last for months or years, and has no definite cause (eg. arthritis, back and neck pain, fibromyalgia, CRPS and headaches). Chronic pain is the result of visceral or somatic nociceptors.
Acute Pain Management Goals
- Analgesics: analgesia should be administered in a dose that is both effective yet minimal, so as to lessen the incidence of side effects;
- Effectiveness: effective pain control promotes early mobilisation, less arising complications, shorter period of hospitalisation leading to lower costs, and more importantly, increased patient satisfaction.
Analgesics administered can be:
- Multimodal Analgesics – a combination of different medicinal groups of pain relief such as local anaesthetics, opioids and NSAIDs;
- Preemptive Analgesia – treatment is started prior to a surgical procedure so as to reduce sensitisation, which promotes a protective effect on the nociceptors and provides a reduction in post-operative pain and at times prevents chronic pain development;
- Parenteral Analgesia – indicated for patients experiencing severe pain with associated nausea and vomiting who are unable to tolerate oral medication;
- PCA (Patient-Controlled Analgesia) – a method which allows patients to self-administer predetermined doses of analgesia for pain relief;
- Epidural Analgesia – administration of analgesics or anaesthetics into the epidural space for short-term and long-term pain management;
Analgesic Medications
non-opioids
Non-narcotic, peripheral, mild and anti-pyretic agents…
Opioids
Narcotic, central or strong agents…
Opioid Side Effects:
- respiratory depression
- sedation
- nausea
- vomiting
- constipation
- inadequate pain management
- allergies
- pruritis (irritation)
- urinary retention
- tolerance to medication
- addiction to medication
Adjuvant pain medication
- Corticosteroids a.k.a. steroids are anti-inflammatory agents prescribed for a wide range of conditions including auto-immune diseases (attn. may cause hyperglycaemia, moodiness, irritability, insomnia, bone weakness, immunocompromisation – prednisolone, prednisone, cortisone
- Anti-Convulsants a.k.a anti-epileptic / anti-seizure drugs are pharmacological agents used to treat epileptic seizures- carbamazepine, valproate, clonazepam, phenytoin, gabapentin
- Tricyclic Anti-Depressants – amitriptyline, desipramine, imipramine, nortriptyline
- Bisphosphonates can help prevent or slow down osteoporosis, treat some types of cancer that cause bone damage, and treat high levels of calcium in the blood – pamidronate, calcitonin
- Neuroleptics a.k.a. anti-psychotic medications are used to treat and manage symptoms of many psychiatric disorders – haloperidol, chlorpromazine, risperidone
- Anxiolytics help prevent or treat anxiety symptoms or disorders – lorazepam
Non-Pharmacological Pain Management
- heat
- cold
- laughter
- music
- physical therapy
- massage therapy
- aromatherapy
- acupuncture
- self-hypnosis
- TENS (Transcutaneous Electrical Nerve Stimulation)
- SCS (Spinal Cord Stimulation)
Pain Management Nursing Interventions
The nurse’s role with regards to pain management include:
- acute pain management
- help with self-care
- providing reassurance to counteract anxiety
- assisting at times of ineffective coping and fatigue
- assisting with mobilisation
- ensuring adequate nutrition
- ensuring adequate sleep
- providing education and assistance in a holistic manner
Maslow’s Hierarchy of Needs
The Role of Psychosocial Care in Nursing
Psychosocial care involves the provision of care in a holistic way such that the psychological, social and spiritual requirements of the patient are collectively met. For the provision of psychosocial care, the nurse needs to:
- have good verbal and non-verbal communication skills
- be empathic and supportive
- have the required knowledge and the ability of conveying medical information in an easily understood way
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