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Pain Perplex: 5 Things Nurses Need to Understand About Pain Management

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By Iris Dawn Tabangcora, RN

The moment clients greet hospital doors with the universal look of grimace on their faces, nurses instantly know that the case of the hour is pain. According to the American Academy of Pain Medicine, pain is the leading cause of hospital consultations today. In 2011, the Institute of Medicine of The National Academies studied the incidence of chronic pain, and the results showed that it is greater than those of diabetes, cancer, and heart diseases combined.

While pain is common, it poses challenges to nurses’ assessment skills, and may render current pain management useless. It is so prevalent that it is now considered a disease itself. Associated with loss of productivity including the inability to work and maintain health insurances, pain is officially identified as a public health problem. Much has been spent to study and find the cure for it, but sadly, pain is a story that is still not fully understood.

Still, nurses should acknowledge the pain, sit these clients down, and listen to them. To deliver effective pain management, here are five things nurses must hold close to their hearts:

1. Pain is the 5th vital sign.

Vital signs are critical measurements of life functions. These vitals reflect overall health condition, disease progression, and clues to recovery. Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) mandated that pain assessment and documentation should be as automatic and prominent as taking blood pressure and respiratory rate. It is stressed that all clients have the “right to appropriate assessment and management of pain.”

Pain is subjective.
Pain is subjective.

Although pain is highly subjective and validity depends primarily on clients, pain must be taken seriously. Nurses must collaborate with them in administering prescribed relief interventions and advocate for them when it is ineffective. Together with this is the practice of exploration if behaviors and manifestations support pain complaints. It is also important to note when clients deny the existence of pain when it is expected and their reasons for such denial (e.g. fear of opioid addiction, perception of pain as a weakness, etc.).

2. Pain has detrimental effects on the body.

Pain does not go away without affecting the body. Nurses should remember this every time they begin to ignore clients’ complaints of pain. Acutely, it affects five body systems: cardiovascular, pulmonary, gastrointestinal, endocrine, and immune systems. For clients with existing health diseases, old age, and existing injuries, these adverse effects are worsened. With pain, metabolic rate and the load for the heart increases. Cortisol, a stress hormone, increases in blood, and this causes fluid retention. Some patients feel a severe pain that it inhibits them from assuming full lung expansion when breathing. Others just refuse to move at all.

“Pain does not go away without affecting the body.”

When pain lasts for more than six months, it is considered chronic, and this results in prolonged immune function suppression and feelings of fatigue, depression, and social isolation. Chronic pain is also one of the leading causes of disabilities (e.g. arthritic pain)

3. Pain response is not just in the mind.

To view pain as a phenomenon of the mind is ignorant of other factors that significantly affect pain response. These factors affect pain perception and tolerance. Clients complaining of pain are sometimes told to keep their minds away from it, that pain is just ‘all in the mind.’ However, factors like culture, age, expectations about pain relief, and even gender affect pain response.

Beliefs and responses to pain vary among different cultures. At an early age, beliefs and responses are influenced by what individuals are exposed to in regards to stimuli that are expected to be painful and behavioral responses that are acceptable. Therefore, individuals from different cultures react differently to the same intensity of pain. Consequently, expectations to pain reliefs would also vary. A positive treatment expectation increases its effectiveness.

There are different methods in assessment of pain.

Age is perhaps the primary focus of research studies about pain. Up to now, the relationship between age and pain perception is not clear. However, experts agreed that diminished pain perception in elders is because of disease processes and not of aging. Therefore, pain is not a part of normal aging. In most cases, confusion in elderly clients after surgery is due to unrelieved pain and not because of medications.

Gender also affects pain responses. Women report more feelings of fear and frustration due to pain than men do. On the other hand, studies show that men are more anxious about their pain than women.

4. Pain can provide clues to emotional and psychological health.

Keen attention to clients’ verbal statements and behaviors during assessment is necessary. Some pain can be because of emotional and psychological stresses. These may manifest through headaches, muscle pains, and back pains. Keep this in mind especially when all physical causes are ruled out. Sometimes, some people just need someone to hear them out and assist them towards making sense of all the feelings and thoughts that seem incomprehensible to them at the moment.

5. Nurses’ perceptions of pain affect the nurse-patient relationship.

Nurses’ opinion of how pain should be dealt with affect how they treat clients with pain complaints. It is important that they should be aware of this to prevent throwing judgments and imposing preferences to clients. Simply acknowledging pain can go a long way in easing clients with pain, seeing as how it is real to them. On the other hand, nurses should be vigilant about pain that is being faked by some individuals so appropriate referrals can be taken into consideration.

Proper assessment of pain is important.
Proper assessment of pain is important.

Nurses realize that pain persists in millions of lives today. Statistics does not show any affinity or the unique pattern to it. This makes it more tricky to approach. Every pain has a story, but we don’t have definitive explanations for it yet. Sometimes we get lucky, we can trace it down to its origin. On bad days, we witness a story of a pain that a person wakes up with one day and does not seem to have plans of leaving. Still, nurses work with available resources and current evidence-based practices with high hopes of being able to take the pain all away.

Iris Dawn is a nurse writer in her 20s who is on the constant lookout for latest stories about Science. Her interests include Research and Medical-Surgical Nursing. She is currently furthering her studies and is seriously considering being a student as her profession. Life is spoiling her with spaghetti, acoustic playlists, libraries, and the beach.

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