Dull, achy, throbbing, sore Bone metastases, musculoskeletal injury, mucositis, skin lesions It is also important to document the impact pain has on quality of life. Key questions to ask include: Does pain affect sleep?
Pain is often classified as acute or chronic. Acute pain, such as postoperative pain, subsides as healing takes place.
Chronic pain is persistent and is subdivided into cancer-related pain and nonmalignant pain, such as arthritis, low-back pain, and peripheral neuropathy. These authors will draw from the body of knowledge related to chronic pain; however, this chapter will focus on the evidence supporting management of acute pain experienced by hospitalized adults.
Scope of the Problem Almost 35 million patients were discharged from U. Recent data suggest 80 percent of patients experience pain postoperatively 2 with between 11 and 20 percent experiencing severe pain. Importance of Controlling Pain Inadequately managed pain can lead to adverse physical and psychological patient outcomes for individual patients and their families.
Continuous, unrelieved pain activates the pituitary-adrenal axis, which can suppress the immune system and result in postsurgical infection and poor wound healing. Sympathetic activation can have negative effects on the cardiovascular, gastrointestinal, and renal systems, predisposing patients to adverse events such as cardiac ischemia and ileus.
Of particular importance to nursing care, unrelieved pain reduces patient mobility, resulting in complications such as deep vein thrombosis, pulmonary embolus, and pneumonia.
Continuous, unrelieved pain also affects the psychological state of the patient and family members. Common psychological responses to pain include anxiety and depression. The inability to escape from pain may create a sense of helplessness and even hopelessness, which may predispose the patient to a more chronic depression.
Patients who have experienced inadequate pain management may be reluctant to seek medical care for other health problems. Poorly managing pain may put clinicians at risk for legal action.
Current standards for pain management, such as the national standards outlined by the Joint Commission formerly known as the Joint Commission on Accreditation of Healthcare Organizations, JCAHO5 require that pain is promptly addressed and managed.
Having standards of care in place increases the risk of legal action against clinicians and institutions for poor pain management, 6 and there are instances of law suits filed for poor pain management by physicians.
Hospitals stand to lose reputation as well as profit if pain is poorly managed. Patient satisfaction with care is strongly tied to their experiences with pain during hospitalization.
Evidence indicates that higher levels of pain and depression are linked to poor satisfaction with care in ambulatory settings. Undertreatment of Pain The undertreatment of pain was first documented in a landmark study by Marks and Sachar in The undertreatment of pain continues.
Thirty years later inApfelbaum and others 2 found that 80 percent of surgical patients experienced acute pain after surgery, and 86 percent of those had moderate to extreme pain. Of 1, outpatients with metastatic cancer from 54 cancer treatment centers, 67 percent reported pain.
It is estimated that 45 percent to 80 percent of elderly patients in nursing homes have substantial pain that is undertreated. Pain robs patients of their lives. Patients may become depressed or anxious and want to end their lives.
Patients are sometimes unable to do many of the things they did without pain, and this state of living in pain affects their relationships with others and sometimes their ability to maintain employment.
What is often overlooked is that pain has physically harmful effects. It is often actually physiologically unsafe to have pain. The endocrine system reacts by releasing an excessive amount of hormones, ultimately resulting in carbohydrate, protein, and fat catabolism destruction ; poor glucose use; and other harmful effects.
This reaction combined with inflammatory processes can produce weight loss, tachycardia, increased respiratory rate, fever, shock, and death. In the postoperative period, these include hypercoagulation and increased heart rate, blood pressure, cardiac work load, and oxygen demand.
Aggressive pain control is required to reduce these effects and prevent thromboembolic complications. Cardiac morbidity is the primary cause of death after anesthesia and surgery. This response can cause temporary impairment of gastrointestinal function and increase the risk of ileus.
Stress and pain can suppress immune functions, including the natural killer NK cells that play a role in preventing tumor growth and controlling metastasis. Thus, pain now can cause pain later. If acute shingles pain is not treated aggressively, it is believed to increase the risk of postherpetic neuralgia.
In a sample of physicians and nurses, Anderson and colleagues 21 found lack of pain assessment was one of the most problematic barriers to achieving good pain control. There are many recommendations and guidelines for what constitutes an adequate pain assessment; however, many recommendations seem impractical in acute care practice.Pain management refers to the appropriate treatment and interventions developed in relation to pain assessment, and should be developed in collaboration with the patient and family.
Strategies are. We conceptualised pain assessment and management as involving decision making processes, such as the accurate interpretation of the patient’s pain experience (an assessment or judgement), and taking appropriate actions to ameliorate the pain (making treatment decisions) (something we discuss more in depth elsewhere).
After years of neglect, issues of pain assessment and management have captured the attention of both health care professionals and the public. Factors that prompted such attention include the high prevalence of pain, continuing evidence that pain is undertreated, and a growing awareness of.
Adequate pain management requires an interdisciplinary approach. 22, 24 Documentation of pain assessment and the effect of interventions are essential to allow communication among clinicians about the current status of the patient’s pain and responses to the plan of care.
The Joint Commission requires documentation of pain to facilitate reassessment and followup. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management Sixth Edition by Reny de Leeuw (Author, Editor), Gary D.
Klasser (Author, Editor)5/5(2). Assessment and diagnosis for successful pain management.
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