Pain Management (PM)
MANAGEMENT OF A PATIENT WITH CHRONIC PAIN (VERBAL)
This is a process of managing chronic pain by the nurse/midwife using nonpharmacological and pharmacological interventions to promote quality of life. Chronic pain persists for over three to six months and for patients who are able to speak, self-report based on numerical, verbal or graphical rating scales ensures adequate management.
Purpose
- Effectively assess chronic pain in patients who can describe their pain experience
- Implement interventions that will ensure holistic management of pain to a verbal rating score of 0-3
- Relieve the patient of chronic pain, discomfort and suffering
- Promote the dignity of the patient
- Promote early ambulation and discharge of patient
- Reduce pain with minimal adverse effect
- Prevent abuse and addiction
- Counsel patient on adverse effects of pain relieving medications
- Prevent medication resistance
Indications
- Nonpharmacological
- Pharmacological
Equipment
- Patient Treatment chart (Electronic or Manual)
- A tray containing the following
- Spoon
- A cup
- A saucer
- A jug/bottle/sachet of water
- A pair of scissors
- Tissue paper/napkin
- Prescribed pain medication and other adjuvant
- Pulse oximeter
Procedure steps
- Establish rapport with patient to facilitate openness in communication
- Perform the five moments of hand hygiene
- Obtain history of the pain as follows:
- Ask patient about the onset of the pain to confirm chronicity noting if there was a sudden or gradual onset
- Explore the quality of pain to determine if the pain is sharp, burning, tingling, gnawing or dull
- Ask patient to describe the location of the pain and whether it is generalised or localised and illustrate this on the *body map if applicable
- Ask about the severity of the pain on the scale of 0-10 or using the colour recognition from white-black
- Find out whether pain is intermittent or continuous
- Determine the factors that precipitate, aggravate or relieve the pain
- Explore any associated symptoms such as weakness, anxiety, depression, sleep pattern changes, appetite and weight loss
- Find out about the effect of the pain on functional abilities
- Ask about previous treatment and therapies used to manage the pain
- Explore the influence of patient’s perception, experiences and cultural context on pain expression
Precautions
- Pain assessment is part of vital signs
- Provide patient and family with adequate information and education on pain management
- Assess the pain using objective scales such as 0-10 Numeric Pain Rating Scale, Wong-Baker Faces Pain Scale, Colour-Circle Pain Scale etc. and document
- Treat each patient as an individual and involve the patient and family in the pain management
- Employ evidence-based contemporary recommendations for pain management such as:
- Pre-emptive analgesia (analgesic given before a painful stimulus)
- Multi-modal analgesia (using two or more forms of analgesic concurrently)
- Time-scheduled analgesic administration (giving the analgesics according to the time prescribed regularly)
- Non-pharmacological methods of relieving pain such as early mobilization, passive mobilization, positioning, and other appropriate measures should be used as adjuncts to analgesic administration for pain management
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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