Definition for Acute Pain :
Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain); sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months
Subjective data: from patient usually Verbal report of pain
Objective data: Observed evidence of pain, protective gestures avoid pain, Change in muscle tone, Expressive; restlessness, moaning, crying, vigilance, irritability, sighing.
Definition for Chronic Pain :
NANDA Definition: Pain is whatever the experiencing person says it is, existing whenever the person says it does, an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe, constant or recurring, without an anticipated or predictable end and a duration >6 months; a state in which an individual experiences pain that persists for a month beyond the usual course of an acute illness or a reasonable duration for an injury to heal, is associated with a chronic pathologic process, or recurs at intervals for months or years.
Pain is always subjective and cannot be proved or disproved. The client’s report of pain is the most reliable indicator of pain. Clients with cognitive abilities who can speak or point should use a pain rating scale (eg 0 to 10) to identify their current level of pain intensity and determine a comfort/function goal .
Expressions of pain are extremely variable and cannot be used in lieu of self-report. Neither behavior nor vital signs can substitute for the client’s self-report. However, observable responses to pain are helpful in its assessment, especially in clients who cannot or will not use a self-report pain rating scale. Observable responses may be loss of appetite or the inability to ambulate, perform activities of daily living (ADLs), work, or sleep. Clients may show guarding, self-protective behavior, self-focusing or narrowed focus, distraction behavior ranging from crying to laughing, and muscle tension or rigidity. In sudden severe pain, autonomic responses such as diaphoresis, blood pressure and pulse changes, pupillary dilation, and increase or decrease in respiratory rate and depth may be present but are usually not present with chronic pain that is relatively stable. Clients with chronic, cancer, or nonmalignant pain may experience threats to self-image; a perceived lack of options for coping; and worsening helplessness, anxiety, and depression. Chronic pain may affect almost every aspect of the client’s daily life, including concentration, work, and relationships.
ON GOING ASSESSMENT
- Assess characteristics of pain: location, severity on a scale of 1 – 10, type, frequency, precipitating factors, and relief factors using the pain assessment form.
- Observe or monitor signs and symptoms associated with pain, such as BP, HR, temperature, color & moisture of skin, restlessness and ability to focus. Some people deny the experience of pain when it is present. Attention to associated signs may help the nurse in evaluating pain.
- Assess for probable cause of pain.
- Assess patient’s knowledge of or preference for the types of pain relief strategies available. Some patients may be unaware of the effectiveness of non-pharmacological methods and may be willing to try them. Often a combination (e.g., mild analgesics with distraction or heat) may be most effective.
- Evaluate the patient’s response to pain and medications or therapeutics aimed at abolishing or relieving pain. It is important to help the patients express as factually as possible the effect of pain relief measures.
- Assess to what degree cultural, environmental, interpersonal, & intrapsychic factors may contribute to pain or pain relief. Evaluate the unique response of each patient rather than stereotyping any patient response.
- If the patient is on PCA, assess the following: pain relief, patency of IV line, amount of pain medication the patient is requesting & possible PCA complications (excessive sedation, respiratory distress, urinary retention, nausea & vomiting, constipation, & IV site pain, redness or swelling.
- Anticipate need for pain relief. One can most effectively deal with pain by preventing it. Early intervention may decrease the total amount of analgesic required.
- Respond immediately to complaint of pain. In the midst of painful experiences, a patient’s perception of time may become distorted. Prompt responses to complaints may result in decreased anxiety in the patient. Teach patient to request analgesics before pain becomes severe.
- Eliminate additional stressors or sources of discomfort whenever possible.
- Provide rest periods to facilitate comfort, sleep, and relaxation. A quiet environment and a darkened room are measures that help facilitate rest.
- Offer analgesics every __ hours or prn (according to physician’s order). Evaluate effectiveness and observe for any signs and symptoms of untoward effects.
- Explore non-pharmacological methods for reducing pain/promoting comfort:
- Back rubs
- Slow rhythmic breathing
- Diversional activities such as music, TV, etc.
- Warm or cold compress
- Notify the physician if interventions are unsuccessful or if the current complaint is a significant change from the patient’s past experience of pain. Patients who request pain medications at more frequent intervals than prescribed may actually require higher doses or more potent analgesics.
- Encourage the patient to keep a pain diary to help in identifying aggravating and relieving factors of chronic pain.
- Acknowledge and convey acceptance of the patient’s pain experience.
- Provide the patient/family with information about chronic pain.
EDUCATION / CONTINUITY OF CARE
- Provide anticipatory instruction on pain causes, appropriate prevention, and relief measures.
- Instruct the patient to report pain & to evaluate and report effectiveness of measures used.
- Teach patient effective timing of medication dose in relation to potentially uncomfortable activities and prevention of peak pain periods.
- Teach the patient about non pharmacologic pain management strategies – cold/warm applications, massage, progressive relaxation, music, imagery, diversional activities, etc.
- Teach the patient & family about the use of pharmacological interventions for pain management:
- Nonopioids (paracetamol; NSAIDs; & selective NSAIDs (COX-2 inhibitors) – can be taken orally and not associated with dependency and addiction.
- Opioid analgesics (narcotics) – watch for side effects such as nausea, vomiting, constipation, sedation, respiratory depression, tolerance and dependency.
- Antidepressants – may be useful adjuncts in a total program of pain management, especially for those with chronic neuropathic pain. In addition to their effect on the patient’s mood, the antidepressants may have analgesic properties apart from their antidepressant actions.
- Refer the patient and family to community support groups and self-help groups for people coping with chronic pain.