Identifying the problem: pain management

(Previously published)

Identifying the problem: pain management

Pain can be debilitating if not managed correctly, and yet that is what when nurses fail to lead and work with the interdisciplinary team to manage pain. Lack of proper pain control affects the patient as well as the staff, and can cost the facility money for continuous readmission. For this reason, nurses must understand pain and pain management, and know how to work with other disciplines to achieve this goal.

Knowledge of pain and pain management

In biology we learned that pain receptors, or nociceptors, are sensory receptors within the nervous system that detects injury to the body (Starr, Evers, & Starr, 2009). Damage can occur from different sources, but the body’s response to the injury is the same, inflammation. If injury occurs for a short duration, because the damaging agent is removed, the inflammatory response is acute and intense (Tortora, Funke, & Case, 2010). If the injury is continuous, because the injury isn’t corrected or it is impossible to correct, the inflammation is considered chronic and is usually less intense but long lasting (Tortora Funke, & Case, 2010). Inflammation is supposed to remove or reduce the effects of the injurious agent to allow the body to repair or replace the damaged cells. The inflammatory process that occurs due to injury leads to the production of proteins that intensifies the inflammatory process, yet high levels of these proteins may lead to inflammatory disorders (Tortora, Funke, & Case, 2010). Injury to the body also causes vasodilation in the location of damage, thus increasing permeability of defensive substances and fluid, which causes edema. Inflammation, edema or toxic proteins can lead to nerve damage and thus acute or chronic pain (Tortora, Funke, & Case, 2010).

The perception of pain and where pain is felt compared to where it originates from is vital to manage pain. Nociceptors vary throughout the body and are described differently depending on their location. Nociceptors triggered within internal organs are described as visceral pain and are usually felt on the surface either immediately above the location of injury or radiating to proximal body parts, this experience is termed referred pain (Coon & Mitterer, 2010). Somatic pain is felt when injury occurs to the integumentary, muscular or joints and tendons of the skeletal system (Coon & Mitterer, 2010). Somatic pain usually feels sharper than visceral pain, although either can feel sharp or dull depending on the injury occurring. The perception of pain occurs as a warning sign of an injurious agent against the body, yet certain individuals inherit pain insensitivity that causes individuals to feel pain or empathize with others who are in pain (Cox et al., 2006 & Danziger, Prkachin, & Willer, 2006).

Nursing education and experience on pain and pain management

Besides the for mentioned location and duration of pain, pain can be categorized in intensity and etiology as well. Cancer pain, burn pain and postherpetic neuralgia are examples of etiology pain (Smeltzer, Bare, Hinkle & Cheever, 2010). Pain is also perceived by severity or intensity: mild, moderate or severe (Berman & Snyder, 2012). We learn in nursing fundamentals that the perception of pain is different to each individual, as pain threshold and tolerance varies. “Pain threshold is the least amount of stimuli that is needed for a person” to feel pain while “pain tolerance is the maximum amount of painful stimuli that a person is willing to withstand” without need of pain relief or avoidance (Berman & Snyder, 2012).

Pain management is important as we learn in medical-surgical nursing because acute and chronic pain can lead to adverse effects. Pain causes body wide stress, leading to sympathetic activation that can raise blood pressure, increase respirator rate, and inhibit gastric secretion and contraction causing nausea and vomiting (Burns, 2014). Continuous pain without removal of the stimuli or administration of pain relief leads to physiological disorders such as pulmonary infection, prolonged paralytic ileus, venous thromboembolism and even myocardial infarction in acute pain (Smeltzer, Bare, Hinkle & Cheever, 2010). Chronic pain can lead to immune function suppression, which may lead to tumor growth, depression and long term disability (Smeltzer, Bare, Hinkle & Cheever, 2010).

Working in palliative care, pain management is a primary focus of care. Patients can cause harm to the body if not treated correctly. Pain can hinder the progression to recovery of an individual by reducing pulmonary inspiration or physical mobility. Acute pain that isn’t treated leads to chronic pain, and chronic pain that is untreated leads to patients who continuously seek medical treatment for pain relief.

The lack of pain management

Proper pain management is an issue in the Clinical Evaluation Unit at Orlando Regional Medical Center. This is evident by high number of returning patients whose chief complaint is acute and chronic pain in nature. Poor satisfaction occurs when an individual believes there complaint has not been resolved. Within the healthcare setting, poor patient satisfaction occurs when the individual believes there medical complaint is ignored and therefore not treated. Medicaid and Medicare links quality of service to hospital payments. Medicare will reduce payment to hospitals for patients who are readmitted within 30 days of discharge for reasons such as treatment complications, inadequate treatment, inadequate care coordination and follow up, and unexpected worsening of the disease after discharge (Medicare.gov, n.d.).

Patients become frustrated when their pain isn’t managed in a timely manner and nursing staff become frustrated when patients continuously call for pain medication. These occurs because of lack of proper pain management. Patients suffering from pain for an extended period can lead to adverse effects that are harmful to the body as previously mentioned. Health progression is also hindered when pain is not managed. For nursing staff, consistent lack of proper pain management increases workload by requiring the nurse to repeatedly call the provider for medications to control pain or adverse effects management. 

Conclusion

            Pain that is not managed can lead to adverse effects within the patient. For this reason, nurses need to understand pain, its consequence, how they can reduce and manage pain, and how they need to work with other disciplines to manage pain. Awareness of the problem occurring with pain management is the first step towards correcting the issue. With research into the involvement of nurses and the interdisciplinary team with pain management, patients and staff gain to benefit from reduction of adverse effects and hospitals gain to save money.

(Quoted from research paper by Roberto Rivera-Olmo).

References

Berman, A. & Snyder, S. J. (2012). Pain management (p. 1204-1248). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice. Upper Saddle River, NJ: Pearson Education

Burns. S. M. (2014). Pain and sedation management (p.133-150). AACN essentials of progressive care nursing. New York, NY: McGraw Hill Education

Coon, D. & Mitterer, J. O. (2010). Sensation and reality (p. 139). Introduction to psychology: Gateways to mind and behavior. Belmont, CA: Wadsworth

Cox, J. J., Reimann, F., Nicholas, A. K., et al. (2006). An SCN9A channelopathy causes congenital inability to experience pain. Nature, 444, 894-898

Danziger, N., Prkachin, K. M., & Willer, J.-C. (2006). Is pain the price of empathy? The perception of others’ pain in patients with congenital insensitibity to pain. Brain: A journal of neurology, 129(9), 2494-2507

Medicare.gov (n.d.). Linking quality to payment. Hospital compare. Retrieved from https://www.medicare.gov/hospitalcompare/linking-quality-to-payment.html?AspxAutoDetectCookieSupport=1

Smeltzer, S. C., Bare, B. G., Hinkle, J. L. & Cheever, K. H. (2010). Pain Management (p. 230-262). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia, PA: Lippincott Williams & Wilkins

Starr, C., Evers, C. & Starr, L. (2009). Neural control and the senses (p. 531). Biology today and tomorrow. Mason, OH: Cengage Learning

Tortora, G. J., Funke, B. R. & Case, C. L. (2010).Innate immunity: Nonspecific defenses of the host (p. 460-461) Microbiology: An introduction. San Francisco, CA: Pearson Benjamin Cummings