Unrelieved pain can have significant harmful effects by activating the stress response and impacting multiple body systems. It causes metabolic changes like increased catabolism, hyperglycemia, and insulin resistance. Cardiovascular effects include increased heart rate, blood pressure, and risk of heart attack or stroke. Respiratory issues involve decreased function and risk of pneumonia. Gastrointestinal and genitourinary changes can also occur. Musculoskeletal spasms and immobility are risks, as is reduced cognitive function. Proper pain management is important for patient health, comfort, and recovery.

1. Pain ManagementPain Management
The Legal SideThe Legal Side
References:References:
Pain: Clinical Manual-M. McCaffery & C. Pasero &Pain: Clinical Manual-M. McCaffery & C. Pasero &
Core Curriculum For Pain Management Nursing-B. St.MarieCore Curriculum For Pain Management Nursing-B. St.Marie
ANA Pain Management Nursing: Scope and Standards of PracticeANA Pain Management Nursing: Scope and Standards of Practice
NANDA Nursing Diagnosis approved list.NANDA Nursing Diagnosis approved list.

2. Millions of dollars are awarded every year toMillions of dollars are awarded every year to
patients who have suffered and endured painpatients who have suffered and endured pain
needlessly. Nurses, like doctors, have beenneedlessly. Nurses, like doctors, have been
held accountable for failure to adequatelyheld accountable for failure to adequately
treat pain and suffering.treat pain and suffering.
When we as professionals fail to treat pain, weWhen we as professionals fail to treat pain, we
put ourselves at risk for licensure suspension,put ourselves at risk for licensure suspension,
disciplinary action, fines or having ourdisciplinary action, fines or having our
privileges revoked.privileges revoked.

3.  Every state has a nurse practice act and a board of
nursing rules and regulations. This act defines the
practice of APN, RN, and LPN’s.
 The NPA is designed to help protect the public by
broadly defining the legal scope of nursing practice.
 Every nurse is expected to care for their patients
within these defined practice limits.
 If a nurse practices outside these limits or fails to
provide care within these limits, they become
vulnerable to charges of violating the law and losing
his/her licensure.

4. For a copy of your State Nursing PracticeFor a copy of your State Nursing Practice
Act or Board of Nursing rules andAct or Board of Nursing rules and
regulations call:regulations call:
(312) 419-2900(312) 419-2900

5. Know your StandardsKnow your Standards
 ANA-Nursing StandardsANA-Nursing Standards
 APS-American Pain SocietyAPS-American Pain Society
 ASPMN-American Society of PainASPMN-American Society of Pain
Management NursesManagement Nurses
 AANA-American Association of NurseAANA-American Association of Nurse
AnesthetistsAnesthetists
 JCAHO-Joint Commission on Accreditation ofJCAHO-Joint Commission on Accreditation of
Healthcare OrganizationsHealthcare Organizations

6. STANDARDS OF CARESTANDARDS OF CARE
Standards of care: include safeStandards of care: include safe
and accepted nursing careand accepted nursing care
practices. The standard ofpractices. The standard of
care is assessed by policiescare is assessed by policies
and guidelines that areand guidelines that are
written by nationallywritten by nationally
recognized organizations orrecognized organizations or
specialty societies.specialty societies.
Standards include formalStandards include formal
training, as outlined intraining, as outlined in
hospital policies orhospital policies or
contained in authoritativecontained in authoritative
textbooks and articles.textbooks and articles.

7.  Standards of Care are written byStandards of Care are written by
nationally accredited organizationsnationally accredited organizations
such as the ANA, ASPAN andsuch as the ANA, ASPAN and
JCAHO. These standards are oftenJCAHO. These standards are often
used as guidelines for best practiceused as guidelines for best practice
and are evidence based.and are evidence based.
 They are referred to and used asThey are referred to and used as
evidence in malpractice trials.evidence in malpractice trials.
 Standards of care are theStandards of care are the goldgold
standards used in healthcare.standards used in healthcare.

8. JCAHOJCAHO
 1992-Standards manual now includes1992-Standards manual now includes
effective pain management as one of the rightseffective pain management as one of the rights
of a dying patient.of a dying patient.
 1994-Previous statement was broadened to1994-Previous statement was broadened to
include all patients, not just the dying.include all patients, not just the dying.
 1997-JCAHO begins working with institutions1997-JCAHO begins working with institutions
to create standards for pain assessment,to create standards for pain assessment,
treatment and national quality improvementtreatment and national quality improvement
programs.programs.

9. JCAHO STANDARDS FOR PAINJCAHO STANDARDS FOR PAIN
MANAGEMENT.MANAGEMENT.
 Patients are involved in all aspects of their care,Patients are involved in all aspects of their care,
including effective pain managementincluding effective pain management
 Patients have the right to adequate assessment andPatients have the right to adequate assessment and
treatment of pain.treatment of pain.
 Pain is assessed in all patientsPain is assessed in all patients
 Policies and procedures support safe medicationPolicies and procedures support safe medication
prescription or ordering, including scheduledprescription or ordering, including scheduled
prescriptions and patient controlled analgesia. Spinalprescriptions and patient controlled analgesia. Spinal
administration of pain management technologies usedadministration of pain management technologies used
in patients with pain.in patients with pain.

10. JCAHO STANDARDS ( Continued )JCAHO STANDARDS ( Continued )
 Their pain is monitored during the post procedure period forTheir pain is monitored during the post procedure period for
pain intensity, duration, location, character, and response forpain intensity, duration, location, character, and response for
treatments, among other items.treatments, among other items.
 Standards, intents, and examples for rehabilitative care andStandards, intents, and examples for rehabilitative care and
services, includes pain interfering with function and mobility.services, includes pain interfering with function and mobility.
 Patients are educated about pain and its management as part ofPatients are educated about pain and its management as part of
treatment, as appropriate.treatment, as appropriate.
 The discharge planning process provides for continuing careThe discharge planning process provides for continuing care
based on the patient’s assessed needs at the time of discharge,based on the patient’s assessed needs at the time of discharge,
including symptom management.including symptom management.

11. JACHO now closely monitors pain management andJACHO now closely monitors pain management and
patient satisfaction related to pain management.patient satisfaction related to pain management.

12. Patients RightsPatients Rights
 Patients have the right toPatients have the right to
receive optimal pain relief andreceive optimal pain relief and
be involved in their painbe involved in their pain
management treatments,management treatments,
benefits and risks ofbenefits and risks of
procedures, alternative painprocedures, alternative pain
management modalities, andmanagement modalities, and
expected outcomes.expected outcomes.

13. PATIENT RIGHTSPATIENT RIGHTS
FOR PAIN CONTROLFOR PAIN CONTROL
BILL of RIGHTS for people with painBILL of RIGHTS for people with pain
 I have the right to have my reports of pain accepted andI have the right to have my reports of pain accepted and
acted on by health care professionals.acted on by health care professionals.
 I have the right to have my pain controlled, no matter whatI have the right to have my pain controlled, no matter what
its cause or how severe it may be.its cause or how severe it may be.
 I have the right to be treated with respect at all times.I have the right to be treated with respect at all times.
When I need medication for pain, I should not be treatedWhen I need medication for pain, I should not be treated
like a drug abuser.like a drug abuser.
……Remember, the single MOST RELIABLE indicator ofRemember, the single MOST RELIABLE indicator of
pain is the PATIENT’S SELF REPORT!!!pain is the PATIENT’S SELF REPORT!!!

14. Poor pain management andPoor pain management and
substandard documentation cansubstandard documentation can
trigger:trigger:
 Survey citations for abuse, violation of patient rightsSurvey citations for abuse, violation of patient rights
and substandard care.and substandard care.
 Litigation against hospitals, outpatient clinics,Litigation against hospitals, outpatient clinics,
nursing homes, doctors, nurses, therapist andnursing homes, doctors, nurses, therapist and
administrative personnel.administrative personnel.
 Legal action against individual professionals who failLegal action against individual professionals who fail
to act in the patients best interest.to act in the patients best interest.

15.  Nurses are held accountable for their individualNurses are held accountable for their individual
actions. Healthcare organizations are likely to holdactions. Healthcare organizations are likely to hold
negligent employees accountable for their actions.negligent employees accountable for their actions.
If you fail to follow your employer’s policies andIf you fail to follow your employer’s policies and
procedures you may stand alone in a legal battle.procedures you may stand alone in a legal battle.

16. Patients ExpectPatients Expect
 Knowledgeable and competent healthcareKnowledgeable and competent healthcare
staffstaff
 High quality careHigh quality care
 Safe environmentSafe environment
 Attentive and compassionate careAttentive and compassionate care
 Comfort care and management of painComfort care and management of pain
 Privacy and confidentialityPrivacy and confidentiality

17. Why Suffer?Why Suffer?
 Resources andResources and
knowledge exist toknowledge exist to
provide satisfactoryprovide satisfactory
and safe pain reliefand safe pain relief
in 90% of all peoplein 90% of all people
who suffer pain.who suffer pain.

18. ……HoweverHowever
 50% of conscious patients who die in the hospital50% of conscious patients who die in the hospital
setting will experience moderate to severe pain.setting will experience moderate to severe pain.
 61% of acute pain sufferers reported pain ratings of61% of acute pain sufferers reported pain ratings of
7-10 on the pain scale.7-10 on the pain scale.
 67% of metastatic cancer patients reported pain and67% of metastatic cancer patients reported pain and
62% of those had pain severe enough to impair their62% of those had pain severe enough to impair their
ability to function. 42% of those patients were notability to function. 42% of those patients were not
prescribed analgesic capable of relieving their pain.prescribed analgesic capable of relieving their pain.

19. LEGAL IMPLICATIONS ANDLEGAL IMPLICATIONS AND
JOINT COMMISSION ASIDE…JOINT COMMISSION ASIDE…
we want to provide thewe want to provide the
best care for THE PATIENTbest care for THE PATIENT!!
 There areThere are significant harmfulsignificant harmful
effects ofeffects of UNRELIEVED painUNRELIEVED pain
 The stress responses activate theThe stress responses activate the
sympathetic nervous systemsympathetic nervous system andand
cause effects involvingcause effects involving multiplemultiple
systems.systems.

20. UNRELIEVED PAIN AND THEUNRELIEVED PAIN AND THE
ENDOCRINE SystemENDOCRINE System
 Increased adrenocorticotrophic hormone (ATCH)Increased adrenocorticotrophic hormone (ATCH)
 Increased cortisol & antidiuretic hormone (ADH)Increased cortisol & antidiuretic hormone (ADH)
 Increased epinephrine & norepinephrineIncreased epinephrine & norepinephrine
 Increased growth hormone (GH), catacholamines & reninIncreased growth hormone (GH), catacholamines & renin
 Increased angiotensin II & aldosteroneIncreased angiotensin II & aldosterone
 Increased glucagon & interleukin-1Increased glucagon & interleukin-1
 Decreased insulinDecreased insulin
 Decreased testosteroneDecreased testosterone
 All totalingAll totaling The STRESS RESPONSE!The STRESS RESPONSE!

21. HOLY COW!HOLY COW!
Who would have thought that so manyWho would have thought that so many
changes could occur in the body with pain?changes could occur in the body with pain?
But, that was just theBut, that was just the
ENDOCRINE SYSTEM!ENDOCRINE SYSTEM!

22. UNRELIEVED PAIN AND THEUNRELIEVED PAIN AND THE
METABOLIC SystemMETABOLIC System
 Gluconeogenesis – breakdown into glycogen of aminoGluconeogenesis – breakdown into glycogen of amino
acids & fatacids & fat as though the body is in starvationas though the body is in starvation
 Hepatic glycogenolysis – Conversion of glycogen toHepatic glycogenolysis – Conversion of glycogen to
glucose in the liverglucose in the liver
 HyperglycemiaHyperglycemia
 Glucose intolerance – poor use of available glucoseGlucose intolerance – poor use of available glucose
 Insulin resistanceInsulin resistance
 Muscle protein catabolism (destruction) as well asMuscle protein catabolism (destruction) as well as
destruction of carbohydrates and fatdestruction of carbohydrates and fat
 Increased lipolysis – destruction of fat cellsIncreased lipolysis – destruction of fat cells
……Imagine the implicationsImagine the implications for the diabetic or if the patientfor the diabetic or if the patient
is on steroids!is on steroids!

23. IMPLICATIONS FOR THEIMPLICATIONS FOR THE
ENDOCRINE & METABOLICENDOCRINE & METABOLIC
SYSTEMSSYSTEMS
 Overall, the endocrine & nervous systems, regulate theOverall, the endocrine & nervous systems, regulate the
metabolic system to maintain normal body growth andmetabolic system to maintain normal body growth and
function. Multiple cascading events occur when pain isfunction. Multiple cascading events occur when pain is
not controlled:not controlled:
 Protein, fat & CHO catabolism/destructionProtein, fat & CHO catabolism/destruction
 Poor glucose conversion and use of available glucosePoor glucose conversion and use of available glucose
 INFLAMMATION + ENDOCRINE/METABOLIC changesINFLAMMATION + ENDOCRINE/METABOLIC changes
= weight loss, tachycardia, increased respiratory rate, fever,= weight loss, tachycardia, increased respiratory rate, fever,
shock and eventually deathshock and eventually death

24. UNRELIEVED PAIN AND THEUNRELIEVED PAIN AND THE
CARDIOVASCULAR SystemCARDIOVASCULAR System
 Increased heart rateIncreased heart rate
 Increased cardiac outputIncreased cardiac output
 Increased Peripheral vascular resistanceIncreased Peripheral vascular resistance
 Increased Systemic vascular resistanceIncreased Systemic vascular resistance
 HYPERTENSIONHYPERTENSION
 Increased coronary vascular resistanceIncreased coronary vascular resistance
 Increased myocardial oxygen consumptionIncreased myocardial oxygen consumption
 HypercoagulationHypercoagulation
 Deep vein thrombosisDeep vein thrombosis
ULTIMATELY…PAINULTIMATELY…PAIN actuallyactually CONTRIBUTESCONTRIBUTES TOTO
Heart Attacks, Strokes and DVTs!Heart Attacks, Strokes and DVTs!

25. UNRELIEVED PAIN AND THEUNRELIEVED PAIN AND THE
RESPIRATORY SystemRESPIRATORY System
 Decreased flows and volumesDecreased flows and volumes
 AtelectasisAtelectasis
 ShuntingShunting
 HypoxemiaHypoxemia
 Decreased coughDecreased cough
 Sputum retentionSputum retention
 InfectionInfection
CAUSING…CAUSING…
Decreased oxygen carrying capacityDecreased oxygen carrying capacity
……and evenand even PneumoniaPneumonia

26. UNRELIEVED PAIN AND THEUNRELIEVED PAIN AND THE
GU SystemGU System
 Decreased urinary outputDecreased urinary output
 Urinary retentionUrinary retention
 Fluid overloadFluid overload
 HypokalemiaHypokalemia
 ……Causing increased cardiac workload & HTN,Causing increased cardiac workload & HTN,
dysrhythmias…dysrhythmias…
UNRELIEVED PAIN AND THEUNRELIEVED PAIN AND THE
GI SystemGI System
- Decreased gastric & bowel motilityDecreased gastric & bowel motility
- …… Potential constipation & ileus (GI paralysis)Potential constipation & ileus (GI paralysis)

27. UNRELIEVED PAIN AND THEUNRELIEVED PAIN AND THE
MUSCULOSKELETAL SystemMUSCULOSKELETAL System
 Muscle spasmMuscle spasm
 Impaired muscle functionImpaired muscle function
 FatigueFatigue
 ImmobilityImmobility
 ……More risk for DVT, pneumonia, increased staysMore risk for DVT, pneumonia, increased stays
-- Reduction in cognitive functioning-- Reduction in cognitive functioning
-- Mental confusion-- Mental confusion
UNRELIEVED PAIN ANDUNRELIEVED PAIN AND
COGNITIVE FUNCTIONCOGNITIVE FUNCTION

28. UNRELIEVED PAIN ANDUNRELIEVED PAIN AND
DEVELOPMENTAL IssuesDEVELOPMENTAL Issues
 Increased behavioral and physiologic responses to painIncreased behavioral and physiologic responses to pain
 Altered temperamentsAltered temperaments
 Higher somatization –Higher somatization – to convert anxiety into physical symptomsto convert anxiety into physical symptoms
 Infant distress behaviorInfant distress behavior
 Possible altered development of the pain systemPossible altered development of the pain system
 Increased vulnerability to stress disordersIncreased vulnerability to stress disorders
 Addictive behaviorAddictive behavior
 Anxiety statesAnxiety states
UNRELIEVED PAIN AND THEUNRELIEVED PAIN AND THE
IMMUNE SYSTEMIMMUNE SYSTEM
-- Depression of the immune system-- Depression of the immune system

29. UNRELIEVED PAIN AND RELATIONSHIP TOUNRELIEVED PAIN AND RELATIONSHIP TO
FUTURE PAINFUTURE PAIN
 Predisposed to debilitating chronic pain syndromesPredisposed to debilitating chronic pain syndromes
 Postmastectomy pain increasedPostmastectomy pain increased
 Postthoracotomy pain increasedPostthoracotomy pain increased
 Increased episodes of Phantom pain if pain not controlledIncreased episodes of Phantom pain if pain not controlled
adequately pre-operativelyadequately pre-operatively
 Posttherpetic neuralgia – pain following an attack ofPosttherpetic neuralgia – pain following an attack of
herpes zoster/shinglesherpes zoster/shingles
……Yes,Yes, pain your patients have todaypain your patients have today will affectwill affect
their pain thresholds and their ability to copetheir pain thresholds and their ability to cope
with pain later in life!with pain later in life!

30. UNRELIEVED PAIN ANDUNRELIEVED PAIN AND
QUALITY OF LIFE (QOL)QUALITY OF LIFE (QOL)
ISSUESISSUES
 Increased sleeplessnessIncreased sleeplessness
 Problems with anxiety & fearsProblems with anxiety & fears
 Hopelessness, depression and thoughts of suicideHopelessness, depression and thoughts of suicide
-- certainly not to be seen as “benign,” but on the contrary,-- certainly not to be seen as “benign,” but on the contrary,
can be life threateningcan be life threatening
 Increased stress within familiesIncreased stress within families

31. MISCONCEPTIONMISCONCEPTION
““PAIN NEVER KILLED ANYONE”PAIN NEVER KILLED ANYONE”
 Unrelieved pain may be dangerous and is, therefore,Unrelieved pain may be dangerous and is, therefore,
unacceptable. Research now shows that past attitudesunacceptable. Research now shows that past attitudes
of expecting surgery to hurt and believing that “painof expecting surgery to hurt and believing that “pain
never killed anyone” are no longer justified.never killed anyone” are no longer justified.
 Post-op painPost-op pain can killcan kill by delaying healing andby delaying healing and
contributing to complications that are life-threatening.contributing to complications that are life-threatening.
 Unrelieved post-op pain must now be viewed andUnrelieved post-op pain must now be viewed and
treated as a complication or risk, not as an acceptabletreated as a complication or risk, not as an acceptable
consequence of surgery.consequence of surgery.
 Chronic pain also has many serious adverse effectsChronic pain also has many serious adverse effects
such as suppressing immune function.such as suppressing immune function.

32. -OVERALL –OVERALL –
Poor pain managementPoor pain management
 Increases patient lengthsIncreases patient lengths
of stayof stay
 Causes unnecessaryCauses unnecessary
stress on the heart &stress on the heart &
HTNHTN
 Causes DVT,Causes DVT,
pneumonia or otherpneumonia or other
serious complicationsserious complications
 Decreases the ability toDecreases the ability to
heal efficientlyheal efficiently
 Increases relationshipIncreases relationship
stresses between thestresses between the
patient, family & staffpatient, family & staff
 Can seriously affect theCan seriously affect the
patient’s long-termpatient’s long-term
health and welfarehealth and welfare
 Increases the risk ofIncreases the risk of
liability for the hospitalliability for the hospital
AND the individualAND the individual
staff member – YOU!staff member – YOU!

33. PAIN IS THE #1 REASONPAIN IS THE #1 REASON
patients seek medical carepatients seek medical care
 Document as though aDocument as though a
jury/attorney will bejury/attorney will be
reviewing it – they may!reviewing it – they may!
 Know theKnow the
organizational policiesorganizational policies
and procedures for painand procedures for pain
management andmanagement and
documentationdocumentation
 Follow those guidelinesFollow those guidelines
 Question if the policiesQuestion if the policies
need updating orneed updating or
improvementsimprovements
 Pain managementPain management
should always be ashould always be a
priority in yourpriority in your
continuing educationcontinuing education
 Always provide careAlways provide care
which is conscientiouswhich is conscientious
and compassionate, andand compassionate, and
document accordinglydocument accordingly
 Your patients depend onYour patients depend on
YOU to be an advocateYOU to be an advocate
for them in their time offor them in their time of
needneed

34. Thorough Assessment tools are moreThorough Assessment tools are more
than just a convenience…than just a convenience…

35. ……Pain assessment should bePain assessment should be at leastat least
as often as vital signs:as often as vital signs:
PAIN IS THE 5PAIN IS THE 5THTH
VITAL SIGNVITAL SIGN
 Pain assessment is required to be completed onPain assessment is required to be completed on
ALL patients a MINIMUM of every shiftALL patients a MINIMUM of every shift
 Even if the patient appears asleep, the FLACCEven if the patient appears asleep, the FLACC
scale can and should be usedscale can and should be used
 Remember, sleep does not guarantee that the patient is pain-free –Remember, sleep does not guarantee that the patient is pain-free –
Sleep can be a coping mechanismSleep can be a coping mechanism
 Always reassess pain level when the patient wakes up!Always reassess pain level when the patient wakes up!
 Tolerable levels of pain should be assessed &Tolerable levels of pain should be assessed &
documented regularly, as this is the objective/documented regularly, as this is the objective/
goal to be achievedgoal to be achieved

36. As a patient advocateAs a patient advocate
YOUR care determines outcomesYOUR care determines outcomes
 If the pain goal is not achievable with theIf the pain goal is not achievable with the
current medications/interventionscurrent medications/interventions
 Call the physician for additional ordersCall the physician for additional orders
 Seek a referral for further pain treatmentSeek a referral for further pain treatment
 Ask for order allowing alternative therapiesAsk for order allowing alternative therapies
 If pain control is still inadequate, continue upIf pain control is still inadequate, continue up
the chain of command until adequatethe chain of command until adequate
management is achieved…remember, this is amanagement is achieved…remember, this is a
VITAL SIGN and essential for basic careVITAL SIGN and essential for basic care

37. NANDA - Nursing Diagnoses & PainNANDA - Nursing Diagnoses & Pain
The most OBVIOUS Nursing Diagnosis is “Pain relatedThe most OBVIOUS Nursing Diagnosis is “Pain related
to…” (chronic vs. acute) …and then the apparentto…” (chronic vs. acute) …and then the apparent
cause.cause.
But, there are MANY different possibleBut, there are MANY different possible affectsaffects ofof
uncontrolled pain, we must consider the possibilitiesuncontrolled pain, we must consider the possibilities
of other issues CAUSED BY PAINof other issues CAUSED BY PAIN
Consider… “Activity intolerance R/T (acute orConsider… “Activity intolerance R/T (acute or
chronic) pain”chronic) pain”
Which of the following Nursing Diagnoses could youWhich of the following Nursing Diagnoses could you
have found useful for some of your patients?...have found useful for some of your patients?...

38. NANDA - Nursing Diagnoses & PainNANDA - Nursing Diagnoses & Pain
- Other Possible Diagnoses -- Other Possible Diagnoses -
 Activity IntoleranceActivity Intolerance R/T painR/T pain
 Sleep pattern disturbanceSleep pattern disturbance R/TR/T
painpain
 Ineffective individual copingIneffective individual coping
R/T painR/T pain
 ConstipationConstipation R/T painR/T pain
 Urinary retentionUrinary retention R/T painR/T pain
 HopelessnessHopelessness R/T painR/T pain
 PowerlessnessPowerlessness R/T painR/T pain
 Spiritual distressSpiritual distress R/T painR/T pain
 Acute confusionAcute confusion R/T painR/T pain
 Altered thought processesAltered thought processes R/TR/T
painpain
 Ineffective family copingIneffective family coping R/TR/T
painpain
 NoncomplianceNoncompliance R/T painR/T pain
 Impaired home maintenanceImpaired home maintenance
managementmanagement R/T painR/T pain
 Violence, actual/risk for:Violence, actual/risk for:
directed at self/othersdirected at self/others R/T painR/T pain
 Altered family processesAltered family processes R/TR/T
painpain
 Impaired Social InteractionImpaired Social Interaction R/TR/T
painpain
 Altered growth andAltered growth and
development (behavioral)development (behavioral) R/TR/T
painpain
 Knowledge deficitKnowledge deficit (specify: pain(specify: pain
management, coping skills, meds,management, coping skills, meds,
education for other pain relatededucation for other pain related
diagnoses…) R/T paindiagnoses…) R/T pain
……Others, actually numerous, can beOthers, actually numerous, can be
affected by different levels ofaffected by different levels of
painpain

39. ……A final note aboutA final note about
CHRONIC PAINCHRONIC PAIN
 Decreased Quality of Life (QOL) in patientsDecreased Quality of Life (QOL) in patients
with chronic pain represents the greatest harmwith chronic pain represents the greatest harm
of all…it is the most unforgivable.of all…it is the most unforgivable.
 Chronic pain is so easily treated, but if notChronic pain is so easily treated, but if not
treated, is completely dehumanizing to thetreated, is completely dehumanizing to the
patient and the family.patient and the family.

40. KNOWLEDGE is POWERKNOWLEDGE is POWER
 Patients and Staff are empowered to determinePatients and Staff are empowered to determine
outcomes with effective careoutcomes with effective care
 We are coming out of the dark ages with painWe are coming out of the dark ages with pain
management and moving forward with truly effectivemanagement and moving forward with truly effective
assessment & treatments for pain: the reason patientsassessment & treatments for pain: the reason patients
came here in the first placecame here in the first place
GRASP ONTOGRASP ONTO
THE KNOWLEDGE!THE KNOWLEDGE!