Annual ed pain mgt.clin staff.09.10
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Annual ed pain mgt.clin staff.09.10 Presentation Transcript

  • 1. What Is Pain ? Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms such as damage. *International Association for the Study of Pain
  • 2. Adult Pain Management
    • Older adults often have chronic and acute
    • pain at the same time.
    • May use “ache” or “sore” instead of pain.
    • Feel pain as intensely as younger adults.
    • May take a variety of drugs that could
    • interact with pain management.
    • Desire to be a “good” patient and hesitate to
    • report pain.
    • Under report because they have learned to live
    • with pain.
  • 3. Developmental Differences in Pain Expressions
    • Infants:
    • Exhibit body rigidity or thrashing, may include arc
    • Exhibit facial expression of pain (brows lowered altogether,
    • eyes tightly closed, mouth open and squared)
    • Cry intensely/loud
    • Be inconsolable
    • Draw knees to chest
    • Exhibit hypersensitivity or irritability
    • Have poor oral intake
    • Be unable to sleep
  • 4. Expressions of Pain
    • Toddlers:
    • Be verbally aggressive, cry intensely
    • Exhibit regressive behavior or withdraw
    • Exhibit physical resistance by pushing painful stimuli
    • away after applied
    • Guard painful area of body
    • Be unable to sleep
  • 5. Expressions of Pain
    • Pre-School/Young Children:
    • Verbalize intensity of pain
    • Exhibit thrashing of arms and legs
    • See pain as punishment
    • Be uncooperative
    • Cling to parents, nurse, or significant other
    • Request emotional support ( hugs, kisses)
  • 6. Expressions of Pain
    • Adolescents:
    • Localize and verbalize pain
    • Deny pain in presence of peers
    • Have changes in sleep patterns or appetite
    • Be influenced by cultural beliefs
    • Display regressive behavior in presence of family
    • Exhibit muscle tension and body control
    • Be unable to sleep
  • 7. Be aware of your patient’s attitudes about pain management
    • Remember each patient is different. It’s important to know if a patient is:
    • Afraid
    • Do you fear that pain medicine will cause addiction ?
    • Do you worry about possible side effects of medication than the pain itself ?
  • 8. Integrated Approach
    • Total Pain Components
    • Somatic (anatomical/physiological) Source
    • Socioeconomic/cultural Factors: ask your patient
    • Emotional/Spiritual Factors: ask your patient
    • Meaning of pain to patient: ask your patient
    • Effective Pain Management
    • Must affect all components of Pain
    • Traditional Medical Treatment
    • Complementary Therapies
      • Improve function
      • Decrease medication use
      • Decrease fear of treatment
      • Improve morale and compliance
      • Enhance medication’s analgesic effects
  • 9. Complementary Therapies
    • Success Factors
    • Affects all components of Pain
    • Congruent w/ the patient’s beliefs
    • Not medically contraindicated (i.e.heat/tumors)
    • Examples
    • TENS, electrical stimulation
    • Psychotherapy, counseling
    • Biofeedback Therapy
    • Physical Therapy
    • Music Therapy
    • Massage
    • Exercise
    • Imagery
  • 10. Be aware of patient’s attitude about managing pain
    • Misinformed
    • Ask your patient:
    • Do you believe that pain medicine
    • doesn’t really control pain ?
    • Do you think it is important to save your
    • medication in case your pain gets worse ?
  • 11. Be aware of your patients attitudes about pain management
    • Trying to be “strong”. Find out which patients feel:
    • A “good” pt. should not talk about his or her pain
    • Enduring pain builds character
    • Pain is simply part of life
  • 12. Your Role in Pain Management
    • The Impact of Pain
    • Under treatment of pain is common in all types of settings.
    • Many healthcare providers & consumers used to think that pain was just accepted & unavoidable part of healthcare.
    • Pain wasn’t viewed as harmful or hazardous, just a nuisance.
  • 13. Impact of Pain
    • Pain can dramatically affect the patient’s physical & psychological health.
    • Pain causes enormous stress for the pt.’s entire family.
    • The economic costs of pain are tremendous.
    • It is estimated that $100 billion are spent each year in health care & lost work time related to pain.
  • 14. Undertreatment of Pain
    • Inadequate pain treatment is a serious issue.
    • The University Hospitals meet or exceed the JCAHO standards designed to improve pain management in
    • accredited facilities.
  • 15. Pain Management Standards
    • Patients have the right to appropriate
    • assessment
    • Patients will be treated for pain or referred for
    • treatment
    • Pain is to be assessed and regularly reassessed
    • Patients will be taught the importance of effective
    • pain management and their specific role in pain management
    • Patients will be taught that pain management is
    • a part of treatment
    • Patients will be involved in making care decisions
    • Routine and p.r.n. analgesics are to be administered
    • as needed
  • 16. Untreated Pain
    • Patients whose pain is not well controlled tend to have a higher risk of complications, such as pneumonia & blood clots.
    • Unrelieved pain may prevent the patient from carrying out normal daily activities & can result in fatigue, depression & anger.
  • 17. Common responses of patients to pain may worsen the problem of under-treatment Many patients do not express their pain , for a variety of reasons:
    • The belief that pain is an expected part of their condition, or the
    • aging process (it is not).
    • Fear of becoming “addicted”to drugs.
    • The belief that they will “bother” the staff or be thought of as a
    • complainer.
    • Fear that pain means they will soon die or become disabled.
    • Dementia or confusion may prevent a patient from being able to
    • communicate clearly.
  • 18. Pain can be treated with a combination of medication & other therapies.
    • Gentle massage - around the affected area or on another body part.
    • Warm or cold applications - including ice packs, warm soaks or baths
    • Positioning - help the pt. to find a more comfortable position, padded with pillows or extra blankets.
    • Distractions - TV,cards or music .
  • 19. Pain Medications
    • Non-Narcotic Analgesics Aspirin , Tylenol , NSAIDS:
    • Can be highly effective but reaches limits on maximum effects (“ceiling effect”)
    • Can be given concurrently with narcotics for additive analgesic
    • effects
    • Side Effects:
    • Prolonged bleeding time
    • GI effects
    • GI effects more common in the elderly from NSAIDS
    • Decreased renal blood flow & fluid retention
    • Liver injury if over used
  • 20. Narcotic analgesics
    • Opioids have analgesic activity that is mainly mediated in the
    • CNS
    • Typically used to manage severe acute pain and chronic pain that
    • is cancer-related
    • No ceiling effect
    • No ceiling dose
    • Duration of analgesia varies from drug to drug
    • 30 mg. Of Morphine is the “standard” for comparison
    • Demerol
    • Caution in elderly or patients with renal insufficiency
    • Poorly absorbed through GI tract. Oral dose = 1/2 effectiveness
    • of parenteral
    • Rarely used
  • 21. Demerol is a Dinosaur
  • 22. Alternatives to Demerol
    • Remind the physician of the hospital’s initiative to reduce the use of Demerol if it is more than just a one time order.
    • Ask physician if there is a another medication we can use in place of Demerol.
    • Be a patient advocate. Ask the patient what has relieved their pain in the past.
    • Try alternatives to pain medication as discussed earlier.
  • 23. You’re Important Unrelieved pain has devastating effects on your patients. By being watchful for possible signs of pain & helping the pt. to receive quick & effective treatment , you have greatly improved that patient’s health & quality of life. You’re The Best You Can Make a Difference