This document discusses pain management strategies for various types of pain. It provides an overview of acute and chronic pain, as well as specific types of pain like kidney stone pain, stent pain, and post-procedure pain. The document outlines an interdisciplinary approach to pain management using both drug and non-drug interventions. It emphasizes the importance of comprehensive pain assessment, treatment, and education of patients. Key goals are reducing acute pain, enhancing patient comfort, and preventing severe or long-term chronic pain.

1. Pain Management

2. Pain Management
• An interdisciplinary approach to making
pain manageable, optimizing function
and maximizing quality of life.
• Strategies include:
Drug interventions
Non drug interventions such as
Acupuncture
Nerve block
Physical Therapy
Relaxation Techniques

3. Objectives
• Reduce the incidence and severity of
patients’ acute post procedure pain.
• Educate patients about the need to
communicate unrelieved pain so they can
receive prompt evaluation and effective
treatment.
• Enhance patient comfort and satisfaction.

4. Everyone experiences pain at one point or
another. It's often an indication that something
is wrong.
Each individual is the best judge of his or her
own pain. Feelings of pain can range from mild
and occasional to severe and constant.

5. PAIN
• Pain of any Origin – Acute &
Chronic
• Kidney Stone Pain
• Post Procedure Related Pain
• Stent Related Pain

6. Kidney Stone
Pain
• Abrupt onset of severe, unrelenting flank
or lower abdominal pain
• Pain may remain localized or may radiate into
the lower abdomen or genital region
• Patient is very restless, since no position
affords any pain relief
• Other signs and symptoms include nausea &
vomiting, frequent urination, painful urination,
abdominal pain, chills, fever and hematuria

7. STENT PAIN
Each person has a different tolerance level of discomfort while a stent is in
place. Stent pain of varying degrees is estimated to affect upwards of 80% of
patients having one placed.* Specific symptoms and estimated incidences
include:
•Irritative Voiding Symptoms (most common)
 Frequency (50-60%)
 Urgency (57-60%)
 Dysuria (40%) – discomfort when voiding
 Incomplete Emptying (76%)
Irritative symptoms related to the bottom coil resting in
very sensitive area of bladder; awareness of stent
during awake hours & movement of stent with activity
•Pain or Discomfort
 Flank (19-32%) – especially at the end of voiding
Flank pain believed to be due to reflux of urine from the
bladder to the kidney during voiding
IF PATIENTS ARE AWARE OF THIS HELPS TO DECREASE PAIN
*Joshi HB, Okeke A, Newns N, Keeley FX, Jr, Timoney AG. Characterization of urinary symptoms in patients with ureteral stents. Urology. 2002;59:511–9.

8. POST PROCEDURE PAIN
WHAT TO EXPECT AFTER ESWL.
Patients may experience some degree of discomfort for a day or two after ESWL.
The pain is usually described as a dull ache over the kidney, and is typically at its
worst the evening following surgery. The pain lessens over the following days.
AFTER ENDOSCOPY
Patients may experience abdominal pain and a burning sensation when
urinating. These symptoms are generally mild and gradually decrease after
the procedure. If a Stent is inserted a patient may have flank pain, especially at
the end of voiding.
AFTER BPH
Patients may feel an urgent or frequent need to urinate, or may have to get up
more often during the night to urinate. Generally most men experience burning,
especially at the tip of their penis, near the end of urination.
AFTER PROSTATE BIOPSY
Patients may feel soreness/pressure/throbbing in rectal area

9. Acute pain begins suddenly and is usually sharp in quality. It
serves as a warning of disease or a threat to the body. Acute
pain may be caused by many events or circumstances, such
as:
• Surgery
• Broken bones
• Dental work
• Burns or cuts
• Labor and childbirth
• Muscle injury
Acute pain may be mild and last just a moment, or it may be
severe and last for weeks or months. In most cases, acute
pain does not last longer than six months and it disappears
when the underlying cause of pain has been treated or has
healed. Unrelieved acute pain, however, may lead to chronic
pain.
ACUTE PAIN

10. CHRONIC PAIN

11. Pain Assessment Scale
• Scale
– Numeric Rating
0 -10
– Faces
– Non-English Speaking
Patients
– Pediatric Patients
0 1 2 3 4 5 6 7 8 9
10
0= No Pain
1-2= Mild Pain
3-4= Discomforting
5-6= Moderate Pain
7-8= Distressing
9-10=Severe Pain

12. Assessing Pain
• Pre-Procedure Phone Call
• Day of Procedure
• Post Procedure Phone Call

13. Pre-Procedure
• Phone Call
Up to 7 Days Pre-Procedure
Medical History
Surgical History
Current Medications
Urological History
Present Symptoms
Policy C.22.A (Pre-Procedure Call)

14. Day of Procedure
• Peri-Operative Nursing Assessment
Status day of procedure
Pain Score
Aldrete Scoring System
Discharge Instructions
• Anesthesiologist Assessment
Anesthesia Pre Procedure Orders
Pain medication if necessary
ESWL patients given Tylenol PO prophylactically
prior to procedure

15. Recovery Room
• Peri-Operative Nursing Assessment
Pain Score post procedure
Aldrete Scoring System
Discharge Instructions
• Anesthesiologist Assessment
Post Procedure Orders ~Pain medication if necessary
Discharge Orders

16. Post Procedure
• Phone Call
24 – 48 Hours Post Procedure
Pain Score
Follow-up
Patient Survey
30 day Text
Policy C.23.A (Post Procedure Call)

17. Hospitalizations
• Follow-up of Patients admitted to the hospital or
ER up to 30 days after their procedure at TSC
• Over 41% were admitted for PAIN
• Effort to decrease the number of patients who
seek pain relief at the ER
– Patient education to remind patients that there may
be pain after the procedure – not pain free
– Extra strength Tylenol Pre Procedure for ESWL
patients
– Call MD when have pain first before going to ER if
possible

19. Joint Commission
Standards
• RI.01.01.01 - The organization respects patients
rights. (includes the right to have pain
addressed)
• PC.01.02.07 – The organization assesses and
manages the patient’s pain.

20. Joint Commission
Standards
These standards include:
•Assessing the patient’s pain within age and ability to understand
•Pain reassessed and responded to by the organization
•The organization treats the patient’s pain or refers the patient for
treatment

21. What to Document?
• Location/Type
• Frequency
• Pain Score
• Vital Signs
• Pain Medication
• Effectiveness of Pain Medication
(Follow Pre-procedure Patient Assessment For Pain Algorithm)

22. No pain or pain at a tolerable levelNo pain or pain at a tolerable level
ReassessReassess
No pain or pain at a tolerable levelNo pain or pain at a tolerable level
DischargeDischarge
Procedure (Anesthesia and Analgesia)Procedure (Anesthesia and Analgesia)
Pre-Procedure Patient Assessment For PainPre-Procedure Patient Assessment For Pain
Significant painSignificant pain
Drug and nondrug interventionDrug and nondrug intervention
Assess effect of interventionAssess effect of intervention
No pain reliefNo pain relief
Change drug/doseChange drug/dose
No pain or pain at a tolerable levelNo pain or pain at a tolerable level
Discharge –Discharge –
Transfer to HospitalTransfer to Hospital
Patient/FamilyPatient/Family EducationEducation
Post ProcedurePost Procedure
Post Procedure PhonePhone Calll
No pain reliefNo pain relief
Assess: vital signs, pain score,
response to medication
& document in MR
If Aldrete Score 18 or above
Can be discharged after 30 minutes

23. Patient Education
• Brochure
– Pain Management Techniques For Patients
• Discharge Instructions
• Family or other caregivers
• Policy C. 22. A & C. 23. A
Pre and Post Procedure Phone Calls
• Policy C.24.A (Patient Education)
• Procedure Related Policies

24. Staff Education
• Orientation
• Inservice
• Staff Meetings
• Med Staff Meetings