Acute Pain Management In Individuals with Chronic Pain

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Acute Pain ManagementIn Individuals with Chronic
Pain

• Brenda Murdough MSN, RN-BC
• NHHPCO 14th Annual Fall Conference
• October 7, 2009

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Albert Schweitzer

• We must all die. But that I can save a person
  from days of torture, that is what I feel as my
  great and even new privilege. Pain is a more
  terrible lord of mankind than even death itself.

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Palliative care is aimed at the relief of
suffering and improving the quality of life for
persons who are living with or dying from
advanced illness.
National Hospice and Palliative Care Organization
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Goal of Palliative Care
http//www.themesotheliomalibrary.com/palliative-c
are.html
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http//www.hospicecare.com/resources/pain_pallcare
_hr/docs/access_to_pain_relief_a_human_right_world
_day.pdf
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What is pain
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IASP Definition of Pain

• Pain is an unpleasant sensory and emotional
  experience associated with actual or potential
  tissue damage or described in terms of such
  damage.

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Definition of Pain

• Pain is whatever the experiencing person says it
  is, wherever they say it does.
• Margo McCaffrey RN MS FAAN and
• Chris Pasero RN MSN

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Acute Pain
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Chronic Pain
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Procedural Pain
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All Ages, All Conditions

• Newborns
• Pediatrics
• Medical/Surgical
• Emergency
• Outpatient-Office
• Mental Health
• Home Care/Hospice Care

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Special Populations

• Language and cultural barriers
• Pediatric
• Addiction History
• Geriatric
• Unresponsive patients

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History

• Agency for Health Care Policy and Research
• American Pain Society Quality Improvement
  Guidelines
• JCAHO Standards

VHA Research Series, 2006
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WHY is Acute pain management important?

• Mandated by the JCAHO
• Legally and ethically responsible
• Consequences of unrelieved pain
• Linked to patient satisfaction

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Legal and Ethical Considerations

• ANA code of ethics
• Over prescribing of medications
• Under prescribing of medications

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Consequences of unrelieved pain

• Physiological
• Psychological
• Sociological
• Economic

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Chronic Pain Affects All Aspects of the
Individuals Life
Psychological Depression Anxiety, anger Sleep
disturbances Loss of self-esteem
Quality of Life Physical functioning Ability to
perform activities of daily living Work Recreation
Social Marital/family relations Intimacy/sexual
activity Social isolation
Economic Healthcare costs Disability Lost workdays
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Assessment Tools

• Pain Scales
• Diaries
• Questionnaires

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Alternative Pain Intensity Questions
 
 
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Components of Assessment

• Location
• Intensity
• Quality
• Onset, Duration
• Precipitating Factors
• Relieving factors

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Treatment Options For Managing Pain
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Opioid Analgesia

• Moderate to Severe Pain
• Multiple delivery systems
• Short Acting morphine, hydromorphone,
  hydrocodone, oxycodone.
• Long Acting-morphine, fentanyl, methadone,
  oxycodone

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Non Opioid Analgesia

• Mild to Moderate Pain- Minimize discomfort
• Oral non-opioids ASA ,
• acetaminophen,
• NSAIDS, Cox-2s,
• adjunctive medications

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Adjunctive Analgesia

• Acute and Chronic pain management
• Used alone or in combination
• Used to treat specific or multiple conditions

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Major Classes of Adjunctive Analgesics

• Anticonvulsants
• Antidepressants
• Anxiolytics

• Topical Agents
• Muscle relaxants
• Corticosteroids

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Physical Therapy

• Licensed Professional
• May be helpful in myofascial pain, trigger point
  soreness, fibromyalgia

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Acupuncture

• Trained and credentialed practitioner
• May be useful for fibromyalgia, headache,
  myofascial pain, low back pain, osteoarthritis
• Data on success is growing

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Relaxation Techniques

• Exercise
• Biofeedback
• Music
• Guided Imagery
• Focused Breathing
• Stress Reduction through Yoga
• Aromatherapy

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Additional Options
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Half of the fifty states receive a good grade
of either an A or B. Yet only three states earn a
grade of A. Here are the top ten Vermont (100)
- A Montana (88) - A New Hampshire (85) - A
District of Columbia (80) - B South Dakota
(78) - B Minnesota (75) - B Missouri (73) -
B New Jersey (72) - B Oregon (72) - B Iowa
(70) - B
http//www.capc.org/reportcard/topten
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Barriers to Care

• Fear
• Addiction,
• Tolerance,
• Side Effects
• Morphine is only used at End of Life
• Personal Bias

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Overcoming Barriers

• Education
• Resources
• Support for Family and Caregivers

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References

• McCaffrey, M. Pasero, C. (1999) Pain Clinic
  Manual. St. Louis, Missouri
• Mosby
• St. Marie, B. (Ed.) (2002).Core Curriculum
• For Pain Management Nursing.
• Minneapolis, Minnesota Saunders.

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Resources

• American Society for Pain Management Nursing.
• American Pain Foundation
• American Pain Society.
• The Center to Advance Palliative Care
  http//www.capc.org/
• The Mayday Pain Project.
• International Association for Hospice and
  Palliative Care http//www.hospicecare.com/

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Ive learned that people will forget what you
said, people will forget what you did, but
people will never forget how you made them feel.
Maya Angelou