Transcript Other Pain Issues and Strategies to Manage Pain

Other Pain Issues and
Strategies to Manage Pain

Never use placebos
◦ Unethical
◦ Creates an environment of distrust
 Causes the patient to feel foolish
 Can result in disruptive behavior from the patient
◦ Can result in litigation
◦ Can result in harm
Placebos

There are many “adjuncts” to pain
management

Pain does not have to be relieved with
narcotics “opioids” alone

Find out from the patient what has
controlled pain episodes in the past
Other Pain Strategies
Cold or hot packs treatment
Find out what has been effective before
Does not need a physician order
Can be delegated to a nursing assistant
Massage
Relieves muscle tension
Does require an order from the prescriber
May be covered by insurance
Complementary Therapies

Accupuncture
◦ Invasive
◦ Needs an order from the prescriber
◦ Cannot be done in many situations

Aromatherapy
◦ Can be done by anyone at any time
◦ Cost effective
◦ Promotes total relaxation
Complementary Therapies

Imagery
◦ Completed by the patient (self)
◦ Assisted by trained staff (guided)
◦ Patient thinks about a favorite time, place, or
event
◦ Talk with patient about the images and why
these provide comfort
◦ Instruct patient to use slowed deep breaths
while using imagery
Complementary Therapies

Distraction
◦ Allows patient to focus on something else while
experiencing pain episode
◦ Can be anything meaningful to the patient
 Television
 Puzzles
 Video games (especially for children)
 Knitting or needlework
Complementary Therapies

Music therapy
◦ Some facilities have trained Music Therapists
◦ Provide musical intervention during painful
episodes
◦ May also provide radios, CD’s, or portable
listening devices to record or play back songs
◦ Patient may also use their own music or
portable listening devices
◦ Some may also prefer to sing out loud
Complementary Therapies

NSAIDs
◦
◦
◦
◦
For control of inflammation
Needs to be given consistently for chronic pain
Watch renal function
Watch for stomach irritation
 Heart burn
 Bloody stools
 Nausea
Non-narcotics

Acetaminophen
◦ Some anti-inflammatory properties
◦ Also works on mu receptors
◦ Watch liver function
 If chronic liver disease present, no more than 2
grams total in 24 hours
 If no liver issues, no more than 3 grams in 24
hours in the home setting
 If no liver issues, no more than 4 grams in 24
hours in all settings
 Be careful-acetaminophen is in many other
medications!
Non-narcotics

Muscle relaxants
◦ Calm smooth and skeletal muscle irritation
◦ Can cause sedation
 No driving or operating machinery
 Can cause liver issues
 Should not be used more than 3 times a day
 Space doses out over consistent time frame
Non-narcotics

Anticonvulsants
◦
◦
◦
◦
Work on brain chemistry and receptors
Used mostly for nerve pain
Watch therapeutic drug levels
Do have a maximum daily dose
Non-narcotics

Nervous system sedatives
◦
◦
◦
◦
Decrease neural transmission
Reduces pain perception
Also cause sedation so same rules apply
Watch for changes in level of consciousness
and perception
◦ Watch for suicidal thoughts
Non-narcotics






Also work on brain chemistry
Reduces pain perception
Risk of suicide
Can change mood and behaviors
Have therapeutic drug levels
Needs close monitoring for the first few
months of therapy
Antidepressants

Long acting
◦
◦
◦
◦
Longer action
Longer peak time
Dose can be escalated to control pain
Work on the mu receptors in the brain
 MS Contin (Kadian, Oramorph)
 OxyContin
◦ Increased risk for abuse and dependency
◦ Most commonly abused long acting narcotic
Narcotics
Short acting
 Also work on mu receptors

◦ Many drugs and forms
◦ Used for acute pain episodes or breakthrough
pain
◦ Oral is preferred route
◦ If used with long acting:
 Notify prescriber if more than 4 doses are used in
a 24 hour period
 Should be same drug component as long acting
drug
 Short acting dose should be 25% of long acting
dose
Narcotics

Assess for pruritis (itching)
◦ Most commonly seen with morphine injections
◦ Related to the preservative and not the drug
◦ Treat w/diphenhydramine (benadryl) or
famotidine (pepcid)

Assess effectiveness of the medication
◦ If oral, reassess pain in an hour
◦ If subQ, IM or IV, reassess in 30 minutes
◦ If oral dose was given and not effective,
administer parenteral dose of medication
Side effects

Assess patient bowel function
◦ Patient should be on bowel regimen (stool
softeners and fiber bulking agents)
◦ Ensure adequate hydration
Assess pulmonary status
 Assess for oversedation

◦ It is okay to sleep after medication is given-it
means the body is finally able to rest because
the pain is getting controlled

Assess urinary function
◦ Narcotics can cause urinary retention
Narcotics
Know the difference between addiction,
dependency, and tolerance
 If concerned, discuss with patient
 Bring valid concerns to the attention of
the prescriber
 Obtain pain management consult if
available

◦ Pain nurse
◦ Pharmacist
Concerns







Remember pain is subjective
No room for judgment
Untreated pain is a medical emergency
Watch for clues of untreated pain
Never assume nothing else can be donepatients do not have to live with pain
Make sure pain management goals are
realistic
Document pain interventions
Pain