Pain management

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

Chronic pain can be nociceptive, neuropathic/functional, or both (e.g., pain that persists after the healing of the acute injury, pain related to a chronic disease, pain without an identifiable cause, and pain associated with cancer). 

Patients may be in obvious acute distress (trauma pain) or appear to have no noticeable suffering. 

Acute pain can be described as sharp or dull, burning, shock-like, tingling, shooting, radiating, fluctuating in intensity, varying in location, and occurring in a timely relationship with an obvious noxious stimulus. Chronic pain can present similarly, and often occurs without a timely relationship with a noxious stimulus. 

Over time, the chronic pain presentation may change (e.g., sharp to dull, obvious to vague). 

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Pain can be defined as an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage. Pain is subjective, and the patient s report of pain should always be taken seriously. Pain management in acute and chronic illness is an important responsibility of the nurse Many nurses consider pain as the fifth vital sign and assessment of pain just as important as the assessment of temperature, pulse, respirations, and blood pressure Accurate assessment of pain is necessary if pain management is to be effective Fhtients with pain are often undertreated. 

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

Ms. Taylor is receiving meperidine for postoperative pain management. In assessing Ms. Taylor approximately 20 minutes after receiving an injection of meperidine, the nurse discovers Ms. Taylor s vital signs are blood pressure 100150 mm Hg, pulse rate 100 bpm, and respiratory rate 10 /min. Determine what action, if any, the nurse should take. 

The expected outcomes for the patient may include relief of pain, management of common adverse drag reactions, absence of injury, and an understanding of and compliance with the prescribed therapeutic regimen. 

Senay EC Methadone maintenance treatment. Int J Addict 20 803—821, 1985 Senay EC, Dorus W, Goldberg F, et al Withdrawal from methadone maintenance rate of withdrawal and expectation. Arch Gen Psychiatry 34 361—367, 1977 Sharpe C, Kuschel C Outcomes of infants born to mothers receiving methadone for pain management in pregnancy. Arch Dis Child Fetal Neonatal Ed 89 F33—F36, 2004... 

The Center for Disease Control and Prevention conducted a randomized epidemiological study on patients who had received morphine nerve paste post-operatively for pain management purposes. Ninety-four percent of the patients used in the cohort presented themselves with surgical-site comphcations such as edema and inflammation 24 days (median) post-operation. Upon culturing of the wounds, 64% tested positive for bacterial infection. It is important to note that aU of the patients were found to have residual morphine paste on board indicative of a chronic morphine state (Sacerdote et al. 2000). 

Patients who have had multiple intestinal resections due to CD may have diarrhea related to the inability to reabsorb bile salts. Cholestyramine has been demonstrated to improve diarrheal symptoms in this population.8,15 NSAIDs should be avoided for pain management due to their ability to worsen IBD symptoms. Narcotic analgesics should be used with caution, as they may significantly reduce GI motility. 

Pain management is an important component of therapy and is similar to that of acute pancreatitis. Non-opioid analgesics are preferred, but the severe and persistent nature of the pain often requires opioid therapy. Patients can require chronic doses of opioid analgesics, with a resulting risk of addiction. Pain can also be managed by removing the stimulus of exacerbation if identified.31,38... 

Make a plan for analgesia, in conjunction with a pain management service if possible, to control and prevent pain. Recommend an analgesic with ease of dosing and minimal side effects, realizing that patients with chronic pancreatitis may require large doses of opioids. 

Educate patients and caregivers about effective pain management, dealing with chronic pain, and the use of nonpharmacologic measures. 

Despite the growing emphasis on pain management, pain often remains undertreated and continues to be a problem in hospitals, long-term care facilities, and the community. In one series of reports, 50% of seriously ill hospitalized patients reported pain however, 15% were dissatisfied with pain control, and some remained in pain after hospitalization.14,15... 

Misconceptions about pain management, both from patients and health care providers, are among the most common causes of analgesic failure. Some clinicians may be hesitant to treat pain because they do not believe the patient s reports of pain or feel the patient is exaggerating symptoms in order to obtain medications. Inadequate clinical knowledge of... 

Effective pain management begins with a thorough and accurate assessment of the patient. Even though pain is a common presenting complaint, lack of regular assessment and reassessment of pain remains a problem and contributes to the undertreatment of pain.23... 

Two current foci in pain management are to identify the mechanisms that are responsible for pain hypersensitivity and to prevent this initial hypersensitivity. Therefore, the goal of pain therapy is to reduce peripheral sensitization and subsequent central stimulation and amplification associated with wind-up, spread, and central sensitization.17... 

Clinical Practice Guideline, Cancer Pain Management. United States Department of Health and Human Services, Agency for Health Care Policy and Research. AHCPR Pub. Rockville, MD 1994. Available at http //www.ncbi.nlm.nih.gov/books/bookres.fcgi/ hstat6/07 capcf4.gif.Accessed January 10, 2006. 

Dunlop RJ, Bennet CL. Pain management for sickle cell disease. Cochrane Database Syst Rev 2006 2 CD003350. 

Treating adverse effects of opioids is part of pain management... 

Stinson J, Naser B. Pain management in children with sickle cell disease. Paediatr Drugs 2003 5 229-238. 

Pain management is also of critical importance in patients with spinal cord compression. While dexamethasone will provide some benefit, opioid analgesics also should be used and titrated rapidly to achieve adequate pain control. 

Center for Pharmacy Care Pittsburgh, Pennsylvania Chapter 30 Pain Management... 

Chap. 30 - Pain Management Universal Program Number 014-999-07-044-H04... 

Duract Jul-97 Jun-98 Short-term pain management 50 million... 

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