When It Comes to Pain Management, Consider Your Patient

Pain management has become an increasingly important topic for patients, nurses and physicians. As opioid use and addiction continue to rise, new research indicates that forming a deeper understanding of your patients and their background may impact how you treat their pain.

Is Opioid Abuse on the Rise?

Nationwide, opioid abuse is on the rise and has reached epidemic levels. According to the Centers for Disease Control and Prevention (CDC), deaths from prescription opioids have quadrupled since 1999, with 91 people dying each day due to opioid overdoses. Data from Colorado’s State Health Department shows that, in Colorado alone, opioid-related deaths have surpassed the number of homicides each year since 2011. In 2015, more than 250 people died from opioid overdoses versus 205 homicide deaths.

Because of the increase in opioid addiction and related deaths, nurses graduating from a Bachelor of Science in Nursing (BSN) program may be aware of different approaches when it comes to managing patients’ pain. New research suggests that patient demographics may play a critical role.

How Are Patient Demographics Linked to Pain Management?

According to a study published in the Association of Perioperative Registered Nurses (AORN) Journal, nurses may be able to improve post-operative pain management by paying closer attention to patient demographics.

The study evaluated how patients identified and self-managed their pain following either a total knee or total hip replacement. Nurses assessed patient pain levels for three days post-op, and patients also completed related questionnaires. The findings are summarized below:

  • Variances in educational background may correlate with pain levels. Patients with higher education levels reported considerably lower pain intensity scores and a greater ability to self-manage pain than others with lower education levels.
  • Females may interpret pain differently than males. Female patients reported higher pain intensity scores and a reduced amount of pain self-management behavior than males.
  • Surgical history may influence pain self-management. Patients with a history of prior surgical procedures had higher self-management scores than those with no previous surgeries.

Overall, the research found that there was a strong negative correlation between pain intensity and the level of self-management behavior, suggesting that patients’ perception of pain may be affected by a number of demographic factors. Nurses aware of these correlations may be able to administer pain medication in a more careful and thoughtful way.

Tashika Ellis-Sutton, nursing supervisor at Ambrosia Treatment Center, an alcohol and drug treatment facility with locations throughout the United States, has found this research holds true from her experiences working in PACU, a hospital’s post-anesthesia care unit. “Understanding a patient’s background, specifically their past medical history, allergens, surgical history, and cultural background is the key to providing the best patient-centered care I can deliver,” said Ellis-Sutton. “Post-op pain management is something I address with a patient individually and to their specific needs. Culture and age play a huge part.”

A 2015 study by the National Center for Complementary and Integrative Health (NCCIH) reported data similar to the AORN Journal findings. With close to 50 million adults with chronic or severe pain in the United States, the study found that half of them experience daily chronic pain. Correlations between the severity of pain, race, ethnicity, gender and age were also reported. For example, females, the elderly, and non-Hispanic individuals were more likely to report pain, while patients of Asian descent were less likely to do so.

What Role Do Nurses Play in Pain Management?

Nurses can play a pivotal role in pain management. Because pain can impact virtually all aspects of a patient’s life — from mood to sleep patterns — finding appropriate ways to manage pain is critical. Nurses can both minimize a patient’s exposure to pain medication and educate the patient about other ways to treat and manage their pain.

“The key in minimizing addiction risks is education before [patients] become dependent on opioids,” said Nick Angelis, a certified registered nurse anesthetist (CRNA) in Pensacola, Florida. As new pain management techniques evolve or undergo further study, patients may be unaware of the full range of emerging alternatives.

Ellis-Sutton finds that increasing patient awareness may offset the dependence on opioids and other addictive pain medications. “Patients may not understand that there are options when it comes to their pain management. [They] usually have unanswered questions. During patient education, a nurse gets to answer those questions, give advice, make referrals, and [offer] patients a thorough understanding of the risk and benefits of medications,” she said.

What Are Some Alternate Pain Management Strategies?

There are a number of alternate pain management strategies that nurses can suggest for patients to try:

  • Yoga.
  • Acupuncture.
  • Chiropractic treatment.
  • Guided imagery.
  • Meditation.
  • Physical therapy.
  • Behavioral therapy.
  • Massage.
  • Exercise.
  • Vitamins/supplements.
  • Hypnosis.
  • Music therapy.

For times when medication is still needed, nurses may recommend other options, too. “Nurses can encourage physicians to prescribe Lidocaine patches and adjuncts that reduce the doses of Percocet or Dilaudid the patient will need,” said Angelis. “[Other options are] Neurontin, NSAIDs such as Motrin or Toradol, or heat, cold, TENS units, etc., depending on the type of pain.”

Regardless of the pain management technique used, it is imperative that the patient is regularly re-evaluated says Ellis-Sutton. “Keeping a constant communication with the patient and making suggestions for them to maintain a healthy state of mind [as well as] stressing the importance of following a prescribed regimen may decrease or prevent overexposure to unnecessary pain medication.”

Consider Your Patient

Understanding your patient’s background and the potential impact it can have on their perception of pain and their ability to self-manage may lead to more mindful pain administration. Minimizing patients’ exposure to addictive pain medication and suggesting alternative treatments can be an instrumental part of your nursing duties.

Learn about the Colorado Mesa University online RN to BSN program.


Sources:

Angelis, N. (2017, May 9). Email interview.

Ellis-Sutton, T. (2017, May 8). Email interview.

The Denver Post: Colorado’s Opioid and Heroin Overdose Deaths Outnumbered Homicides in 2015

American Pain Society: NIH Study Shows Prevalence of Chronic or Severe Pain in U.S. Adults

Becker’s Healthcare: Patient Demographics Influence Post-Op Pain Management, Study Shows

Centers for Disease Control and Prevention: Understanding the Epidemic

AORN Journal: Postoperative Pain Self-Management Behavior in Patients Who Underwent Total Knee or Hip Arthroplasty


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