CHRONIC PAIN
Definition:
Unpleasant sensory
and emotional experience arising from actual or potential tissue damage or
described in terms of such damage (International Association for the Study of
Pain); sudden or slow onset of any intensity from mild to severe, constant or
recurring without an anticipated or predictable end and a duration of greater
than 6 months
[Pain is a signal that something is wrong.
Chronic pain can be recurrent and periodically disabling (e.g., migraine
headaches) or may be unremitting. While chronic pain syndrome includes various
learned behaviors, psychological factors become the primary contribution to
impairment. It is a complex entity, combining elements from other NDs, such as
Powerlessness; deficient
Diversional Activity; interrupted Family Processes
Self-Care Deficit; and risk for Disuse
Syndrome.]
Related factor:
• Chronic physical disability
• Chronic psychological disability
Defining Characteristics:
Subjective
·
Verbal or coded report
·
Fear of reinjury
·
Altered ability to continue previous activities
·
Changes in sleep patterns; fatigue
·
[Changes in appetite]
·
[Preoccupation with pain]
·
[Desperately seeks alternative solutions/therapies for relief/
control of pain]
Objective
·
Observed evidence of:
·
protective/guarding behavior; facial mask; irritability;
self-focusing; restlessness; depression
·
Reduced interaction with people
·
Anorexia, weight changes
·
Atrophy of involved muscle group
·
Sympathetic mediated responses (temperature, cold, changes of body
position, hypersensitivity)
Expected outcomes:
The patient will
· • Identify
characteristics of pain and pain behaviors.
· • Develop
pain management that includes activity and rest, exercise, and medication regimen that isn’t pain
contingent.
· • Carry
out resocialization behaviors and activities.
· • State
relationship of increasing pain to stress, activity, and fatigue.
· • State
importance of self-care behavior or activities.
Interventions And Rationales:
Determine: Assess descriptive characteristics of pain, including
location, quality, intensity on a scale of 1–10, temporal factors and sources
of relief; pain tolerance; ethnicity; self-image, coping behaviors, sleep
patterns, activity level, attitude, and values. Assessment will provide
information to help identify interventions for that specific patient.
Perform: Set up a behavior-oriented plan; for instance, set up a plan to
follow the activity schedule. Behavioral–cognitive measures can help
patient modify learned pain behaviors.
Contract with patient to
increase probability that he or she will follow the plan for pain management
that has been developed with him. A contract is an agreement that can
always be referred to when the patient attempts to make decisions outside the
provisions of the plan.
Schedule self-care
activities for the patient. This reduces dependence on caregivers and
others in the patient’s environment.
Administer analgesic pain
medication as outlined in the plan. When a patient requests more than
the plan allows, reiterate the terms of the plan in order not to over medicate.
Inform: Teach patient relaxation techniques such as guided imagery, deep
breathing, meditation, aromatherapy, and progressive muscle relaxation.
Practice with the patient frequently and especially at bedtime. Purposeful
relaxation efforts may help promote sleep.
Instruct patient to
eliminate or reduce caffeine and alcohol intake and avoid foods that interfere
with sleep (e.g., spicy foods). Foods and beverages containing caffeine
consumed fewer than 4 hr before bedtime may interfere with sleep. Alcohol
disrupts normal sleep, especially when ingested immediately before retiring.
Attend: Work closely with staff and family to achieve pain
management goals and maximize the patient’s cooperation.
Encourage patient and
family to express feelings associated with diagnosis, treatment, and
recovery to help patient and family cope with treatment. Schedule
time to spend with the patient’s family.
They need time with healthcare providers to ask
questions.
Encourage activities that
provide distraction, such as reading, crafts, television, and visits to
help patient focus on non-pain-related matters.
Manage: When possible, allow patient to use alternative pain treatments
common in his or her culture (such as acupuncture) as a substitute or a
complement to Western treatments to promote nonpharmacologic pain
management.
Arrange for frequent
multidisciplinary/family care conference to keep care
goal-oriented. Refer patient to support group to help deal
with pain, depression, etc. Refer to social worker/case manager for
follow-up care.
Reference
Siedlecki, S. L. (2006,
September). Predictors of self-rated health status in patients with chronic
nonmalignant pain. Pain Management Nursing, 7(3),
109–116.
COMMENTS