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.]
• Chronic physical disability
• Chronic psychological disability
· 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]
· 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)
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.
Siedlecki, S. L. (2006, September). Predictors of self-rated health status in patients with chronic nonmalignant pain. Pain Management Nursing, 7(3),