07.07 Pain and Nonpharmacological Comfort Measures

In this lesson we're going to talk about pain and non-pharmacological comfort measures.

When we look at our patients pain, we have to remember that it's a subjective thing. So it's something that the patient says that it is. And what we try to do is reconcile what they're telling us they’re experiencing with something objective so that we can treat them. We'll talk about how all that works a little bit later in this lesson, but what I want you to remember is it is what the patient experiences.

Pain can be acute, chronic, or both. So if it's acute pain, it means that it's been a relatively short time since they've had it, it can be really intense, and, it's affecting almost every aspect of their life. Chronic pain doesn't affect their life any less, but just remember that it's been for a very, very long duration, and most of the time the qualities of that pain are much different than acute pain. And sometimes they can have both, meaning a patient that has chronic low back pain, and experiences a new back injury, can have both types.

Also, pain is going to be different for every patient. Some people tolerate a ton of pain, and some people can’t. What that means is that you're going to have to key into what your patient’s telling you so you can manage their pain in the best way possible.

The best way to understand your patient's pain is probably going to be to look at either these two mnemonics. I'm going to cover both of these briefly, but what I want you to understand is that in order to understand our patients pain better, we have to look at different aspects of pain from the patient's point of view to really get a good idea as to what interventions are really going to work.

When we look at old carts, we're going to look at onset so when did it start. Location, where does it hurt. Duration, how long does the pain last? Character, is the pain dull, or sharp, or aching, or throbbing? is there anything that you can do that makes it better or makes it worse? Radiation, does it go anywhere, does it spread out anywhere? Timing, is there a particular time of the day that it's worse or better? And severity, which is how intense is it?

In the opqrst method you're going to get a lot of the same things. so is there anything that makes it worse? Tell me the quality of it. Where does it start and does it spread anywhere? How severe or intense is it? Is there any time of day that's better or worse?

As you can see, pain isn't just a relative number. Pain is something that's really complex, and we need to drive home that we really need more information, so that we can really help our patients out.

When we talk about pain management and goals, you need to tell your patient that you can’t take the pain away, but you’ll work with them to manage it. You want their pain to be tolerable so that they can get out of bed and do regular things. But set that expectation early so that you can work with them on it.

The other thing that you should focus on to our non-pharmacological interventions for pain management. So these are things like guided imagery or Massage, or aromatherapy, or pet therapy. Heat and Ice are often used for pain management. Put these things in your toolbox so that when you need to get them out you'll have them available so that if your patient is having a pain breakthrough you can at least do something for them.

Now when you're talking to your patient about pain, you need to make sure that you're using the right pain scale. If you have a patient, who's a pediatric, they may not be able to understand or comprehend the number scale, which is the one that we most commonly use for our adult patient. There's lots of these different pain scales and there's a really good cheatsheet with this lesson so go check that out.

But the thing that I really want to drive home here is that you should try to use your nonpharmacologic interventions first. If that doesn't work for your patient, then you should move up in a stepwise fashion. For instance, if your patient has a migraine, jumping to the strongest IV opiate medication may actually not help their headache. Patients with migraines often complain about having the lights be too bright, or that noises make the pain worse. So consider turning out the lights and turning down the tv, that way you don't have to jump to immediate medication.

If your patient isn't responding to your nonpharmacologic interventions, then you can maybe try your analgesics like your NSAIDs, or some of the other non opiate medications. And then if that doesn't work then you could step up to oral pain medications, and then if you have to go to your IV pain medications you can. Just know that once you reach that top-level, you really can't go any higher.

The other thing that you should consider is how soon the drug actually kicks in and also what other treatments they may be doing. If you plan on doing a really painful dressing change in 10 minutes, and the only thing that you have available is an oral medication that will kick in for 30 minutes, your patient’s going to hurt. So just be considerate when you're trying to plan care so that you really using the best medication possible.

The last thing I want to talk about de-escalating pain management. And what I mean is that your patient can't stay on IV pain medications forever. So like I said in the beginning, you should set your expectations and goals for your patients so that you can say first thing in the morning hey they're going to stop your pain pump, so we need to get you on some oral pain medications. That's when you introduce the Pain Scale, that's when you educate your patient, and that's when you really start working towards managing your patients pain.

Our nursing concepts really focused on comfort and patient-centered care today. Also, we focused on health promotion for our patients through pain management.
Okay so let's recap.

First off remember that your patients pain is what they say it is. It's a totally subjective experience.

Pain is different for everybody, so be sure to ask them all the questions about what their pain is like.

Set realistic expectations for your patient, and remember that you can't eliminate the pain, but you're going to focus on managing it to something tolerable.

Try your nonpharmacologic methods first, And then step up to the big guns.

That’s our lesson for today. Make sure you check out all the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing!!