A Nurse's Perspective
 
The International Association for the study of pain defines pain as "an unpleasant sensory and emotional experience associated with actual and potential tissue damage or described in terms of such damage, or both"(Cole, 2002). Pain can be classified according to its location, duration, frequency, underlying cause and intensity. Classification of pain is thus is a source of confusion. The classification of pain by the duration of the pain is a widely accepted distinction.

Chronic pain is a pain, which lasts for more than six months. Chronic pain is further classified based on its etiology as 'non-malignant' and 'malignant pain'. Non - malignant is non-cancer related pain and malignant pain is cancer related. Chronic pain persists in spite of normalization after injury or a disease and often interferes with productivity aspect of the individual. Chronic pain depresses, debilates and affects the quality of life (Cole, 2002). The Chronic pain cases need more attention and resources than a single clinician usually can usually provide (Cole, 2002). Pain causes an increase in the heart rate, cardiac work and oxygen consumption. Chronic pain reduces physical activity. Pain Scales are tools that help health care givers to diagnose and measure a patient's pain intensity. The most widely accepted scales are Visual,Verbal,Numerical or combinations of all the three.

Managing pain:

Learning to live with pain is managing pain effectively. This include medicines that relieve pain. These drugs are known as analgesics and the process of pain relief is analgesia. The most commonly used analgesics include Acetaminophen, Nonsteroidal Anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen and Narcotics or Opioids.

A recent publication on chronic non-malignant pain, establishes the effect of physical exercise in such patients (Fran Hall, 2003). The study stresses the importance of exercise in terms of increased physical activity in pain management. Previous studies have also shown that exercise is beneficial (Fordyce, 1973; Jensen et al, 1991; Burns et al, 1998).

Recently, Patient-controlled analgesia (PCA) has often been shown to be better than the intermittent delivery of intramuscular opioids. Patient-controlled analgesia is a process where the patients can determine the pain relief process. It is an evidence based medical practice that works by providing a safe framework in which medical professionals and patients can make tough decisions by safe guarding their concerns by a fair and scientifically sound process together. Postoperative use of intramuscular narcotics has been found to be potentially hazardous in frail elderly patients. Patient-controlled analgesia (PCA), on the other hand, allows patients to self-administer small doses of narcotic, allowing better dose titration, enhanced responsiveness to variability in narcotic requirements, and reduction in serum narcotic level fluctuation (Egbert et.al, 1990).

Pain management is dynamic and pain medications need to be altered accordingly. Studies indicate that the patients with chronic pain are keen to prove that the pain they experience is real when they interact with the nurses (Johansson et.al, 1999). The chronic pain patients also want to explain their pain in such a way that nurses will understand their pain (Price, 1996). McCafferry and Pasero (1999) list out misconceptions held by health care professionals towards people experiencing chronic non-malignant pain. There is a misconception, according to the study that 1."Because of the chronic nature of the pain, patients are less sensitive and better able to tolerate pain; 2.Pain for which there is no organic cause (known) is a symptom of psychological disturbance;3. If the patient's pain occur or increases soon after a traumatic life event, the stress probably caused the pain. 4.Patients who are awaiting litigation after an injury or who receive worker's compensation is likely to exaggerate their pain for financial gain. 5. A patient who exaggerates his or her pain and/or has an explained by the physical cause is consciously trying to manipulate others or obtain secondary gains. 6. If a patient is depressed, especially if there is no cause of the pain, the depression is causing his/her pain and the pain would subside if the depression could be treated; 7.Opioids are in appropriate for all patients with chronic non-malignant pain.8. People with chronic pain who have been taking opioids for months or years are addicted to narcotics; 9.When patients with chronic non-malignant pain are non-compliant, it is probably because they do not want to give up their pain.

Conclusion

A recent study of the experiences of nurses with chronic non-malignant patients has (Paulson et.al, 1999) shown that the nurses need to maintain a relationship with these patients to make them feel respected. The study has further indicated that the nurses should convince these patients that they believe in their narratives of the pain and need to behave in a way that will convince the patients that they are really cared for by their care providers. Hence, there is a need for pain assessment and management training for nurses at the curriculum level towards quality pain management.

References

• Aubrun, et.al (2003). What pain Scales do the Nurses use in the postanaesthesia unit, European Journal of Anaesthesiology, 20, 745-49.
  
  
• B.Eliot Cole. (2002), Pain Management; Classifying, Understanding and Treating Pain, Hospital Physician, 6:12-13.
  
  
• Ballantyne JC, et al. (1993) Postoperative patient-controlled analgesia: meta-analyses of initial randomized control trials, J Clin Anesth.5(3): 182-93.
  
  
• Carmen R. Green et.al (2002). How well is chronic pain managed? Who does it well?   Pain medicine, .3, 56-57.
  
  
• Clarke et.al (1996). Pain management knowledge, attitudes and Clinical Practice; the impact of nurse's characteristics and education. Journal of Pain and Symptom Management, 11(1).
  
  
• Denis C Turk and Akiko Okifuji (1999). Assessment of patients' reporting of pain; An Integrated Perspective. Lancet, 353:1784-88.
  
  
• Egbert, L. H. Parks, L. M. Short and M. L. Burnett (1990). Randomized trial of postoperative patient-controlled analgesia vs. intramuscular narcotics in frail elderly men. Archieves of International Medicine, 50(9).
  
  
• Elizabeth Manias et.al (2002).Observation of pain assessment and management - the complexities of clinical practice. Journal of Clinical Nursing, II; 724.
  
  
• Fordyce, W.E., Fowler, R.S. Jr, Lehmann, J.F. et al. (1973). Operant conditioning in the treatment of chronic pain. Archives of Physical Medicine Rehabilitation 54: (9), 339-408.
  
  
• Fran Hall, Use of exercise in the management of non-malignant chronic pain, Professional nurse. 18 (07), 01 March.
  
  
•  Johansson et.al. (1999). The meaning of pain; an exploration woman's descriptions of symptoms. Social Science and Medicine, 46(2).
  
  
• McCafferry et.al, Nurse's knowledge about Cancer pain. Journal of Pain and Symptom Management, 10(5).
  
  
• Price B (1996). Illness Career-a chronic illness experience, Journal of Advanced Nursing, 24(2)275-79.
  
  
• www.partnersagainstpain.com.
  
  

 

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