Pain Management (Review)

Aug 31

7 min read

You will find in this section, the information needed to prepare for the Home Health Aide In-Service exam. You can view, download and print for better preparation.

PAIN MANAGEMENT

The following are four conversations that were overheard while taking care of a patient. Each one demonstrates a misunderstanding about pain. Can you identify the problem or suggest a better way to think and talk about pain? Don't worry if you don't recognize the problem, because in this lesson you will learn about pain and how to deal with it in your work.

SCENARIO 1

Mrs. Flynn: "My hands are really hurting today. That medicine the doctor gave me doesn't help very much."

Attendant Donna: "I know how you feel. I have arthritis in my knees and they really hurt sometimes with all the walking I have to do. I guess it just gets worse the older you get, so we might as well get used to it and not complain about it."

SCENARIO 3

Attendant Joan: "Poor Mr. Howard. He's so confused, he doesn't even recognize his own daughter sometimes."

Attendant Jerry: "Well, one good thing, at least he doesn't complain about anything. Even when he fell and hurt his leg, he didn't ever say it bothered him. I heard that when your mind goes you don't feel pain."

SCENARIO 2

Attendant Mary: "That Mrs. Garrett is always complaining about her pain. She takes way too much of her pain medicine if you ask me. I think she's addicted to it."

Attendant Alex: "You're probably right. Anyway, I don't think she really hurts all that bad. She's just lonely and wants some attention."

SCENARIO 4

Attendant Laura: "Good morning, Mrs. Moore. How are you feeling today?"

Mrs. Moore: "I don't like to complain."

Attendant Laura: "Is something wrong?"

Mrs. Moore: "Yes, my back is killing me and it hurts to walk, but please don't tell anyone. If my daughter or my doctor hear about it, they'll start doing a lot of painful tests on me and put me in a nursing home. Just help me get up and I'll be okay.”

Common Misconceptions About Pain

Patients and workers may think that:

Pain is a sign of aging.
Nothing can be done about some kinds of pain.
Pain is a punishment for past actions.
Pain is a sign of serious illness or impending death.
Complaining of pain is a sign of weakness.
Complaining of pain will lead to unpleasant medical tests.
Complaining of pain will result in losing one's independence.
Elderly and disabled people have a higher pain tolerance.
Confused people have a higher pain tolerance.
People who complain of pain are just trying to get attention.
Elderly and disabled people are likely to get addicted to painkillers.

In the conversations you read, which of these misconceptions about pain can you find? Write the number of the matching misconception(s) beside the conversations on the preceding page.

All these ideas are wrong. Pain is a sign that something is wrong with our bodies, and it doesn't occur just because we get older. Healthy older people should not have pain. If something hurts, a physician should investigate to determine whether the pain is caused by a treatable condition. If the pain is caused by a condition that cannot be improved with treatment, then the doctor should prescribe medications that will allow the person to live without constant pain. With today's medications and treatments, there is no reason for a person to suffer in silence. Note that in some cultures, admission of pain is a sign of weakness. So that person may wish to withhold any complaint of pain from you. That is the time to look for nonverbal indications of pain and offer intervention.

Everyone has the right to try to live without pain if it is possible to do so and the right to receive appropriate pain management when necessary. No one should suffer unnecessarily when treatment or relief is available.

Pain as a Subjective Experience

Pain is defined as an unpleasant sensory and emotional experience. However, it's important to realize that with pain, it's whatever the person experiencing it says it is and exists where the person says it does.

To find out whether a person is healthy or not, we often check the four major vital signs: blood pressure, temperature, pulse and respirations. In addition, we should check to determine whether the person is experiencing any pain. This is now being called "the fifth vital sign," because we know that the presence of pain is an indication of a health problem that should be investigated. When patients tell you they are having pain, or you see nonverbal signs of pain, you should always report this to your supervisor.

In addition, we must remember that only the patient really knows how he or she is feeling or how much pain he or she is experiencing. The person having pain is the only expert on this subject, and no one else has the right to make a judgment about the type or amount of pain an individual has. We must always believe a person's self-report of pain. Typically, if a person is seeking medical help with pain being a factor, he will be given a chart and asked to identify or rate the face of pain that best reflects what he feels. This chart could be a series of faces, or even a scale of one to 10.

How do you know if someone is in pain and can't or won't tell you? You can gain a lot of information by looking at the face and the movement of your patient. Words often do not reflect what the person is actually experiencing. For the person's own reasons, he or she may not wish to share verbally with you.

Watch for these nonverbal signs of pain:

Guarded movements
Facial grimacing
Rapid heartbeat
Rapid breathing
Sadness or depression
Elevated blood pressure
Restlessness or sleeplessness
Moaning, groaning, or sighing
Bracing or tensing the muscles

Any of these symptoms should be reported to your supervisor.

Types of Pain

Acute pain

Acute pain is severe and usually signals an injury or illness that must be treated. Kidney stones and heart attacks cause acute pain. When the cause of the pain is cured, the pain goes away.

Acute pain can be a symptom of serious problems that require emergency treatment. Acute pain is generally too intense to ignore and will often cause people to clutch the part of the body that is in pain. This type of pain indicates that medical attention is needed.

Chronic pain

Chronic pain is a persistent, ongoing pain that lasts for weeks, months, or years. Sometimes the pain was originally caused by an injury or illness that was cured, but for unknown reasons the pain continues. There may be an incurable disease causing the pain, such as cancer. Chronic pain can even occur without any known injury or illness causing it. The best that can be done in these situations is to treat the pain, without curing the underlying disease.

Chronic pain is not always constant and continuous but can come and go. Sometimes chronic pain becomes very sharp or severe for a time and then subsides. It can be very disabling to live with chronic pain, because the pain makes it too painful or tiring to perform everyday activities. Chronic pain can be exhausting.

Chronic pain is caused when the nervous system keeps sending out pain signals repeatedly. It can cause loss of appetite, depression, irritability and sleeplessness. Chronic pain sufferers get caught in a vicious cycle of exhaustion and depression that can make the pain worse. The pain is often unpredictable.

New medicines and treatments make it possible to relieve even the most severe pain. No one today should have to live with untreated chronic pain.

Major types of chronic pain

The following are some of the common kinds of chronic pain. Each has a variety of causes.

Headache
Low back pain
Cancer pain
Arthritis pain
Angina the chest pain caused by restricted blood flow to the heart
Neurogenic pain this kind of pain comes from the nerve tissues and includes such painful conditions as trigeminal neuralgia, a disease that causes severe pain in the face.
Psychogenic pain - this kind of pain is not due to any known disease or injury but seems to come from the brain or mind.
Persistent pain this type of pain lasts for a prolonged period (usually more than three to six months) and is associated with chronic disease or injury. Persistent pain is not always time dependent but can be characterized as pain that lasts longer than the anticipated healing time. Autonomic activity is usually absent, but persistent pain is often associated with functional loss, mood disruptions, behavior changes and reduced quality of life. One example of persistent pain is osteoarthritis.
Nociceptive pain this type of pain refers to pain caused by stimulation of specific peripheral or visceral pain receptors. It results from disease processes (e.g., osteoarthritis), soft-tissue injuries (e.g., falls) and medical treatment (e.g., surgery, venipuncture, etc.). It is usually localized and responsive to treatment.
Neuropathic pain this type of pain is caused by damage to the peripheral or central nervous system. This type of pain is associated with diabetic neuropathies, post-herpetic and trigeminal neuralgias, stroke and chemotherapy treatment for cancer. It is usually more diffuse and less responsive to analgesic medications.

Major Types of Pain Management

Medication prescribed by a doctor is the best treatment for pain. There are also nondrug treatments that caregivers can use.

Mild exercise helps to increase flexibility and strength, relieving muscle stress that can cause backaches, headaches and fatigue. Exercising in warm water is particularly good for arthritis sufferers, because the water relaxes and supports the muscles, making exercises easier to perform. Many areas offer exercise programs carried out in warm swimming pools with special classes for those with arthritis. Movement in water often allows more flexibility and less pain. Movement reportedly actually results in less pain.

Warm or cool compresses applied to a painful area can bring temporary relief for headache, backache and arthritis.

Massage is useful for back pain, but any painful area that is red or swollen should not be massaged until a doctor has evaluated the problem.
Sometimes a sympathetic listening ear and a caring attitude are the best medicine for people with chronic pain.

Opioid Crisis

The opioid crisis in the United States has impacted families across the nation. On average, 40 people die each day from opioid overdose with an estimated 4.3 million Americans engaged in non-medical use of prescription opioids (CDC.gov/drugoverdose/prescribing guideline.html). As home health and hospice providers we are often carrying for patients prescribed opioids. The following are some tips on how to help reduce the risk of opioid abuse.

Observe how the patient stores medication. If the patient is concerned with someone else having access to the medication, notify your supervisor. Patients can use lock boxes to secure the medication.

Suggest to patients they remove prescription bottle labels prior to throwing empty bottles away. This will prevent others from knowing that there are opioids in the home.

Medications that are not currently being used should be disposed of according to state guidelines. Many communities have drug take back events where patients can take unused medications to a designated area for disposal.

Source: Essential In-Services for Home Health, 2023