I have spent a good deal of time this past weekend managing pain – my own dental pain. It is a full time job. I had to plan my meals to be just the right temperature, take just the right combination of pain meds at exactly the right times, avoid ice cream, sleep when I could, etc. It was an exhausting weekend. But today, my pain will be fixed.
What does this have to do with home health, hospice, etc? I was reminded first hand that there is more to managing pain than just teaching the patient to take their medications as ordered. And that is what I see the majority of the time. A patient complains of pain and a nurse teaches the patient to take meds as ordered.
It takes creativity and insight to manage pain. Patients who are not healthcare professionals need our help to do this. Pain management cannot be accomplished without individualizing care plans for patients.
Taking medications as instructed is always important regardless of the med. But just as we do not expect diabetes to be managed by medications alone, we should not expect pain from arthritis, disc problems, etc. to be managed by medications alone. Terminal patients with retractable pain obviously need large doses of narcotics to cope with pain but a good nurse can balance the side effects of narcotics with the patient and family needs to spend quality time together.
Since beginning this blog post, I have spent some quality time with my dentist. My pain has been drilled away. So many of our patients have pain that is not solved by a 30 minute procedure. If ever we as nurses can be of value to our patients it is in the mitigation and management of pain. I challenge you to be as creative and effective as possible in pain management. It takes time and imagination but it is worth it – especially to our patients.
Some suggestions I have learned from my clients:
- If a patient is afraid to take pain pills because they will be hooked, ask the MD if a non-narcotic may help. If so, refer to the medicines as anti-inflammatory meds instead of pain pills.
- Teach the aide to call the patient before visits and teach the patient to take pain meds before the aide arrives to make bathing, etc. more comfortable.
- Pain meds often contribute to falls in the elderly. Teach the patient to eat, void and be in a position to relax prior to taking narcotic pain meds.
- For pain moderate pain, try NSAIDS during the day and stronger pain meds at night. This allows the patient to get rest and participate in household activities during the day.
- Fear exacerbates pain. Whenever possible, reassure the patient that their pain is not a sign of a worsening or new illness and that it can be treated.
- Physical and occupational therapy can teach the patient how to function safely while minimizing pain.
- Be very careful of pain medications containing Tylenol. Many over the counter pain relievers, allergy meds and prescription pain meds all contain Tylenol. It is easy for an elderly patient to get too much Tylenol when on multiple medications.
- Non pharmaceutical pain relief measure may be beneficial by themselves or in conjunction with pharmaceutical measures. Consider meditation, breathing and relaxation exercises, yoga, music therapy, distraction through books and movies, etc. to assist in pain relief measures.
Remember that any rating of seven and greater on a 1 – 10 pain scale is considered to be severe pain and should be addressed.
Any additional suggestions that you wish to share with readers would be greatly appreciated. As always, you can email me or leave a post below.
Another thing I instruct my patient on is to not their pain get too “bad” before taking their prescribed medication, because the medicine may not work as well because it has to play “catch up”.
Many years ago, I took a class from Margo McCaffery herself. I learned so much. Not the least of which was her famous statement “Pain is whatever the experiencing person says it is.” As nurses, we need to live by that. We cannot ASSUME that someone is having ‘drug seeking’ behavior if we do not have evidence they have a history of it. I can also remember the shock of classmates when she talked about some of the huge doses of opiates that many Hospice patients take.
We often, as you state, forget about things not medication when it comes to pain. We leave heat and cold to the physical therapist but rarely apply it to our own practice. Diversion, guided imagery, and other non-pharmacological techniques help immensely.