More people experience pain than cancer, diabetes and heart disease combined, and although treatments have become more sophisticated, barriers to patient pain control persist.
The number of people with pain is astronomical, says Karen Kiefer, RN, BAIS, a nurse at Overlook Hospital in Summit, N.J., and legislative chair of the garden state chapter of American Society for Pain Management Nursing. However, lately people are finally starting to realize they dont have to suffer in silence and tolerate pain, so they are speaking up.
Consider these statistics from the National Center for Health Statistics:
More than one-quarter of Americans (26%) age 20 and older report they have had a problem with pain of any sort that persisted for more than 24 hours. (This number does not include acute pain).
An estimated 20% of American adults report that pain or physical discomfort disrupts their sleep a few nights a week or more.
More than half of all hospitalized patients experienced pain in the last days of their lives.Marlene Humphreys, RN
Among the barriers to pain control is lack of education about medications. Nurses have to ask more questions when a patient refuses a medication, says Marlene Humphreys, RN, BSN, MS, CHPN, director of staff development at Calvary Hospital in the Bronx, N.Y. A patient might refuse methadone, for instance, because they associate it with drug addiction.
At Calvary, which focuses on palliative care and end-of-life pain management, most of the patients come in with pain. Nurses assess pain on admission and constantly look for signs of discomfort.
One sign is watching the clock, Humphreys says. If a doctor has prescribed pain medication for every four hours, some patients will experience pain but will think its not time for their breakthrough medication, and they will keep their eyes on the clock. We dont want the patient to wait until the pain gets too severe. If they have pain, we want them to call the nurse at the first sign.
Another myth nurses may need to dispel for patients is that because they are entering palliative care, they should expect severe pain. There will be some pain, but our goal is to give the optimum level of comfort, Humphreys says.Diane Serra, RN
Signs of pain are not always as obvious as a moan or grimace, Kiefer says. Patients may be in pain when they are guarding different body parts, when they are agitated or pacing, when they cannot sit or lie still or when they are breathing rapidly, she said.
Just believing a patient who reports pain overcomes one big barrier to pain management, Kiefer says. Patients afraid that they wont be believed or will be seen as drug misusers may hide or underreport pain.
At Overlook, pain control comes from the top administration down, Kiefer says. The culture empowers nurses to be an integral part of finding pain solutions.
Instead of a nurse reporting to a doctor that a medication is not effective and relying on that doctors knowledge base to find a solution, nurses at Overlook are expected to suggest alternatives based on evidence-based best practices, Kiefer says.
Any pain management plan should have a multimodal approach, Kiefer says. It may include anything from holding a hand to surgically implanted devices.Karen Kiefer, RN
Diane Serra, RN, is a holistic nurse liaison for Beth Israel Medical Center in New York City, where she works with head and neck cancer patients. She has seen positive results in using techniques or combinations of techniques, such as guided imagery, controlled breathing, therapeutic touch, acupuncture, relaxation and acupressure.
Cancer patients have particular issues with pain, such as skin exposure to radiation, muscle tightness from radiation, difficulty swallowing, painful scar tissue and pain from surgery. Each patient will react differently to each technique and may need different ones at different times, she said.
When youre treating the patient, youre treating more than the diagnosis of cancer. In the integrative process, youre treating the psychological and spiritual effects as well, Serra says.
At Beth Israel, the treatments are provided from the start, as patients are going through their traditional chemotherapy and radiation treatments. They are provided in the radiation-oncology department, which is important, Serra says, to eliminate the stress of adding appointments.
Oncology nurses have to be particularly cognizant that cancer patients often feel intensely that they have no control, particularly in regard to their diagnosis, so teaching techniques that they can practice on their own is vital, Serra says.
At Northeastern Pain Management Center, part of Nyack (N.Y.) Hospital, nurse practitioner Susan Pedersen, ACNP-BC, says she is seeing good results with spinal cord stimulators, which transform pain into a tingling sensation for patients whose chronic pain is not likely to go away. Patients who have chronic back pain, for instance, or those whose nerves have been damaged are able to operate a remote control to signal an implanted neurotransmitter to change the pain sensation.
Sometimes it allows back patients to come off all their pain medications or significantly reduce them, Pedersen says.
The center also is using intrathecal pumps, often with cancer patients, which deliver pain medication continuously through a permanently implanted device. The medication is controlled electronically and refilled periodically by a physician. The pumps may be used when conventional therapies have not worked and surgery has been ruled out.
With increased options for controlling pain and the heightened emphasis on patients playing a bigger role in their own healthcare with healthcare reform, identifying barriers to pain management will become increasingly important.
Pain is truly a public health crisis, says Kiefer, who is an American Pain Foundation Action Network leader for New Jersey. People are finally speaking up and saying, I dont deserve to be in pain. People are tired of being on the fringes of society and not able to participate.