Pain is useful, it
provides a warning sign of illness or injury. However, once the warning sign
is recognized, pain should be treated and managed. Inadequate pain management can have serious
adverse effects including:
- increased sympathetic nervous system response•
- increase heart, blood pressure and vasoconstriction
- patient anxiety, depression, and sleep deprivation
- decrease gastrointestinal
- increased metabolic activity resulting in catabolism, impaired normal healing after injury or surgery.
release of stress hormones•
- increased blood viscosity
- increase sodium and water retention
- impaired immune response
- decreased mobility
- impaired ventilation
- increased the risk of deep vein thrombosis and subsequent pulmonary embolus
- undertreatment of acute pain may cause permanent nervous system remodeling and the possibility of a chronic pain syndrome.
For most of us pain is a part of life from birth to death. In fact, humans are capable of experiencing pain from about twenty-four weeks gestation. In the U.S., about 34% of females and about 27% of males age 18 years and older, have experienced pain that lasted at least 6 months. About 32% of those suffering chronic pain report severe pain of ≥7 on a scale of 0-10.•
Because pain is identified primarily by self-report,
there are certain patients who are at higher risk than others of having their
pain undertreated. At risk individuals include infants and children, those
whose primary language and cultural background differ from their healthcare
providers, some elderly patients, and individuals who are developmentally delayed,
cognitively impaired, or are severely emotionally disturbed.
Pain is one of the most frequent reasons that cause Americans to seek medical treatment. Surprisingly, inadequate medical treatment of
pain, is a serious problem in the United States and is associated with unnecessary
suffering, increased healthcare costs, workplace absenteeism and
decreased quality of life. Barriers to adequate pain management often include provider: ignorance, fear and bias involving the use of analgesic opiates.
The Institute of Medicine (IOM) has identified a number of clinical barriers to improved pain care. These barriers include:
- "Well-validated evidence-based guidelines on assessment and treatment have yet to be developed for some pain conditions, or existing guidelines are not followed.
- Health care professionals are not well educated in emerging clinical understanding and best practices in pain prevention and treatment.
- Should primary care practitioners want to engage other types of clinicians, including physical therapists, psychologists, or complementary and alternative medicine practitioners, it may not be easy for them to identify which specific practitioners are skilled at treating chronic pain or how they will do so.
- A lack of understanding of the importance of pain management exists throughout the system, starting with patients themselves and extending to health care providers, employers, regulators, and third-party payers.
- Regulatory and law enforcement policies constrain the appropriate use of opioid drugs.
- Restrictions of insurance coverage and payment policies, including those of workers’ compensation plans, constrain the ability to offer potentially effective treatment.
- Additional basic and clinical research is needed on the underlying mechanisms of pain, reliable and valid assessment methods, the development of new treatments, and the comparative effectiveness of existing treatments." - IOM
Inadequate pain management is an uncommon problem in the U.S.
Nursing has a legal and ethical duty to prevent and/or manage pain. In order
to fulfill these duties, nurses must:
- Accept a patients subjective complaint of pain as accurate
Resist the temptation to discount the value of pain assessment and intervention when
other issues seem to take precedence.
Advocate for appropriate pain management resources.
Educate themselves about current pain management
practices and research in order to meet their obligation to patients.
assessment and management are legal duties owed to the patient.