Collaborative mangnement of Pain and Agitation - Essay Example

The first step in the management of pain and agitation is assessment. This includes patient characteristics, type and method of injury, clinical status of the patient, associated mortality and morbidity and assessment of the degree of pain and agitation. Pain assessment mainly validated scales, along with vital signs and subjective and objective assessment. Agitation must be defined and risk factors identified (Greenway, 2010). In postoperative patients, pain along with agitation that occurs when the patient is awaken from agitated states, is a major challenge.

It is very important to rule out causes for agitation like hypercapnia, hypoxemia, gastric distension and retention of urine with distension of bladder. Treatment of such triggering factors for agitation usually helps resolve agitation. Also, in postoperative pain, factors like onset, site of surgery,severity, incidence and age also must be taken into account. Those with neurotic personality traits are likely to suffer more pain than others. Preoperative pain counseling also has a major influence on postoperative pain.

While mild pain can be managed with mild narcotics, severe pain may need higher doses of narcotic drugs. When narcotics are used for pain relief, they decrease respiratory rate and the tidal volume and also regularize the pattern of respiration. However, narcotic induced depression of respiration is a potential sequelae and hence dosing of narcotics must be done cautiously. Encouraging the patient to breathe deeply and cough is another strategy to decrease pain and agitation. Morphine is a good narcotic for postoperative analgesia and decrease of agitation.

The dose is 1-3 mg, given every 15- 30 minutes. Continuous infusion of narcotics is better than intermittent bolus doses because it allows maintenance of constant blood levels of narcotics and the dosage requirement per day is also low. However, it requires careful monitoring of the patient and titration of doses. Patient controlled analgesia is a better option in this regard. Other modes of provision of analgesia include regional analgesia and epidural block. In intensive care patients, agitation affects atleast 71 percent of patients.

Pain aggravates agitation. Other factors which contribute to increased agitation are anxiety, delirium and illness. In some cases, sedation also may lead to agitation (Siegel et al, 2003). Treatment of agitation is often neglected despite the fact that it is very important to treat agitation to improve clinical outcomes and fasten recovery. Management of pain and anxiety to some extent decreases agitaion. Anxiolysis is possible by giving drugs like benzodiazepines. However, since over sedation itself can lead to agitation, it is important carefully decide upon the dosing of sedatives (Siegel et al, 2003).

Pain and agitation can occur even in chronic pain and primary care physicians find in challenging to manage such scenarios. According to a study by Dobscha et al (2009), collaborative management of pain and agitation between psychologists and physicians delivers better clinical outcomes than the routine management by physicians alone. Improvement has been reported to be better in terms of severity of pain, disability related to pain and depression. According to the researchers, "although many of the improvements were modest, they may be especially meaningful because patients in our sample were older, had long-standing pain, multiple medical problems, and reported high baseline rates of