Pain and Its Management in Nursing - Research Paper Example

? Pain Management in Nursing of Introduction Pain and its management have been integral to the nursing profession since time immemorial. In fact, pain management is one of the core functions of nurses. Consequently, nurses must ensure their patients’ pain are well managed to improve their well-being. Pain management is a specialty of medicine also referred to as algiatry (Gordon et al., 2005). It is a branch of medicine that draws knowledge and expertise from a wide scope of researches, literatures, and day to day practices to ease the suffering and improve the quality of life of people with pain (Gordon et al., 2005). Luckily, quite a lot of studies and print and electronic literatures cover the subject of pain management. In many occasions, literatures define pain management as composed of medical practitioners, occupational therapists, clinical nurse specialists, clinical psychologists, physiotherapists, and nurse practitioners (Gordon et al., 2005). When need arises, other practitioners such as massage specialists and psychiatrists may be incorporated in pain management practices, especially in cases of non-physical pain. Pain healing process is sometimes rather quick, once the underlying disease or trauma has been healed. This kind of pain management requires mostly one physician to deal with completely, using drugs such as analgesics (Gordon et al., 2005). On the other hand, proper management of long-term pain will require a dedicated team of physicians from a wide range of specializations to manage effectively. Medicine is concerned with the treatment of sickness and injury to enhance speedy heeling, and also treats upsetting symptoms like pain to alleviate suffering during the recovery process. In cases where a painful injury fails to heal quickly, or when the pain persists even after the injury or sickness has healed, or when the cause of the pain cannot be ascertained, the task of medicine is to relieve the pain (Gordon et al., 2005). Clinical Trials of Pain Management and Studies of Pain Mechanisms are some of the avenues by which pain management has achieved considerable growth and development in recent times. For instance clinical trials by the World Health Organization (WHO), institutions such as the National Institutes of Health, National Institute of Neurological Disorders and Stroke and pharmaceuticals such as GSK Pharmaceutical. For example, the National Institute of Neurological Disorders and Stroke did a pilot trial of intravenous pamidronate for chronic low back pain while a GSK Pharmaceutical sponsored a randomized randomized, double-blind, placebo-controlled, crossover pilot trial of lamotrigine for central pain due to multiple sclerosis: a model for the role of lamotrigine in the treatment of central pain. Investigator initiated grant. This paper investigates the available and accessible studies and print and electronic literatures on pain management in nursing with a view to finding the current pain management methods in use, their effectiveness, and chance for improvement if any. Further, the relevance of these literatures and any gaps and other weaknesses will be explored. Literature Review on Approaches to Pain Management in Nursing The reviewed literatures revealed that quite a number of approaches to pain management in nursing have been in use for a very log time. These techniques include; the use of physical therapy, antidepressants, analgesics, anticonvulsants, physical exercise, psychological measures like biofeedback, application of heat or ice, and in some cases, cognitive behavioral therapy (World Health Organization, 2013). Pain management in nursing can also be attained by the use of drugs or through interventional means. The interventional methods available are commonly used to cure chronic back pain. Examples of these intervention procedures are injection of facet joints, the use of spinal cord stimulators, and use of epidural steroid injections. As stated earlier, pain management may sometimes involve physicians from different branches of medicine. Hence, a patient stands to benefit from the contributions of therapists, psychologists, and even pharmacologists. It is only by working together that a pain management team may come up with a package that would largely benefit a patient (World Health Organization, 2013). Luckily, currently, there are pain management physicians, who are professionals trained in and certified by relevant bodies in pain management. These professionals could be neurologists, psychiatrists, physiatrists or anesthesiologists. An example of a body that may issue pain management certification is the American Board of Physical Medicine and Rehabilitation. One organization that has published numerous literatures, guidelines, and stud findings on pain management is the World Health Organization (WHO). The World Health Organization’s Regulation on Pain Management The world’s health umbrella body- the World Health Organization, has laid out a three-step strategy for pain management in nursing. This method was first recommended for pain management for cancer patients but its use has spread even to non cancer patients as well. For instance when handling chronic pain, the pain could be sharp or mild, the three-step pain management procedure provides a guideline on when to and how much of a pain reliever should be used (World Health Organization, 2013). The amount of medication used is portrayed to vary from country to country and with individual hospitals. The overall analogy of this method is that if any stage fails to deliver the expected results, then the physician can move the treatment to the next level of medication based on the set regulations (World Health Organization, 2013). The following are the major stages of this pain management. The first is the ‘mild pain’ stage at which Paracetamol or a non steroidal anti inflammatory drug (NSAID) such as ibuprofen is used to relieve pain (World Health Organization, 2013). The second stage is referred to as the ‘mild to moderate pain during which a NSAID, paracetamol, and/or a mixture of these drugs with a weak opioid like hydrocodone is used to provide faster and more effective relief than separate use of the same drugs. Vicodin, Norco, or acetaminophen may also be used in combination with opioid. The third category is medically referred to as ‘moderate to severe pain’. When dealing with this kind of pain, the pain needs to be first diagnosed as chronic or acute, the reason being the type of medication being used depends on the type of pain (World Health Organization, 2013). Certain medications also work better for acute pain; others work better for chronic pain while others work well for both. Besides WHO, other authors and researchers recommend chronic pain medication for treating long lasting or on going pain while acute pain medication is recommended for the alleviation of rapid onset of pain due to an induced trauma during an operation (World Health Organization, 2013). The following are common drugs recommended in WHO literatures for pain management for nursing. The most common and widely used among these is morphine. The other drug is Fentanyl, which has the advantage of having fewer side effects since it releases less of the substance histamine. The other advantage is that it can be administered using a skin patch, which is a convenient method for the management of chronic pain. Another drug in common use in America for alleviating chronic pain is Oxycodone, which is available in ampules, tablets, syrups and capsule (World Health Organization, 2013). It also has a slow release formula, making it effective in curing breakthrough or acute pain. Other drugs in use, although less frequently, are methadone, buprenorphine and diamorphine. Pethidine, alternatively referred to as meperidine, is not recommended for pain relief because of its short duration of action, low potency, and toxicity that comes with repeated use. Amitriptyline is also a drug that is recommended for chronic muscular pain in the neck, arms and lower back (World Health Organization, 2013). Lastly, opioids are prescribed for chronic pain management though high doses are discouraged due to risk of opioid overdose. Medication Used For Pain Management in Nursing This section of the literature review briefly summarises and describes some of the commonly covered drugs in many literatures and studies for pain management purposes in nursing. According to Cleeland (1998), opioids are the most commonly used pain management drugs. The use of opioids for medication can give a short, intermediate and long lasting painlessness or analgesia, effects that depend on the properties of the drug and whether it is manufactured as an extended release drug (Cleeland, 998). Opioids are administered orally, through nasal mucosa, by injections, rectally, epidurally, intrathecally, or intravenously. In curing chronic pain conditions using opioids, a combination of drugs that are long-acting or extended release medication is normally recommended for use together with quick acting medications such as hydromorphone (Cleeland, 998). Most opioid treatments are done orally in the form of syrups, capsules, or tablets. Skin patches can also be prescribed in certain conditions. Although they are strong analgesics, opioids do not provide complete pain relief. They are totally efficient in chronic pain but only partially effective with acute pain (Cleeland, 998). Despite their usefulness in pain management, opioids have associated side effects especially when a patient stars using them or happens to be undergoing a change of dose. Prolonged use of opioids also results in chemical dependence, drug tolerance and addiction. Measures have been put in place to curb these side effects (Cleeland, 998). Measures may include assessing the patient for the likelihood of drug abuse, addiction or misuse, and family history of substance abuse before assigning a patient on a dosage. The physician should also keenly make observations such as the patient claiming reduction in pain while no significance improvement has been noted on his part for this is one of the indications of drug dependency and addiction (Cleeland, 998). Examples of commonly used opioids are Oxycontin, Exalgo, Opana and Nucynta. Another common group of substances for pain management are the non-steroidal anti-inflammatory drugs (NSAID). Acetaminophen may be administeredin combination with NSAIDs. Independently administered NSAIDs such as piroxicam and ketoporfen do not have much benefit in chronic pain management. They are also associated with adverse effects in cases of long term use. A special class of NSAIDs described as selective COX-2 inhibitors have cerebrovascular and cardiovascular risks and therefore have limited use. The other types of pain management drug are the antiepileptic drugs and antidepressants. The antiepileptic drugs and antidepressants act within the pain pathways of the CNS even though peripheral mechanisms have been discovered to exist as well (Cleeland, 998). The mechanisms vary and have been found effective in pain management in neuropathic disorders and regional pain conditions. Substances like gabapentin are used for pain control. The side effects of these drugs are similar to those of opiates as listed before (Cleeland, 998). A unique feature with these drugs however is the fact that sudden stoppage is strongly not recommended as serious consequences such as seizures may develop (Cleeland, 998). Cannabinoids is the other class of pain management drug. One of the many uses of medical marijuana is chronic pain. A 2012 survey in Canada for the medicinal use of marijuana indicated that well over 80% of the users do so because of pain management (Cleeland, 998). The evidence that medical marijuana is efficient in pain management has been documented and not subject to debate anymore. A 2013 review study published in Fundamental & Clinical Pharmacology shows that cannabinoids have comparable effectiveness to opioids in management of acute pain, and even greater success with chronic pain. Procedures for Pain Management in Nursing There are a number of procedures that are used to manage pain in nursing. These methods may involve neural modulation, pulsed radiofrequency, nerve ablation, and direct introduction of medication as a means to target either the organ or tissues responsible for the chronic pain. The following are the different procedures for pain management: physical approach/physiatry, acupuncture, laser therapy, and psychological approach (Gordon et al., 2005). Physical medicine as a means of pain management in nursing involves use of physical techniques like electrotherapy, thermal agents, behavioral therapy, and therapeutic exercises in combination with normal pharmacotherapy to alleviate pain (Gordon et al., 2005). Second, acupuncture refers to a method of pain treatment that involves the insertion and manipulation of needles into specific parts of the body to reduce pain or for therapeutic reasons. This method is extremely effective and has been in use for centuries. The third procedure, the laser therapy uses low level laser as an effective tool for curing low back pain effectively (Gordon et al., 2005). A 2007 research published in the Annals of Internal Medicine indicated that low level laser therapy effectively cures chronic and acute lower back pain. Finally, literatures define the psychological approach as a technique that encompasses as cognitive behavioral therapy, which has really assisted patients suffering from pain to relate their physiology to thoughts, behaviors, and emotions. This mode of treatment treats by encouraging positive thought that targets a behavioral pattern of healthy activities like exercising. Studies have shown psychological approach is greatly effective in treating lower back pain. Literary Gaps and Relevance of the Review to Practitioners Of particular interest in nursing practice is pain management in the elderly, especially those in nursing homes. However, focus by authors and researcher on pain management in the elderly is rather wanting. Hence, literatures have quite often overlooked pain management in the elderly (Blomqvist, 2003). Hence, this issue of pain experiences in the elderly members of society living in nursing homes has remained largely unattended. The extent of suffering, anxiety, insomnia, depression, loss of appetite, and change in activity that pain brings to the aged has not been explored to the expected extent (Blomqvist, 2003). Consequently, the quality of life for the elderly has really suffered with regards to pain management. That research estimates put the percentage of daily pain in old people living in nursing homes at 40%-85% has not helped the situation. Instead, many literatures and studies seem to focus on pain and pain management in people with conditions such as diabetes, cancer, tuberculosis and other terminal and chronic diseases. The literature review brings out the need for authors and future studies to focus on the strategies and implications of pain management not only for chronic disease patients but also for other vulnerable members of society. Conclusion and recommendations Literatures and studies have established that pain management in nursing is a collaborative effort that involves experts from different branches of medicine. It is extremely important in alleviating both chronic and acute pain. Like other areas of medicine, pain management is a developing field with numerous literary and research and practice challenges. The challenges facing pain management in nursing have been discussed in study reports and literatures and can be addressed to make the practice more productive. However, there is need to write more educational and professional literary materials on pain management. These literatures and study findings will inform and train nurses about pain and the methods to effectively manage pain and give avenues for further research (Weissman et al., 2000). Multiple instructional and training methods can be used with research reports and literatures on pain management. In areas where extensive pain management research and literary initiatives are already in place, improvements as high as 74% in pain management service delivery has been reported. Nurses and other pain management professionals need to be trained on attitude change when managing pain in old people. Patients in pain should also be sensitized on the importance of taking drugs as a means of curing their pains. References Gordon, D. B., Dahl, J. L., and Miaskowski, C. (2005). “American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force.” Archives of Internal Medicine, 165(14): 1574-1580. Retrieved on October 6, 2013 from http://www.annals.org/cgi/reprint/148/2/141.pdf Cleeland, C. S. (1998). "Under Treatment of Cancer Pain in Elderly Patients". Journal of the American Medical Association, 279(23): 1914–5. Blomqvist, K (2003). "Older people in persistent pain: Nursing and paramedical staff perceptions and pain management". Journal of Advanced Nursing, 4(6): 575–584. World Health Organization (2013). “Cancer: WHO's pain ladder for adults.” Retrieved on October 6, 2013 from http://www.who.int/cancer/palliative/painladder/en/ Reference Grid APA Purpose Sample Design Measurement Results Ranking Gordon, D. B., Dahl, J. L., and Miaskowski, C. (2005). “American Pain Society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force.” Archives of Internal Medicine, 165(14): 1574-1580. Retrieved on October 6, 2013 from http://www.annals.org/cgi/reprint/148/2/141.pdf To set guidelines for pain management in cancer and acute pain management Cancer and acute pain patients Task Force Cleeland, C. S. (1998). "Under Treatment of Cancer Pain in Elderly Patients". Journal of the American Medical Association, 279(23): 1914–5. Pain management in cancer patients Nursing staff and elderly patient Randomized study Questionnaires and interviews for nursing staff and elderly patients Blomqvist, K (2003). "Older people in persistent pain: Nursing and paramedical staff perceptions and pain management". Journal of Advanced Nursing, 4(6): 575–584. Determine pain management perceptions Nursing and paramedical staff Randomized study Questionnaire for nursing and paramedical staffs World Health Organization (2013). “Cancer: WHO's pain ladder for adults.” Retrieved on October 6, 2013 from http://www.who.int/cancer/palliative/painladder/en/ Pain management steps for adults Nursing staff Randomized study Interviews and questionnaires Read More