Learning objectives

At the conclusion of this session, participants will:

1. Recognize the right to pain management
2. Understand pain as the fifth vital sign
3. Pay attention to patients’ reports of pain and recognize nonverbal signs
4. Know about different kinds of pain
5. Know basic pain management concepts.

What's wrong here?

Here are four conversations that were overheard in an assisted living facility. Each one demonstrates a misunderstanding about pain. Can you identify the problem or suggest a better way to think and talk about pain? Don’t worry if you don’t recognize the problem, because in this lesson you will learn about pain and how to deal with it in your work.

Mrs. Flynn: “My hands are really hurting today. That medicine the doctor gave me doesn’t help very much.”
Attendant: “I know how you feel. I have arthritis in my knees and they really hurt sometimes with all the walking I have to do. I guess it just gets worse the older you get, so we might as well get used to it and not complain about it.”

Attendant Mary: “That Mrs. Garrett is always complaining about her pain. She takes way too much of her pain medicine if you ask me. I think she’s addicted to it.”
Attendant Alex: “You’re probably right. Anyway, I don’t think she really hurts all that bad. She’s just lonely and wants some attention.”

Attendant Joan: “Poor Mr. Howard. He’s so confused, he doesn’t even recognize his own daughter sometimes.”
Attendant Jerry: “Well, one good thing, at least he doesn’t complain about anything. Even when he fell and hurt his leg, he didn’t ever say it bothered him. I heard that when your mind goes, you don’t feel pain.”

Attendant: “Good morning, Mrs. Moore. How are you feeling today?”
Mrs. Moore: “I don’t like to complain.”
Attendant: “Is something wrong?”
Mrs. Moore: “Yes, my back is killing me and it hurts to walk, but please don’t tell anyone. If my daughter or my doctor hear about it, they’ll start doing a lot of painful tests on me and put me in a nursing home. Just help me get up, and I’ll be okay.”

Common misconceptions about pain

Patients and workers may think that:

1. Pain is a sign of aging.
2. Nothing can be done about some kinds of pain.
3. Pain is a punishment for past actions.
4. Pain is a sign of serious illness or impending death.
5. Complaining of pain is a sign of weakness.
6. Complaining of pain will lead to unpleasant medical tests.
7. Complaining of pain will result in losing one’s independence.
8. Elderly and disabled people have a higher pain tolerance.
9. Confused people have a higher pain tolerance.
10. People who complain of pain are just trying to get attention.
11. Elderly and disabled people are likely to get addicted to painkillers.

All of these ideas are wrong. Pain is a sign that something is wrong with our bodies, and it doesn’t occur just because we get older. Healthy older people should not have pain. If something hurts, a physician should investigate to see if the pain is caused by a treatable condition. If the pain is caused by a condition that cannot be improved with treatment, then the doctor should prescribe medications that will allow the person to live without constant pain.

*Everyone has the right to try to live without pain if it is possible to do so and the right to receive appropriate pain management when necessary. No one should suffer unnecessarily when treatment or relief is available.

Pain: The fifth vital sign

To find out whether a person is healthy or not, we often check the four major vital signs: blood pressure, temperature, pulse, and respirations. In addition, we should check to see if the person is experiencing any pain. This is now being called “the fifth vital sign” because we know that the presence of pain is an indication of a health problem that should be investigated. When residents tell you they are having pain, or you see nonverbal signs of pain, always
report it to your supervisor.

In addition, we must remember that only the patient really knows how he or she is feeling or how much pain he or she is experiencing. The person having pain is the only expert on this subject, and no one else has the right to make a judgment about the type or amount of pain an individual has. We must always believe a person’s selfreport of pain.

How do you know if someone is in pain and can’t or won’t tell you?

Watch for these nonverbal signs of pain:
- Guarded movements
- Facial grimacing
- Rapid heartbeat
- Rapid breathing
- Sadness or depression
- Elevated blood pressure
- Restlessness or sleeplessness
- Moaning, groaning, or sighing
- Bracing or tensing the muscles

Any of these symptoms should be reported to your supervisor

Types of Pain

Acute pain
Acute pain is severe and usually signals an injury or illness that must be treated. Kidney stones and heart attacks cause acute pain. When the cause of the pain is cured, the pain goes away. Acute pain can be a symptom of serious problems that require emergency treatment. Acute pain is generally too intense to ignore and will often cause people to clutch the part of the body that hurts. This type of pain indicates that medical attention is needed.

Chronic pain
Chronic pain is a persistent, ongoing pain that lasts for weeks, months, or years. Sometimes the pain was originally caused by an injury or illness that was cured, but for unknown reasons the pain continues.
There may be an incurable disease causing the pain, such as cancer. Chronic pain can even occur without any known injury or illness causing it. The best that can be done in these situations is to treat the pain, without curing the underlying disease. Chronic pain is not always constant and continuous, but it can come and go. Sometimes chronic pain becomes very sharp or severe for a time, and then subsides. It can be very disabling to live with chronic pain because the pain makes it too painful or tiring to perform everyday activities. Chronic pain is caused when the nervous system keeps sending out pain signals repeatedly. It can cause loss of appetite, depression, irritability, and sleeplessness.

Chronic pain sufferers get caught in a vicious cycle of exhaustion and depression that can make the pain worse. New medicines and treatments make it possible to relieve even the most severe pain. No one today should have to live with untreated chronic pain.

Major types of chronic pain
These are some of the common kinds of chronic pain. Each has a variety of causes.
- Headache
- Low back pain
- Cancer pain
- Arthritis pain
- Angina—the chest pain caused by restricted blood flow to the heart
- Neurogenic pain—this kind of pain comes from the nerve tissues and includes such painful conditions as trigeminal neuralgia, a disease that causes severe pain in the face.
- Psychogenic pain—this kind of pain is not due to any known disease or injury but seems to come from the brain or mind.

Major types of pain management
Medication prescribed by a doctor is the best treatment for pain. There are also nondrug treatments that caregivers can use.

Mild exercise
Exercise helps to increase flexibility, strength, relieving muscle stress that can cause backaches, headaches, and fatigue. Exercising in warm water is particularly good for arthritis sufferers, because the water relaxes and supports the
muscles, making exercises easier to perform.

Heat or cold applications
Warm or cool compresses applied to a painful area can bring temporary relief for headache, backache, and arthritis.

Massage
Massage is useful for back pain, but any painful area that is red or swollen should not be massaged until a doctor has evaluated the problem.

Support
Sometimes a sympathetic listening ear and a caring attitude are the best medicine for people with chronic pain.

CLICK START TO BEGING THE TEST