Effective Pain Management to Improve Patient satisfaction – A Review

 

Dr. V. Indra

Academic Head, SON, Texila American University, Coimbatore, India

 

ABSTRACT:

 

 

INTRODUCTION:

Effective pain management is a national and global challenge:

Lack of integration of current knowledge and practice of effective pain management by health care professionals into day-to-day care adversely affects patients, resulting in unnecessary physical, psychological, and emotional manifestations. Implementation of research findings on pain management has slowly evolved and led to improvements in patient care. The Joint Commission and the World Health Organization, along with many national professional organizations and agencies, have recognized that pain management is an essential aspect of patient care [1].

 

Pain has been defined as “an unpleasant physical, sensory and emotional experience associated with actual or potential tissue damage, as well as [an] unpleasant and therefore also an emotional experience.” According to McCaffery [1], “Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does.”

 

DIMENSIONS OF PAIN MANAGEMENT:

Five identified dimensions contribute to pain management. The dimensions have physiological, sensory, affective or cognitive, and sociocultural components unique for each patient that should be considered. Research on pain management in the 1970s and 1980s peaked as a breakthrough in theoretical knowledge of the physiological, psychological, and social aspects of improved quality of life associated with pain relief, but application of the findings to the general practice of medicine have been delayed. Aggressive pain control is still lacking for patients with acute pain. Although some concepts have been integrated into practice to enhance effective pain management, application of the concepts in the treatment of patients with pain has been slow, despite the availability of efficacious analgesics and multiple published clinical practice guidelines for management of acute pain. The American Pain Society published the most current guidelines in 2005 for improving the management of acute pain and cancer pain (the initial guidelines were released in 1995). The 5 most current guidelines include prompt recognition and treatment of pain, involvement of patients in the pain management plan, improvement of treatment patterns, reassessment and adjustment of the pain management plan as needed, and monitoring processes and outcomes of pain management [2].

 

 PATIENT OUTCOMES:

Adequate pain management enhances earlier mobility and lessens the complications of ileus, urinary retention, and myocardial infarction. Sleep deprivation, which can increase postoperative fatigue, resulting in decreased mobility, is also reduced, as are pulmonary complications, and an aggravated catabolic hormonal response to injury. When physiological complications are better controlled, patients and their families are better able to respond to stress and to cope with the patient’s situation. Additional benefits of adequate pain management include decreased length of stay, lower readmission rates, earlier overall recovery, improved quality of life, increased productivity, and decreased costs for patients and the health care system.

 

During the early 2000s, the dissemination of research, science, and evidence-based practice was slowly embraced by clinicians, even though the literature had long described available pain interventions and methods to reduce potential pain. The American Pain Society developed one of the first national quality improvement programs in which the emphasis shifted from improved delivery of effective pain management to measurable patient outcomes, such as decreased length of stay, reduced hospital costs, and increased patient satisfaction [3].

 

Lack of pain education provided to patients about preoperative and postoperative surgical procedures and expectations can result in poorer outcomes for the patients. Egbert et al reported that providing pain education to preoperative and postoperative patients resulted in significant improvements in the patients’ outcomes. Patients who received pain education required 50% fewer narcotics during hospitalization, excluding the day of the procedure, and were discharged sooner than were patients who did not receive the education. When acute pain is predictable, providing effective pain education and information on the anticipated postoperative experience should include special regard to the multiple causes and effects of pain, along with the range of treatments available to a patient. This pain education can reduce patients’ distress, reduce the number of signs and symptoms, and improve functional status. What a patient believes and understands about pain is critical in influencing the reaction to the pain therapy provided. Pain education alone may be the most effective treatment provided by health care professionals.

 

The clinical practice guidelines recommend that patients and their families receive pain education during the presurgical visit that includes an explanation of the surgical procedure; the expected postoperative routine; the interventions and options for pain relief, including available pain medication; and the need for progressive increased mobility. Proper education and adequate treatment of postoperative pain can also result in positive emotional outcomes for patients, such as a decrease in anxiety and depression, an increase in coping skills, a greater sense of individual control, and an increase in a sense of well-being [3].

 

IMPROVEMENT OF PAIN ASSESSMENTS:

Lack of proficient and uniform pain assessment is one of the most challenging barriers in achieving adequate pain control. The most acknowledged and recognized barrier to effective pain assessment is patients’ subjectivity, the individual, personal, and private experiences within the dimensions of pain management. Assessment of a patient’s pain requires that professionals become well educated in recognizing a patient’s perception of pain, previous experiences with pain, current knowledge of pain, spiritual and religious beliefs, and sociocultural components. A thorough pain history and shared goal setting are critical components of effective pain management that leads to beneficial outcomes. Synergistic concepts of pain assessments are complex and include assessment of a patient’s clinical status, pain history, age, body weight, comorbid conditions, psychological status, previous exposure to analgesic medication, opioid-naive status (an opioid-naive patient is one who has not previously received opioid drugs and now, often because of trauma or surgery, receives regular daily doses of opioids), and insight into the patient’s current treatments for pain, along with the specific type of surgery the patient will undergo [4].

 

Pain assessment is only the first step in effective pain management; what is done with that information can make a marked difference for a patient. The measurement and treatment of pain must be appropriate for each patient. The outcome of each patient’s pain experiences varies according to the risks and benefits associated with different analgesics administered. Different treatment approaches should guide each patient’s pain therapy without relying on pain scales alone [4].

 

 

Improved pain assessments can help nurses prevent analgesia gaps, or lapses in administration of pain medication, that can increase pain or even lead to uncontrolled pain. Analgesia gaps can occur while a patient is emerging from anesthesia, being transferred from a postanesthesia care unit to a surgical unit, having the route of administration changed from epidural to intravenous to oral, and during progression in mobility. By astutely identifying anticipated postoperative phases that might require additional analgesia during a patient’s acute recovery, nurses can avoid interruptions in pain therapies. Principles of analgesic management include using fixed doses of scheduled analgesics when continuous pain is anticipated rather than solely using medications for breakthrough pain. Modifications to administration of analgesics depend on an accurate pain assessment, including pain intensity, pain relief, and side effects, such as nausea and vomiting, lightheadedness, dizziness, and urinary retention, and use of adjuvant medications such as nonsteroidal anti-inflammatory drugs. Assessment of the intensity of acute postoperative pain at rest is as important as pain assessment during subsequent postoperative activity. Assessing pain only at rest will not provide the critical information necessary to determine effective pain management [5].

 

CONCLUSION:

Disparities in treating pain continue. A major challenge in providing patients the most effective treatments for pain lies in the difficulty of translating research to practice. Examples of barriers include developing new analgesics, applying evidence-based approaches in practice, and the integration of interdisciplinary team approaches. Research indicates a persistent gap between an understanding of the pathology of pain and recommended treatment of pain.

 

Pain relief has been acknowledged as a basic human right by the World Health Organization: “The unreasonable failure to treat pain is viewed as an unethical breach of human rights.” Notable progressive innovations have occurred in some medical practice models, focusing attention on the need for more research, such as research on the development of newer pain medication agents with fewer adverse side effects and aggressive implementation of balanced analgesia. The interdisciplinary team approach in pain management is a complex yet fundamental part of providing excellence in patient care. The team approach provides important insight for patients and is highly correlated with improved patient recovery, outcomes, knowledge, and satisfaction.

 

REFERENCES:

1.        Czarnecki ML, Turner HN, Collins PM, Doellman D, Wrona S, Reynolds J. Procedural pain management: a position statement with clinical practice recommendations. Pain Manag Nurs. 2011; 12(2):95–111.

2.        Apfelbaum JL, Chen C, Mehta S, Gan. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97(2):234–540.

3.        Polomano RC, Dunwoody C, Krenzischek D, Rathmell J. Perspective on pain management in the 21st century. Pain Manag Nurs. 2008;9(1) (suppl): S3–S10.

4.        Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med. 2010;83(1):11–25.

5.        Twersky R, Fishman D, Homel P. What happens after discharge? return hospital visits after ambulatory surgery. Anesth Analg. 1997;84(2):319–324.

 

 

 

 

 

Received on 27.05.2019          Modified on 12.06.2019

Accepted on 24.06.2019     © A&V Publications all right reserved