Pain is one of the most unpleasent and feared symptoms of the sick. It is, therefore, a subjective experience: its experience depends on the characteristics of the person who experiences it, a vital aspect to consider for treatment.
We must identify physical and non-physical components that make up the concept of “total pain” or suffering, which encompasses the physical stimulus with the psychological, social and spiritual factors of the people affected, its context and meaning.
Nursing care in the treatment of pain:
In a didactic way, nursing care can be grouped around two fundamental levels of participation in pain management:
The Independent level involves the assessment, planning and administration of nursing treatments, mainly non-invasive pain control techniques and habit education to prevent or reduce the number of episodes.
Interdependent level, together with the rest of the multidisciplinary team, participating from their area of training and knowledge in the assessment, administration of treatments (invasive techniques, drugs, etc.) and monitoring of the evolution of the patient and the family group
Check with the patient:
– Quality (oppressive, burning, stabbing, like
electric shocks, fixed and continuous)
Since it is such a subjective experience, we must believe the patient, avoiding phrases such as :
- “Hold very little”,
- “Complains too much”,
- “It can’t hurt because…”,
- “He is very nervous”,
- “Wait, I have something more important to do”,
- “What do you want if it is as if a truck had run over you.”
Administer the analgesic prescribed by the doctor to control a specific type of pain (these are individualised treatments):
– The most sensible thing is to anticipate the onset of pain, administering prescribed analgesics at fixed times, “by the clock”, according to the half-life of the analgesic in question. Never prescribe painkillers on demand.
– Evaluate and record the response to treatment
– Avoid hopelessness and never say phrases such as: “what I gave you should have relieved you”, “I can do nothing else to help you”, and “you don’t have any more painkillers.”
Painkillers side effects:
Nurses must recognise these problems if they appear and reinforce the information that the doctor would have offered to the patient, always clearly and understandably.
Do not use placebos: “the only accurate conclusion regarding the person who reacts positively to a placebo is that he wants pain relief very strongly and that he trusts something or someone to help him obtain it.”
Reduce painful stimulus whenever possible:
– Avoid unnecessary movement
– Make the patient adopt the most appropriate positions to avoid pain
Help to position yourself comfortably without muscle tension.
- Alter pain perception
- Try to reduce the factors that lower the pain threshold.
- social neglect
- Introversion etc
Use the environment in therapy. Provide a suitable atmosphere, paying attention to details: light, temperature, smells, music, colours, photographs, desserts, plants… these little things can make the patient focus their attention on more pleasant sensations, thus having a positive effect on the painful perception experienced.
Encourage him to combat boredom, using the methods of distraction that the patient prefers and that can be adapted to his current possibilities: watching television, reading, painting, listening to music, walking, etc. Of course, these methods alone will never be an alternative to medication.
Adopt complementary measures to treat pain if deemed appropriate:
- Cutaneous stimulation: heat, cold, massage, and transcutaneous electrical nerve stimulation
- Cognitive-behavioural techniques: relaxation, hypnosis, positive reinforcement, music therapy, guided imagery, biofeedback, etc.
Establish adequate communication with the patient:
Demonstrate a sincere interest in him and his pain, listen actively, adopt an empathic attitude, being aware that patients respond to verbal and non-verbal behaviour. Always maintain a calm, serene mood, offering him an affectionate, concerned and understanding relationship.
With the family: promote the potential support of the family by involving them in care, recognising their work and favouring the rapprochement that hospitalisation sometimes interrupts.
Give information: a family that knows what is happening and the measures being adopted is more effective in supporting the patient. Warn them to identify any factor unrelated to the disease that may contribute to increased pain and signs of depression, anxiety, irritability, etc.
To promote proper action. With the rest of the team: all the information given to the patient must be followed by the other colleagues, establishing objectives and care plans agreed upon by all the team members. In addition, being able to count on an interdisciplinary group and working as a team will more effectively solve the problems and difficulties that arise.
Monitor the patient’s response to analgesia and other measures taken.
Evaluate, document and record the evolution of the patient and the achievement of results.