Objectives. Pain Management Knowing How To Help Yourself. Patients and Family Requirements. Your Rights As A Consumer

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1 Objectives Pain Management Knowing How To Help Yourself Jackie Carter, RN MSN CNS Become familiar with the definitions of pain Be aware of your rights to have your pain treated Become familiar with the types of pain Be aware of the types of medications used to treat pain Be aware of the types of non-drug methods used to help manage pain 1 2 Be open Be responsible Be knowledgeable Patients and Family Requirements Your Rights As A Consumer American Pain Foundation Right to report your pain and be treated with respect and dignity Right to have your pain assessed and treated promptly Right to be educated about your pain Right to participate in the decisions regarding the management of your pain 3 4 Your Rights As A Consumer (cont d) American Pain Foundation Right to have your pain reassessed and treatment adjusted if not working Right to be referred to pain specialist if your pain persists Rights to answers to your questions, time to make decisions and to refuse treatments Pain is An unpleasant sensory and emotional experience associated with actual or potential tissue damage. or an experience described in terms of such damage. (APS, 1994) Whatever the experiencing person says it is, existing whenever the experiencing person say it does. (McCaffery, 1968) 5 6

2 What does it all mean You know your body better than anyone. If you have pain, no should tell you that you do not. Pain can be a warning sign, take it seriously. Types of Pain Nociceptive (involves the muscles, bones, joints, skin and organs of the body) Neuropathic (involves the nerves of the body) Social Spiritual 7 McCaffery & Pasero, The Right to Report Your Pain Your pain will be assessed using a pain scale Please report your score accurately Please answer questions as thoroughly as you can. How We Differentiate Pain Acute Pain An isolated event Effectively controlled with standard analgesic doses Has an underlying treatable cause Resolves with treatment Rarely requires long term analgesics Chronic Pain Last longer than 3 months Chronic Pain requires continually observation Behavior varies with each individual Can be hard to manage with medications alone It can lead to permanent disability and learned illness behavior. Is not life threatening 9 McCaffery & Pasero, The Right To Have Your Pain Assessed and Treated When did the pain begin Where the pain is Is it continuous or does it come and go Describe the pain Anything you notice that makes the pain better or worse Describing your pain Nociceptive (Muscles, Bones, etc) Dull Aching Sharp Throbbing Neuropathic (Nerves) Burning Sharp Shooting Tingling 11 McCaffery & Pasero, Any other concerns

3 Pain Tools Wong-Baker FACES Pain Rating Scale Oucher Scale - Which shows faces of a child at different levels of pain. Numerical Pain Rating Scale - which is the 0-10 scale, 0 = No Pain and 10 = Worst possible pain. Pain in Infants Crying Insomnia (not sleeping) Change in feeding habits Depression (seems withdrawn) Squirming The Right To Be Informed What s causing the pain Tell them what you think What s the treatment plan Let them know if it s working What are the risks, benefits and cost All decisions come with consequences Treatment of Sickle Cell Pain Non-opioids - Used for Mild to Moderate Pain Aspirin Acetminophen Ibuprofen Naproxen Ketorolac Celecoxib 15 Guidelines for the Management of Acute and Chronic Pain in Sickle Cell Disease, Opioids - Used for Moderate to Severe Pain Codeine Dilaudid Methadone Morphine Demerol Adjuvants Antidepressants - Found to have some pain relieving effects Anticonvulsants - Useful in relieving some burning and tingling pain Steroids - Used to relieve pain associated with swelling Guidelines for the Management of Acute and Chronic Pain in Sickle Cell Disease, Guidelines for the Management of Acute and Chronic Pain in Sickle Cell Disease,

4 Constipation Nausea/Vomiting Side Effects Sedation and mental clouding (sleepy or confused) Sleep Disturbances Itching Urinary retention Respiratory depression 19 Addiction Is defined as a pattern of compulsive drug use characterized by continued craving for an opioid and the need to use the opioid for effects other than pain relief 20 Addiction Physical Dependence Myths Patient is addicted if asking for pain medication every two (2) to four (4) hours. Pt. may be under dosed. Same dose of oral medication is equal to same IV medication. Not true, usually IV in at least three times as strong. A weaker pain medication upon discharge is appropriate for the care providers comfort ( I don t feel comfortable discharging the patient on strong pain medication. The patient s pain control is the primary goal. Areas of concern Requesting IV pain medication only. Refusing all other medication unless deal is made. Requiring one type of pain medication Using pain medication in forms other than prescribed Allergy to all other pain medications Occurs when taking pain medication over time. If you stop taking the pain medication quickly, you may experience sweats, muscle aches, or chills. Always ask your doctor before stopping a medication, then ask how to stop taking a medication Tolerance Occurs when your body needs more medication to treat your pain. This may happen if you have taken the for a long time. Tolerance is normal and expected. Non-Drug Treatments Psychological Management Distraction Reading Music Television Video games 23 Guidelines for the Management of Acute and Chronic Pain in Sickle Cell Disease,

5 Behavioral Management Deep breathing Relaxation exercise Self-hypnosis Biofeedback Behavior modification Deep Breathing Exercise Clench your fists, breathe in deeply and hold it a moment Breathe out and let yourself go limp. Start yawning Repeat several times Guidelines for the Management of Acute and Chronic Pain in Sickle Cell Disease, McCaffery & Pasero, 1999, Pain: Clinical Manual, p Physical Management Hydration Heat Massage Physical Therapy Guidelines for the Management of Acute and Chronic Pain in Sickle Cell Disease, How to take care of yourself Be aware of your body If your afraid of the Doctor s office take a friend with you Carry a small tablet with you, to write down questions or concerns for the doctor Carry the names of any medications you take with you to all your doctors appointment 28 Know any allergies - describe what happens to you Know the difference between allergy and side effect Keep your doctor appointments or reschedule as soon as possible Take pain medications with you to all appointments. You made need them. The Future Know that Sickle Cell Disease may slow you down, but it does not have to deny you of a future