7.1 Concepts and Causes of Pain

Pain is an uncomfortable or unpleasant sensation that signifies injury or illness. Pain is caused by receptors in the body sending a signal to the brain to let an individual know that they are in pain.
Pain is whatever the person says it is, when they say it occurs.
Pain may be characterized as acute, chronic, or breakthrough according to its onset and duration. Acute pain lasts up to three to six months, chronic pain lasts longer than six months, and breakthrough pain is a sudden onset of pain lasting for a short period of time.
Pain may also be characterized as neuropathic or nociceptive according to the type of damage that causes it. Neuropathic pain is caused by damage to nerves or other parts of the nervous system, whereas nociceptive pain is caused by damage to the body tissue.
Pain may also be referred, which means that pain in one part of the body may be felt as pain in another part of the body.

7.2 Pain Assessment

Pain is often considered the fifth vital sign, and pain assessments should be performed routinely to allow for better pain management by developing a treatment plan that meets the individual needs of the patient.
Nurses should assess for the risks for pain, as well as its type, character, onset, location, duration, severity, pattern, and associated factors.
The severity of pain may be assessed using a variety of tools, including the numerical rating scale, FACES scale, FLACC scale, PAINAD scale, behavioral pain scale, or CPOT. It is important to utilize the most appropriate pain scale according to the patient’s age and condition.
Nurses must remember that pain is subjective and whatever the patient says it is, whenever the patient says it is.
Pain should be reassessed within one hour of intervention, or within fifteen to thirty minutes for intravenous interventions, according to institutional policy. Additional interventions (pharmacological and/or nonpharmacological) and pain reassessments are warranted until the severity of the pain reaches the pain goal identified by the patient.

Pharmacological methods of pain management include opioids, nonopioids, and adjuvant medications.
Nonopioids, such as acetaminophen and NSAIDs, are typically administered as a first-line defense for mild to moderate pain.
Opioids may be administered for moderate to severe pain, but the patient should be carefully monitored for respiratory depression and addiction.
Coanalgesics, or adjuvants, are not intended to treat pain but they produce an analgesic effect that can be used to help manage pain.
It is the nurse’s responsibility to provide education related to pharmacological pain management therapies in a manner that is culturally and linguistically appropriate for the patient. Patients should be educated on their right to adequate pain management, general medication information, potential side effects, expectations for pain management regimens, and safe medication storage. Nurses should also be prepared to dispute myths associated with pain medications.

Nonpharmacological pain treatments are interventions that can be used to complement pain medications or as alternatives to medications. Examples of nonpharmacological interventions include cold and heat therapy, alterations of environmental stimuli, rest, TENS therapy, massage, and acupuncture.
The nurse is responsible for assessing the need for nonpharmacological pain interventions, discussing the options with the patient, implementing the interventions, and evaluating the effectiveness of the interventions. Use of nonpharmacological methods should be a collaborative effort between the patient and the care team.
The nurse should educate the patient on potential risks and benefits of treatments and inform the patient to discuss use of any nonpharmacological interventions with their provider.

A substance use disorder (SUD) is a disorder that occurs when the repeated use of alcohol and/or other drugs significantly impairs a person’s health and results in an inability for them to meet major responsibilities at work, school, or home.
SUDs are chronic diseases that may be treated with medications to avoid withdrawal; common treatments also include therapy and rehabilitation.
The best way to prevent opioid use disorders (OUDs) is to reduce the frequency of opioid prescriptions.
Other strategies to prevent OUDs include education regarding awareness of the harms of opioid misuse and methods for safely storing and disposing of opioids.
Prescription drug monitoring programs also play an important role in preventing OUDs.
Pain and SUDs should be treated independently using a patient-centered approach that may involve both pharmacological and nonpharmacological interventions. Sources of nonpharmacological therapies and nonopioid medications should be maximized prior to treating the pain with opioids; however, there may be times when opioids are required.