The Problem with Pain

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The Gout Code

Pain management is a vital part of nursing care. It can be tricky to measure, since there is no definitive test or scale to measure pain with complete accuracy and a completely objective interpretation of pain is usually not accurate.  As a nurse, you will rely on helpful tools, the patient’s report, your senses, intuition and the patient’s history.  Pain is nothing to brush off. It is the body’s way of communicating that something is wrong. You have the power to get your patient on the road to relief and comfort, with a little detective work.

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In So Many Words

When you are doing a pain assessment, your patient will be verbal, cooperative, and oriented. This is in a perfect world, of course! If your patient is able to communicate with you, document where the pain is located, when it began, if there was an incident the patient remembers that instigated the pain, what makes the pain worse, and what makes it better. Then, it is helpful to ask the patient to describe what the pain is like. There are so many words to describe pain; pounding, aching, sore, tender, gnawing, cramping, etc. Sometimes the patient will say the pain feels like something, such as a vice, a tight band, or like a needle, to name a few. Accurate documentation of exactly how patients describe their pain can be vital to the treatment and pain management.

A Painful Puzzle

I remember an elderly patient who was cognitively impaired, who had fallen and broken a hip, and his arm in two places. He could communicate with phrases sometimes, and drifted in and out of reality. By the time my shift with him began, he had gone 12 hours without any medication for pain. He was grimacing, moaning, and shifting about in his bed. But when the nurse before me had asked him if he was having pain, he whispered “No, no, no.” Because she took his verbal report only, and did not take his non-verbal cues into consideration, she missed an opportunity to bring this gentleman relief from the discomfort he was obviously in. So how does a nurse assess pain in a patient who can’t answer back, such as a baby, a small child, or a person with dementia?  The first thing to consider is the history. If they just had an injury, a surgery, or a raging ear infection, it’s a safe bet that they are probably in some pain. Non-verbal cues that might indicate pain can be crying that can’t be soothed with ordinary methods, guarding a body part, grimacing, sleep disturbances, restlessness, reluctance to be touched, withdrawal, or poor appetite. A small child might be able to point to a sad face on a Faces Scale, indicating how severe their pain is.  Children and the elderly are sometimes wrongly viewed as making up or exaggerating their pain, which is something to consider when doing your own evaluation.

Putting the Pieces Together

With a detailed history, the patient’s report, your own observations, and use of the many pain evaluation tools and scales available, you will have the clues you need to effectively comfort your patient. The most important thing to keep in mind is that pain is whatever the patient says it is. Different people react to pain in different ways. Some may break down in tears, some may be stoic. Patients may even be reluctant to say anything, because they are concerned about being “a bother.” Assess pain regularly, listen and note cues,  and follow an appropriate pain management plan.  Your patient will experience comfort and the peace of mind of knowing they are in capable, caring hands.