P
ain is a subjective individual
experience (Strong et al, 2002),
which is not just a simple
response to an unpleasant sensation.
It is affected by psychological and
social factors, such as the site and
nature of the injury, personality,
age, gender, anxiety, understanding
and cultural factors (Godfrey, 2005).
Uncontrolled pain can have harmful
physiological, psychological and
emotional effects on an individual
(Williams and Salerno, 2012).
This article, the second in a
two-part series, looks at the various
techniques the community nurse
can use to manage pain once a
comprehensive assessment has
established its cause (Gregory, 2014).
Dealing with acute and chronic pain:
part two — management
wide differences in the reaction to
both pharmacological and non-
pharmacological pain measures.
Pharmacological pain
management
There is a choice of analgesic drugs
available depending on the nature,
severity and the individual patient’s
reaction to medication. When
advocating the use of analgesia
community nurses should consider
expense. Some analgesia can be
purchased very cheaply compared
to the cost of a prescription. Patients
should be advised to prevent pain by
taking analgesia regularly, rather than
waiting for pain to occur and then
taking analgesia, as this leads to the
individual ‘chasing the pain’ rather
than managing or controlling it.
The effectiveness of analgesia has
been studied and systematic reviews
of randomised controlled trials
produced. The results of these studies
can be found at the Oxford Pain
Site (http://www.medicine.ox.ac.uk/
bandolier/Extraforbando/APain.pdf).
The three main classes of
analgesia include:
Paracetamol (simple analgesia)
Non-steroidal anti-inflammatory
drugs (NSAIDs)
Opioids.
Julie Gregory, nurse lecturer, School of
Nursing, Midwifery and Social Work,
University of Manchester
Pain is experienced by many patients in primary and secondary
care and its assessment and management is a fundamental aspect
of nursing treatment. Community nurses need to possess a strong
knowledge base of the various ways of treating pain to inform and
advise their patients. This in turn enables nurses to help and empower
patients to effectively control their pain with minimal side-effects. This
article, the second in a two-part series on pain, provides an update on
the management of acute and chronic non-malignant pain (the first
part of this article, on the assessment of pain, appeared in Journal of
Community Nursing 28[4]: 83–86).
KEYWORDS:
Pain Pain management Pharmacology Analgesia
Julie Gregory
THE SCIENCE — WHAT IS PAIN?
Pain manifests as an unpleasant sensation conveyed
to the brain by sensory neurons and signals actual
or potential damage to the body. Pain is more than
simply a physical sensation — it is also a perception
representing a person's subjective interpretation of
discomfort. This perception provides the person with
information on the location of the pain as well as its
intensity. The conscious and unconscious responses
to pain — including the emotional response — further defines the overall
concept of pain.
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PAIN MANAGEMENT
Community nurses need to have an
understanding of pain management
options available to help their
patients. The reduction of pain to a
tolerable level is necessary to prevent
complications and enable patients to
function.
Once pain has been identified
and assessed it is managed
using pharmacological and non-
pharmacological interventions,
often in combination. It has already
been established that pain is an
individual experience and the
effectiveness of interventions can
vary between individuals, with
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