The Geriatric Journal: Positioning for Pain Control

Proper positioning of a patient in pain has nearly become a lost art with the advent of patient-controlled analgesia and the focus on pain as the 5th vital sign. However, proper positioning, used as an adjunct to appropriate analgesics, can often help elderly patients find an acceptable level of pain relief.

Most nurses and CNAs have been taught the obvious -- elderly patients must be moved gently and carefully due to fragile skin and weakened bones – but few of us have been taught the subtler techniques of patient positioning that can often give good pain relief. Additionally:

• Never pull the patient by the arm to help her roll onto her side
• Always use the pad or the flat part of your hand against the largest firm patient structure – the hip, upper thigh, mid-back between the scapulae-- to roll a patient to the side.
• If the bedridden patient’s linens need to be changed, have all the supplies ready and in position before turning the patient.
• Newer mattress materials make it easier to adjust the bottom sheet or underpad by pushing down on the mattress and pulling under the patient, rather than by lifting or rolling the patient.

Assess the patient’s current position in the bed. Note the position of the hips relative to the bed. If the hips are moved to just above the place where the bed bends [ ___x/ ], the patient will be able to have better lung and abdominal excursion, thus contributing to enhanced comfort levels.

Are the hips and shoulders in line? Does the patient’s position look natural or does the patient appear to be misaligned? Even a slight misalignment with a patient who is in Buck’s traction can cause an unacceptable level of pain. The patient will be more comfortable with the hips and shoulders in line and the patient’s weight distributed equally over the body.

Assess the state of the bedding. Hip fracture patients can feel every wrinkle in the sheets. It is not always necessary to roll the patient fully onto her side in order to straighten the wrinkled sheet or pad. Try grasping the part of the sheet that needs adjustment, then push down into the mattress as you pull the sheet toward you.

Assess the patient’s head and neck position. Is the pillow under the back of the neck or has it migrated? Always ask the patient before moving the pillow, as some patients are very emphatic about their preferences. Take your cue from the patient. Make suggestions – for instance, if the patient’s pillow is rolled up under her head, perhaps she’d prefer the bed rolled up a little higher. Very few patients refuse, and the attention that you pay to the patient can go a long way toward making the patient feel more relaxed.

A more relaxed patient is less apt to have pain and therefore could require less medication. The patient is then more alert and less apt to become confused and fall. Everyone benefits.