Pain Management Nursing

by traumaRUs, MSN, APRN, CNS Admin | 3,008 Views | 7 Comments

Pain management nursing is a wide-open specialty. Since CMS and Medicaid have declared it the fifth vital sign, ways to manage pain are being brought to the forefront of our nursing care. There are opportunities for both bedside nurses as well as APNs. Both pharmacologic and nonpharmacologic means are used.

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    Pain Management Nursing

    Pain is what the patient says it is – we have all heard that. However, does pain have to exist for our patients? With good pain management, most pain can be eliminated or at least, lessened. By using best nursing practice and evidenced based medicine, pain can be treated. It is now considered the fifth vital sign also and per Medicare/Medicaid guidelines, must be addressed with each patient. Pain management teams are often set up in hospitals to address this issue across the board. Whether its an infant getting circumcised, an adult trauma patient with multiple fractures, a heroin addict with rhabdomyolysis or an elderly patient with a fractured hip, they all need pain management. There are many routes to alleviating pain, both with medicine and with nonpharmacological means.

    Qualities
    • Empathy for patients who have pain. It’s not a visible malady like a fractured leg or a laceration.
    • Knowledge regarding pain management techniques, both nonpharmacological and pharmacological.
    • Ability to be an advocate for the patient. This might mean butting heads with other nurses, physicians or other medical personnel.
    • Knowledge of both the medical cause of the pain as well as the proposed treatment.

    Working Environment

    Registered Nurses can be hired into pain management in many roles.
    • Bedside nurse of a patient in acute pain
    • Clinic nurse in a private pain management clinic
    • Perioperative nurse during pain pump procedures
    • Caring for addicted patients who have pain
    • Working with hospice nurses to alleviate pain at end of life

    Advanced practice nurses (APN) can work in pain management too.
    • Employed as a certified registered nurse anesthetist (CRNA) in a pain management clinic
    • Consultant to physicians and other nurses to improve bedside care of the patient in acute care
    • Collaborator with physician or other APNs in research to improve acute and chronic pain management
    • Educating nurses on pain control via a patient-controlled analgesia (PCA) device through the use of a designated agent for patients unable to administer it themselves
    • Providing education regarding new modalities of pain management to other nurses, physicians and ancillary personnel

    Education

    Registered nurses are usually the personnel working with pain management patients bedside as few states allow LPNs to administer IV narcotics. APNs are also used in pain management. APNs have a minimum of a masters degree in nursing and many nowadays are getting a doctorate.

    Resources

    allnurses has a busy Pain Management forum.

    Some recent topics include:

    Pain is better but still hurts sometimes/a little
    California nurses and medical marijuana
    Start Here: Pain Management Resources
    End-of-life care curriculum for medical teachers

    American Society of Pain Management Nursing is an organization devoted to educating nurses regarding pain management. They also have position papers, sponsor a certification examination and provide ways to advocate for pain management patients. http://www.aspmn.org/

    WebMD has a good articles about pain management.

    Another way to manage chronic pain is nonpharmacological.

    The National Institutes of Health also weigh in on pain management

    The Centers for Disease Control have several papers on nonpharmacological pain management.
    Last edit by Joe V on Nov 18, '13
    TSgtRodrigues, thusitha, dianah, and 3 others like this.
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    About traumaRUs, MSN, APRN, CNS

    traumaRUs has '20+' year(s) of experience and specializes in 'Nephrology, ER, ICU'. From 'Midwest'; Joined Apr '00; Posts: 41,961; Likes: 17,127.

    Read more articles from traumaRUs

    7 Comments so far...

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    This is a GREAT article! I wish so many more nurses were like you! So many of us (the pain patients of the world) delay or avoid seeking help because we fear how we will be treated. In many cases, these fears are well founded and based on sad experience. Chronic pain doesn't look like acute pain, but it deserves treatment, too. We shouldn't be punished because we aren't as fixable as the person with the broken leg, or because we have years of coping strategies that allow us to mask it well.
    traumaRUs likes this.
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    I am lucky enough to be an LPN who administers IVP narcotics to patients in the ED. When I have a pt who c/o pain (and has a ride/is to be admitted) I always reinforce to the prescriber that if s/he does not write for pain medication our HCAHPS will decline. I am surprised at how effective the phrase "HCAHPS" is!! I'm glad that we all realize our salary/bonuses/annual raises depend on this pt's satisfaction scores!!

    Personally, I came from a food service industry and the (A/O) customer is always right.

    PS... pain is often considered the 6th VS. (1: temp 2: HR 3: RR 4: B/P 5: O2 6: pain)
    traumaRUs likes this.
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    PS- not just pain but when you work in the ED, like I do, discomfort other than mere pain can be further complications.


    Let's think about the pt who has a fever and suffers from shivering. The family is up your butt! The pt is up your butt! Both are up every passing RN/LPN/Medic/PST's butt by the door to get a freaking blanket.....

    Now, we can reduce or eliminate that need. Please cover the pt's hand's and feet with towels or blankets to trick the hypothalamus into thinking it has reached the proper homeostatis!! I love it!! Its in the new Nursing 2013 article.

    November 2013 - Volume 43 - Issue 11 - p 49–51
    doi: 10.1097/01.NURSE.0000434315.90818.45

    I know that is not cited properly... i'm lazy and not in the mood. But there you go! The article, for those who have a subsciption, can see the layout of the different layers of fever and why covering just the hands and feet will relieve the pt's discomfort! This is the kind of information that makes me glad to be a nurse!


    <3 Nursing!!!!
    traumaRUs likes this.
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    Thanks everyone for some thought-provoking comments.
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    Pain is what the patient says it is
    That isn't always true. It's a valid generalization but there are enough exceptions to call that into question as a basis for all treatment of pain.
    traumaRUs likes this.
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    Overprescribing of Opioids Impacts Patient Safety and Public Health

    "More people in the U.S. die from a drug overdose than they do from motor vehicle accidents and more of those deaths are caused by prescription opioids than those attributable to cocaine and heroin combined," said Alexander, associate professor of Epidemiology at the Bloomberg School and co-director of the new Johns Hopkins Center for Drug Safety and Effectiveness.
    Overprescribing of opioids impacts patient safety and public health
  9. 0
    In the scramble to contain an epidemic of opioid misuse and overprescribing, one HMO is taking what a former federal prosecutor is calling a “highly progressive approach” to address the problem.
    http://www.painmedicinenews.com/View...770&a_id=19212
    Last edit by SocratesJohnson on Nov 24, '13


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