Helping pts cope with painful procedures

xtxrn, ASN, RN · Aug 8, 2011

I've had a LOT of painful procedures (4 bone marrow biopsies in the last 1 1/2 years alone). What helps me is to be told what is going to happen, and how i can help it go smoother (some people don't want to know anything- so this is very individualized). I found that the two I'd seen before on other people were much worse than the ones I've had !!

Also, if there's likely to be discomfort, tell the patient. It's easier to put up with something for a few seconds/minutes if you know what to expect (again- have to gauge how the patient is reacting to the idea of the procedure).

If you can use EMLA for injections, that can help. (I personally don't like lidocaine with IVs- it's just one more stick- and I'm a horrible stick- had IVs in my breast twice, foot- don't even remember how many).

With kids, if they're old enough, maybe an analgesic lollypop (if dose appropriate); distraction, papoose- and if the parent is making things worse, see if you can get them out of there- if not, dose 'em both !! (just kidding )

nurseprnRN, BSN, RN · Aug 8, 2011

had your ob rotation yet? that panting thing works really well; i used to teach it to patients all the time. gives them something else to concentrate on, and blows their ph down a bit and makes the nerves a little less efficient at transmitting painful impulses, too. i've even trained my dentist to teach it to his patients to use while he's putting in the local .

linguine · Aug 8, 2011

haha, I remember during my OB rotation, the nurse was working hard to coach the woman through her breathing while the baby was crowning. I felt a little helpless and just kept saying "almost there, I see the head!" I kept repeating this multiple times before the baby came all the way out. I reflected back on this, thinking how irritating that must have been for her and I should have just been silent.

the deep breathing is great

Nascar nurse, ASN, RN · Aug 9, 2011

I always like to know whats going to happen and how long it's going to last. I can get thru anything as long as I have an idea of when it will be over and have an idea of how bad it's going to get. Unexpected pain is the worse and don't sugar coat it. If it's going to hurt, tell me it's going to hurt.

I have dealt with my kids the same way. I have watched both sit perfectly still thru blood draws, immunizations and IV starts since they were very little (they always held my hand with their free hand and were always told to squeeze when it hurt and I would squeeze back gently with an "almost over").

Funny stories - Took daughter in for pre-op labs at age 4. Explained entire procedure to her and told her it would hurt but must sit still, will only hurt for a minute. She bravely put her arm out and sat perfectly still - needle in and she's watching the entire event. Sudden look of shear panic "MOOOOMMMM....how are they gonna close that hole in my arm". (Oops, forgot to explain that part to her - haha).

Same kid at 14 to the eye Dr for the first time. Never explained anything because I didn't expect any pain. She walked into office and nearly freaked out because of all the "scary" equipment.

Trekfan · Aug 9, 2011

Hi all,
I work in an urgent care clinic and many times, patients come in requiring short procedures (minor burn management, wound care). I am wondering, from your personal experiences (maybe even as a patient), what are some strategies to help your patients cope with short term, acute pain? I suppose the strategies vary by population too.
Give them directions? ("take deep breaths")
Try to talk to them about something irrelevant? (I am bad at doing this because I can't focus on a conversation while performing a procedure very well.....)
When I am getting my blood drawn (painful, but sort of nerve wrecking still) or having wound care done, I prefer not say anything so I can go to my happy place.
What do you prefer?

Just today I had two painfull procedures done One was a shot in foot for that one the doc was grate and froze my foot and told me everything I was going to fell befor he did it and waited for me to say ok .he also bruight in his daught to to play wih my dog and she asking me all kinds of questions so I think he planed that :)

By contrast later I had to go have somthing eles done and my other doctor is good but has no bedside maner . the doc did not want to do this and just told the nurse to handel it but there where some problems and by the time she ran to drag him in there i was already in pain and then began to beg them to stop "witch they did " but the pain just keep coming and I began to cry and cry not knowing what to do the doctor and nurse just stood there . :crying2:

WHAT would have been better is if they had gave me somthing :rolleyes: and if the doc come in to start with :crying2:and if they had distracted me or at least talked to me that would have helped .

Trekfan · Aug 9, 2011

i've had a lot of painful procedures ([color=sandybrown]4 bone marrow biopsies in the last 1 1/2 years alone). what helps me is to be told what is going to happen, and how i can help it go smoother (some people don't want to know anything- so this is very individualized). i found that the two i'd seen before on other people were much worse than the ones i've had !!
also, if there's likely to be discomfort, tell the patient. it's easier to put up with something for a few seconds/minutes if you know what to expect (again- have to gauge how the patient is reacting to the idea of the procedure).
if you can use emla for injections, that can help. (i personally don't like lidocaine with ivs- it's just one more stick- and i'm a horrible stick- had ivs in my breast twice, foot- don't even remember how many).
with kids, if they're old enough, maybe an analgesic lollypop (if dose appropriate); distraction, papoose- and if the parent is making things worse, see if you can get them out of there- if not, dose 'em both !! (just kidding )

omg ouch :crying2: i would have told them no way in hell are you doing that to me with out drugging me :eek: i have had to to just put my foot down more then once .

xtxrn, ASN, RN · Aug 9, 2011

OMG OUCH I would have told them no way in hell are you doing that to me with out drugging me I have had to to just put my foot down more then once .

They really don't hurt much at all- I've had IVs that were worse- but they're considered painful..... Plus, the doc used a lot of Lidocaine..... Neupogen and Neulasta hurt a LOT worse- as in doesn't go away hurt, until it wears of in a few days.

elthia · Aug 9, 2011

http://www.ideafit.com/fitness-library/deep-breathing-and-pain-management

http://journals.lww.com/smajournalonline/Fulltext/2009/07000/The_Effects_of_Deep_Breathing_Training_on_Pain.5.aspx

Some studies say deep breathing helps for acute pain...some say it doesn't.It is used widely chronic pain,and has evidence to prove it works there. I use it with pt's whose BP is too low to give pain meds to sometimes, or with pt's who are on the tranplant list who have chronic angina that can't receive any more IV nitroglycerin/pain meds and are still having pain, but are quite ready for ICU tx. It does increase pt satisfaction, and along with guided imagery does put the pt back into some control over their pain vs the pain controlling the pt.

Also, in a pt who has a PCI site or graft that has blown, and you are trying to keep them from vagaling, deep breathing really helps keep them from bearing down when you are holding lots of pressure on that groin site.

xtxrn, ASN, RN · Aug 9, 2011

http://www.ideafit.com/fitness-library/deep-breathing-and-pain-management
http://journals.lww.com/smajournalonline/Fulltext/2009/07000/The_Effects_of_Deep_Breathing_Training_on_Pain.5.aspx
Some studies say deep breathing helps for acute pain...some say it doesn't.It is used widely chronic pain,and has evidence to prove it works there. I use it with pt's whose BP is too low to give pain meds to sometimes, or with pt's who are on the tranplant list who have chronic angina that can't receive any more IV nitroglycerin/pain meds and are still having pain, but are quite ready for ICU tx. It does increase pt satisfaction, and along with guided imagery does put the pt back into some control over their pain vs the pain controlling the pt.
Also, in a pt who has a PCI site or graft that has blown, and you are trying to keep them from vagaling, deep breathing really helps keep them from bearing down when you are holding lots of pressure on that groin site.

The breathing brought up on this thread was in regards to acute pain - and procedures. (I have found that the panting can help with acute pain) Not diagnoses. :) I often have to keep myself from having vasovagal BP dumps from dysautonomia- and breathing does help that.

IME, if someone comes in and wants me to do guided imagery while they're drilling a hole in my pelvis, I'd think they were a royal dingbat. (fortunately, lidocaine takes care of the bone marrow biopsy pain well enough- is it perfect, no- but I wouldn't expect anything to completely remove that discomfort). :) I have a LOT of chronic pain- and it doesn't work for a lot of people, or we'd all be running around with dopey grins thinking about being at the beach...:) I've tried a lot of things- and short of a sledge hammer "guided" upside my head, it doesn't help. Now, once there is some element of pain relief, distraction can help ME with keeping it from getting worse as quickly- but I'm one broad who strongly disagrees with the idea that patients could only have less pain if they tried harder. And no pain control/relief works for everyone Please don't lump 'everyone' into the increased satisfaction group w/chronic pain....:)

A study of 40 patients hardly supports anything. IMO. You can't get a McDonalds' survey to mean anything with only 40 customers.

The second one said there was no difference in pain control- just patient satisfaction- maybe because someone spent time with them so they felt they were being taken seriously?????

elthia · Aug 9, 2011

Panting doesn't help me...deep breathing does...

I've had herniated disks in my neck, I've had bowel obstructions, and I'm a migraineur.

I live with pain. I've explored nonpharmacological pain techniques, and I know what works for me. Guided imagery works, if applied correctly with deep breathing it is a form of self hypnosis but it is best with chronic pain. Yes, when I am in status migraine and it has been going on for days and I am vomiting uncontrollably, I can't do my guided imagery, but when it is only 5/10...yes it works.

I've held patients hands and had them breathe through the pain while they were bleeding out from a blown graft and the blood pressure was in the toilet, and the MD's fist was in the groin, and we were pressure bagging blood on the way to the OR, and couldn't give any pain meds...and the pt thanked me later....

I've done the same for a pt who threw an arterial thrombus and and was screaming from the pain, and the MD wouldn't let me give any sedation...because he was afraid it would interfere with the anesthesia as we were on the way to the OR

Sometimes when pain meds are contraindicated, that's all a nurse has to work with...

xtxrn, ASN, RN · Aug 9, 2011

Panting doesn't help me...deep breathing does...
I've had herniated disks in my neck, I've had bowel obstructions, and I'm a migraineur.
I live with pain. I've explored nonpharmacological pain techniques, and I know what works for me. Guided imagery works, if applied correctly with deep breathing it is a form of self hypnosis but it is best with chronic pain. Yes, when I am in status migraine and it has been going on for days and I am vomiting uncontrollably, I can't do my guided imagery, but when it is only 5/10...yes it works.
I've held patients hands and had them breathe through the pain while they were bleeding out from a blown graft and the blood pressure was in the toilet, and the MD's fist was in the groin, and we were pressure bagging blood on the way to the OR, and couldn't give any pain meds...and the pt thanked me later....
I've done the same for a pt who threw an arterial thrombus and and was screaming from the pain, and the MD wouldn't let me give any sedation...because he was afraid it would interfere with the anesthesia as we were on the way to the OR
Sometimes when pain meds are contraindicated, that's all a nurse has to work with...

That's great that it works for you :) And guided imagery may work for SOME- not everyone, unless I'm an alien, and nobody told me Your experience is valid- as your experience:) And mine is valid for mine :) Nothing works for everyone