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.

Positioning for Pain Control

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.

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UM Review RN

About UM Review RN, ASN, RN

Utilization Review Registered Nurse

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Having been a nurse assistant for a few years before becoming an RN it is great to see someone with a lot of experience teaching others the "simple" things like positioning and transferring that can make all the difference in a patient's comfort. It amazed me when I entered nursing school that we spent about 1 day in the skills lab learning patient toileting, transferring, and positioning - I guess it is assumed the auxiliary staff will be the only ones responsible for these tasks!

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Specializes in ER, Acute, home health, LTC, & Psy.

being a charge rn in ltc i can agree that proper positioning to decrease anyones pain is crucial! the only problem and biggest problem is these insurance companies that will not cover positional equipment. i know we can use towels/blankets/pillows etc, but really......to get optimal positioning items such as wedges etc .. are needed. :yeah::twocents:

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thanks for the info! ;-)

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Specializes in CAMHS, acute psych,.

thanks for the tips. Couple of questions for you

1. Do you use silken (probably a variation on nylon) slide sheets in the US? They are very helpful in making major adjustments when a pt has slid down in the bed and also in helping someone to get into bed and swing their legs up

2. I was taught it's better for your own back to push rather than pull pts for repositioning - do you agree?

3. In ltc in the US when you have a bed-bound and/or stuporous or otherwise mentally/physically unable pt do you routinely use turning sheets as part of your documentation? (ie x pt was turned at 2pm, 4pm etc)

thanks in advance

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What a wonderful blog!! I am always amazed when I get report that a patient has 'been on the light all night' with a statement of 'I gave them their meds (pain/sleeper) but they just won't stop!" Then upon entereing that patient's room, you see them, slid down in the bed...head laying flat... or on their side with no pillow between the knees and the arm with the old rotator cuff injury unsupported at an odd angle because the muscles no longer support the arm etc, etc.

Positioning alone or as an adjunct to pain medications should work together as a whole medication 'regimen' among a few other things.

As a 'Nurse Educator' in a past life for a facility, some of my favorite 'classes' involved having the nursing staff enter the room, sign in and then sit on their hands while I gave the class (never directly saying why I wanted them to sit on their hands). This would go on until I saw genuine discomfort, then I would discuss both the effects of pressure and the importance of frequent repositioning. It usually gets the point across.

Thanks again and what a great article!!

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Great Blog and very useful. I have a question, the resident has a right to refuse care, meds, and treatment. If they refuse care, and they need the care,(incontinence care) how do you handle it. I haven't found a good way. Most residents welcome the cna's rounds(11-7)shift, but some flat out fight. I am almost tempted to give up and allow them to sleep. The big problem is it is no good for there skin. What is your suggestion?

Thanks in advance

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