Pain Management: 5 Things Nurses Need to Understand

Pain is the leading reason patients come through the hospital doors, according to the American Academy of Pain Medicine. In 2011 the Institute of Medicine found the incidence of chronic pain greater than diabetes, cancer, and heart disease combined. It is common, it is hard to assess, and it is now treated as a disease in its own right and a public health problem. We have spent a great deal studying it and still do not fully understand it.

Acknowledge the pain, sit the patient down, and listen. Five things to hold onto when you manage it:

1. Pain is the 5th vital sign.

Vital signs are critical measurements of life function: they reflect overall condition, disease progression, and recovery. The Joint Commission (JCAHO) mandates that pain assessment and documentation be as automatic and prominent as blood pressure and respiratory rate, and that every patient has the right to appropriate assessment and management of pain.

Pain is subjective and its validity rests mostly on the patient, but take it seriously. Collaborate on prescribed relief, advocate when it fails, and watch whether behaviors and manifestations match the complaint. Note when a patient denies pain you would expect and why (fear of opioid addiction, seeing pain as weakness).

2. Pain has detrimental effects on the body.

Pain does not go away without affecting the body. Acutely it hits five systems: cardiovascular, pulmonary, gastrointestinal, endocrine, and immune. The effects are worse in patients with existing disease, advanced age, or current injury. Metabolic rate and cardiac load climb. Cortisol rises in the blood and drives fluid retention. Severe pain can stop a patient from taking a full breath, and some refuse to move at all.

When pain lasts more than 6 months it is chronic, which brings prolonged immune suppression, fatigue, depression, and social isolation. Chronic pain (arthritic pain, for example) is a leading cause of disability.

3. Pain response is not just in the mind.

Treating pain as purely mental ignores the factors that shape it. Culture, age, expectations about relief, and gender all affect pain perception and tolerance. Telling a patient it is "all in the mind" misses this.

Beliefs and responses to pain vary across cultures, shaped early by what stimuli a person is taught to expect as painful and which reactions are acceptable. People from different cultures react differently to the same intensity, and their expectations of relief differ too. A positive treatment expectation increases effectiveness.

Age draws the most research, and the relationship between age and pain perception is still unclear. Experts agree that reduced pain perception in older adults comes from disease processes, not aging itself, so pain is not a normal part of aging. Confusion in elderly patients after surgery is usually unrelieved pain, not the medications.

Gender matters too. Women report more fear and frustration from pain; studies show men are more anxious about theirs.

4. Pain can provide clues to emotional and psychological health.

Watch verbal statements and behavior during assessment. Some pain is emotional or psychological in origin and shows up as headaches, muscle pain, or back pain, especially once physical causes are ruled out. Sometimes a patient needs someone to hear them out and help make sense of feelings that feel incomprehensible in the moment.

5. Nurses' perceptions of pain affect the nurse-patient relationship.

How you think pain should be handled shapes how you treat patients who report it. Stay aware of that so you do not pass judgment or impose your preferences. Acknowledging pain goes a long way, because it is real to the patient. Stay alert to faked pain as well, so appropriate referrals can be made.

Pain persists in millions of lives, with no reliable pattern, which makes it hard to approach. Every pain has a story. Sometimes you trace it to its origin; other times a patient wakes with pain that has no plans to leave. Work with the resources and the evidence you have.