During your pain management practice, you should be prepared to assess the health status of your patients and evaluate their ability to respond to pain management therapy. This includes the evaluation of pain using an organization-approved pain scale. It is also essential to ensure that your education and management competencies are up-to-date and reflect best practices.
Preoperative patient evaluation and planning
Whether a hospital or a health care provider, you need a thorough preoperative patient evaluation and pain management plan. This evaluation aims to reduce morbidity and mortality related to surgery. This includes preventing complications and reducing the length of the postoperative stay.
Your preoperative evaluation should include a thorough history and physical examination. You should also consider a psychiatric consultation if you suspect your patient may have underlying psychiatric disorders. It would help if you also looked for signs of an ongoing infection or other comorbidities.
A preoperative history should include a detailed review of your patient’s medical record, including their past and current illnesses and surgeries. It would help if you also asked about any medications they are taking and a family history of drug reactions.
A physical examination should evaluate your patient’s overall functional capacity, as well as any anatomic abnormalities. It would help if you also looked for any reversible pulmonary pathology. You should note any cognitive dysfunction in your older patients undergoing general anesthesia.
You should also be aware of any medication errors you have seen. If you have noticed any reversible abnormalities, you should develop a plan to correct them before the procedure.
Ensure education and management competency are current and reflect best practices
Having a well-crafted set of pain management competency benchmarks to aim for is a worthy pursuit. Developing such a set can improve the odds of a pain-free outcome for a patient and family member. Currently, there are few, if any, pain management competency benchmarks in place. To improve the quality of care in the health care system, the current crop of entry-level health professionals must be equipped with the tools and knowledge to help the next generation of pain sufferers. Luckily, a litany of resources is available to assist with this endeavor. A small but dedicated group of professionals were assembled to develop a benchmark set. These individuals were selected based on their prior experience and demonstrated interest in assisting with the process. The group consists of university-based educators from across Canada. The group subsequently endorsed an initial set of standards. Once validated, the second round of qualifying pain educators was invited to participate. A final set of benchmarks was approved. Using a modified Delphi design, the group above produced a consensus-based set of standards that are now part of the Canadian Pain & Rehabilitation Education Initiative.
Assess pain using an organization-approved pain scale
Using a pain scale is essential in evaluating a patient’s pain. It can help to improve diagnosis and treatment. However, the benefits of using a pain scale can vary depending on the type of pain being evaluated. Many different pain scales are available to medical professionals, ranging from the simple numerical rating scale to more comprehensive multi-dimensional scores.
The most common type of pain scale is the numerical rating scale (NRS). It asks patients to rate their pain on a 0- to 10-point scale.
Some scales combine numbers with pictures to help visualize the pain experience. One example is the Wong-Baker FACES Pain Scale, which correlates each face with the pain experienced by that person.
A more comprehensive pain assessment includes assessing the intensity of the pain and the behavioral, physical, and emotional signs and symptoms of pain. The results from the evaluation are used to guide the design of optimum analgesics.
Another pain scale commonly used in healthcare is the visual analog scale. This is similar to the numerical rating scale, but instead of using numbers, the patient marks a point on a 10 cm line.
Assess pain in patients with cognitive impairment or an inability to communicate
Performing pain assessments in elderly patients with cognitive impairment or an inability to communicate is challenging. The comorbidities of these individuals include breathing difficulties, anemia, and Parkinson’s disease. They are also less likely to receive opioid analgesics. It is unclear whether the cognitive impairment or an inability to communicate influences alternative pain assessment methods in the ED setting. Identifying the factors that influence these behaviors is necessary.
To assess pain in cognitively impaired individuals, it is essential to evaluate their medical history. This will help determine their pain risk and inform the appropriate management of their pain. It is also necessary to document the procedure.
These patients’ most commonly observed pain behaviors are vocal and protective body movements. These behaviors may decrease with the severity of the cognitive impairment. Using behavioral observation scales to measure these behaviors is helpful. Collateral information from family members can also be beneficial. However, this method has yet to be studied in the cognitively intact population.
The prevalence of different pain behaviors was assessed in a United Kingdom study. The verbal analog scale was routinely used. The study found that 55% of cognitively impaired patients did not record their pain scores.
Ensure nonpharmacologic or complementary interventions before administering analgesics
Ensuring nonpharmacologic or complementary interventions before administering analgesics in pain management practice is a wise move. Pain is a complex phenomenon that various factors, including trauma, injury, and medical treatments, can cause.
The American Society of Clinical Oncology (ASCO) convened a meeting with the American Society of Hematology (ASH), the National Comprehensive Cancer Network (NCCN), and the Centers for Disease Control and Prevention (CDC) to discuss pain management for cancer patients.
The CDC conducted a systematic clinical evidence review on opioids for chronic pain. This review included contextual questions regarding clinician and patient values, cost, and risk mitigation strategies.
The CDC also published a draft clinical practice guideline. The guideline is based on five systematic reviews. It includes 12 recommendations. The recommendations are based on clinical and contextual evidence and were evaluated by independent federal advisory committees.
The CDC’s clinical practice guideline also includes specific recommendations for the opioid prescribing process. These recommendations include ensuring that analgesics are prescribed for the right patient, in the correct dose, at the right time, and for the correct duration.
The CDC’s clinical practice guidelines are based on the ACIP-adapted GRADE method. This is a systematic approach to identifying and implementing the best practices for pain management.
Hands-on treatments reduce pain.
Using hand tools to perform physical therapy may be old hat, but using a few specialized devices can improve your well-being. Among other things, hands-on treatments can reduce pain, enhance flexibility and improve the function of impacted tissue.
A physical therapist may administer a combination of manual, electrical, and rehabilitative therapies. This treatment can reduce pain by removing scar tissue, repairing muscles, and strengthening weak muscles. A splint can also help manage carpal tunnel syndrome or CTS.
In general, the best hands-on treatment is one that incorporates a multidisciplinary approach. For instance, a patient may undergo a combination of acupuncture, massage, chiropractic manipulation, exercise, manual manipulation, and other manual techniques.
In general, hands-on therapy is a more cost-effective alternative to surgery. For example, it can correct a herniated disc or relieve the discomfort of a pulled muscle. A physical therapist can prescribe assistive devices such as braces and casts and recommend exercises to strengthen core muscles.
The best hands-on therapy involves a long-term treatment plan with frequent re-evaluations. To increase the odds of success, the therapist should be patient-focused and not abrasive. The trick is finding a therapist that best fits your personality, needs, and lifestyle.
