Ask Vanessa: Pain Management In The Home

DEAR VANESSA,

I will be providing live-in care to a 65-year-old patient with a history of severe rheumatoid arthritis. He lives alone, has had several joint replacements, is in constant chronic pain, and has limited mobility. How can I comfort him and what advice can you give regarding pain assessment and management?

Thank you. 

-ELENA

Dear Elena,

The most widely accepted definition of pain is as follows: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (McCaffery & Pasero, 2003). One of your biggest challenges is to provide your patient with physical and psychological comfort. To comfort means to provide pain relief, to ease his grief or trouble, to cheer, and to give strength and hope. Ask him his concept of what constitutes comfort. Build a relationship by listening actively, being patient, and showing respect. If it’s possible, maintain eye contact and provide gentle touch when talking to him.

You need to be well-informed on the pain management program and strategies that are being implemented. Learn your patient’s routine and “as needed” analgesics and their effects. Provide measures that promote his comfort and sense of well-being; these include warm baths, thorough personal hygiene, and adequate rest. If he has difficulty in performing self-care activities, encourage him to discuss his feelings about the loss of function in order to find ways to cope with pain and the lifestyle it imposes. Use proper positioning techniques and methods of assisting with ambulation.

There are noninvasive techniques that are used for pain relief. These therapies include cutaneous stimulation (heat, cold, massage, and TENS (Transcutaneous Electric Nerve Stimulation), distraction, relaxation, guided imagery, hypnosis, and biodfeedback. These techniques can decrease anxiety, are inexpensive and easy to perform, and have low risk and few side effects.

There is no specific “picture” of a patient in pain but he may manifest these behavioral signs: rigid body position, restlessness, frowning,grimacing, clenched teeth, crying, and moaning. Physiologic signs include: increased pulse rate, increased depths and frequency of respirations, increased blood pressure levels (systolic and diastolic), pallor, dilated pupils, muscle tension (face, body), and nausea and vomiting. The Pain Assessement Guide includes the following: How does pain feel?, Intensity (0-10), Location, Duration, Aggravating and Alleviating Factors, and How Pain Affects Sleep, Appetite, Energy, Activity, Relationships, and Mood.

VANESSA