Pain can be considered acute or chronic. Chronic pain occurs when pain signals continue to fire in the nervous system. This is ongoing, lasting longer than the typical healing timeframe which is typically defined as pain that is present for longer than 3-6 months. Every person will experience pain differently and every individual’s tolerance for pain will be different. Overtime, constant pain can begin to affect other areas of a person’s life including their daily activities. Likewise, individuals suffering from chronic pain are also at an increased risk of depression and anxiety. Individuals may also begin experiencing sleep disturbances due to the pain they experience.
Causes
The cause of the pain can be extensive and vary from person to person. For example, some individuals may experience chronic pain due to chronic conditions such as arthritis while others may experience chronic pain due to another acute diagnosis such as cancer. Some injuries or illnesses may leave an individual more sensitive to pain, and sometimes people may be experiencing multiple causes of pain that overlap resulting in a chronic pain. A brief list of additional causes is listed below:
- Infections
- Migraines
- Back injuries
- Fibromyalgia
- Nerve damage
- Pervious surgeries
Symptoms
Chronic pain can occur anywhere within the body and is often described as feeling:
- Dull, achy
- Soreness, stiffness
- Stinging
- Throbbing
- Burning
- Shooting
Risk Factors
Some individuals may be more prone to developing chronic pain than others. Individuals at a higher risk of experiencing chronic pain include the elderly and obese individuals, as well as, people who have had previous injuries, increased stress, and use tobacco products. Unfortunately, genetics can also play a role in increased risk of chronic pain, particularly as it relates to chronic pain associated with migraines.
Treatment
As previously mentioned, chronic pain can be complicated and feel differently for each person and it can be the result of multiple factors. Therefore, there are several treatment options available. Various types of treatment include medications, acupuncture, local electrical stimulation, and sometimes surgery. In addition, psychotherapy, relaxation therapies, biofeedback, and behavior modifications have also been shown to have promising effects in treating pain.
Expected patient outcomes
- Patient will maintain acceptable pain level
- Patient’s vital signs will remain stable
- Patient will be able to verbalize chronic pain management strategies for discharge
- Patient’s environment will remain free from increased pain triggers
Nursing Assessment for Chronic Pain
1. Assess patient’s pain level using age and developmentally appropriate pain scale (i.e. FLACC, Wong-Baker Faces, Visual Analogue Scale).
Assessing patient’s pain level includes location, description, duration, and intensity. This allows the nurse to receive subjective data from the patient and thereby individualize the treatment plan and treat what the patient is truly experiencing.
2. Complete head-to-toe assessment.
This allows the nurse to note any physiologic signs that may be present as a result of the increased pain level the patient has. (For example, a patient experiencing significant pain may become restless).
3. Assess vital signs.
Blood pressure and heart rate may become elevated due to severe pain. Patient’s breathing pattern and respirations may also change resulting in a change in oxygen saturation.
4. Assess current environment.
Current environmental factors could be increasing patient’s pain level.
5. Assess patient’s current psychosocial status/health.
Psychosocial health can impact patient’s pain level. Patients can be more prone to depression and anxiety when experiencing chronic pain thereby making it harder to control and treat.
Nursing Interventions for Chronic Pain
1. Assist patient with repositioning.
Certain positions may be more painful than others. Allowing for frequent position changes may assist in pain management
2. Administer analgesics as prescribed.
If the provider has ordered pain medications this may be helpful in controlling the patient’s pain. Administering pain medication should be based on the pain assessment.
3. Assist patient with developing a regular exercise routine.
Physical and occupational therapy may be beneficial in treating pain or in keeping it at a manageable level.
4. Use complementary and alternative medicine therapies as appropriate (i.e. massage, ice packs, heating pads).
Some therapies such as massage may help decrease patient’s pain level. In addition, the use of hot or cold therapy may assist in keeping pain at a more manageable pain level.
5. Assist patient with behavioral therapy exercises.
Behavioral therapy exercises such as relaxation, deep breathing, or meditation may assist patient with being able to control pain better.
6. Provide patient education.
Patient education includes helping patient to understand there is no cure for chronic pain but instead treatment is focused on the management of the pain. Education also allows patients to set realistic goals and expectations. Likewise, education can help patient to identify what s/he is able to do at home to manage their pain better.
References and Sources
- Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th edition). Mosby.
- American Academy of Family Physicians. (2019). Chronic pain. https://familydoctor.org/condition/chronic-pain/
- Cleveland Clinic. (2021). Chronic pain. https://my.clevelandclinic.org/health/diseases/4798-chronic-pain
- National Center for Complementary and Integrative Health (2018). Chronic pain: In depth. https://www.nccih.nih.gov/health/chronic-pain-in-depth
- National Institute of Neurological Disorders and Stroke (2019). Chronic pain information page. https://www.ninds.nih.gov/Disorders/All-Disorders/Chronic-Pain-Information-Page
