New Castle News

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August 15, 2013

Lori Brothers: Pain management key to healing process

NEW CASTLE — According to Hospitals and Health Network, more hospitals are developing formal in-patient pain management programs. The aim is to improve care and boost patient satisfaction. Programs should be multidisciplinary and utilize evidence-based care protocols and pathways where appropriate.

The challenge for hospitals across the country is to develop communication strategies that will allow patients to feel that their needs for pain management are being met in the most timely, compassionate, and also medically responsible way. Comfort in healing is the goal.

Jameson Hospital has had an on-going care plan with patients regarding pain management that includes encouraging more communication with the patient, helping the patient set a goal for pain management, and regular check-ins by nurses and aides to see if the patient’s pain level is remaining tolerable. While pain is subjective, delivering a sense of empowerment for the patient in pain management is the care plan.

There is a certain amount of pain tolerance that is required for a patient to heal, says Jameson’s surgical services coordinator, Kim Nocera.

Nocera explains that not all pain can be, nor should be, cut out after surgery or injury, if the patient is expected to heal well. “A patient’s ability to feel, gauge and tolerate pain can help to determine if there is improvement over time, or if a condition is worsening,” Nocera says.

The standard pain scale is a rating of the individual patient’s experience from 0 to 10, with 0 indicating no pain and 10 rating unbearable pain.

“Good pain management is not getting a patient to a zero,” says Barb Bernardi, Nurse Executive at Jameson.

However, one person’s rating of 4 (which is usually considered tolerable pain) is another person’s 6. This is based on the subjective reporting of each individual patient. This is why the scale is based on tolerable pain as opposed to eliminating pain while healing from injury or surgery, Bernardi explained.

Pain tolerance is influenced by people's emotions, bodies, and lifestyles and pain sensitivity can be affected by depression, anxiety, obesity and smoking.  Also, your amount of physical activity can directly affect your pain tolerance.  An athlete tends to tolerate pain better that someone who is sedentary.

Other biological factors including spinal cord and other injuries, and genetics can also determine how pain is perceived.  Chronic diseases such as advanced diabetes can cause nerve damage which tends to also shape pain perception.

“A fear of pain is only preceded by a fear of death,” according to Madeline Melidona, Patient Care Manager at Jameson’s Maternity Care Unit.

This is why the Joint Commission introduced a hospital accreditation standard that requires monitoring of patients' pain levels as a “fifth vital sign” in 2001.

Establishing good communication, and agreed-upon goals and expectations, gives patients the focus and tools to cooperate in their care. This empowers patients with a sense of control in their pain management plan which has proven to support a positive healing process.  

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