Pain Management

PAIN MANAGEMENT• An interdisciplinary approach to making

pain manageable, optimizing function and maximizing quality of life.

• Strategies include:Drug interventionsNon drug interventions such as

AcupunctureNerve blockPhysical TherapyRelaxation Techniques

OBJECTIVES

• Reduce the incidence and severity of patients’ acute post procedure pain.

• Educate patients about the need to communicate unrelieved pain so they can receive prompt evaluation and effective treatment.

• Enhance patient comfort and satisfaction.

Everyone experiences pain at one point or another. It's often an indication that something is wrong.

Each individual is the best judge of his or her own pain. Feelings of pain can range from mild and occasional to severe and constant.

PAIN• Pain of any Origin – Acute & Chronic

• Kidney Stone Pain

• Stent Related Pain

• Post Procedure Related Pain

KIDNEY STONE PAIN

• Abrupt onset of severe, unrelenting flank or lower abdominal pain

• Pain may remain localized or may radiate into the lower abdomen or genital region

• Patient is very restless, since no position affords any pain relief

• Other signs and symptoms include nausea & vomiting, frequent urination, painful urination, abdominal pain, chills, fever and hematuria

STENT PAINEach person has a different tolerance level of discomfort while a stent is in place. Stent pain of varying degrees is estimated to affect upwards of 80% of patients having one placed.* Specific symptoms and estimated incidences include:•Irritative Voiding Symptoms (most common)

Frequency (50-60%) Urgency (57-60%) Dysuria (40%) – discomfort when voiding Incomplete Emptying (76%)

Irritative symptoms related to the bottom coil resting in very sensitive area of bladder; awareness of stent during awake hours & movement of stent with activity

•Pain or Discomfort Flank (19-32%) – especially at the end of voiding

Flank pain believed to be due to reflux of urine from the bladder to the kidney during voiding

IF PATIENTS ARE INFORMED OF STENT PAIN IT HELPS TO DECREASE PAIN*Joshi HB, Okeke A, Newns N, Keeley FX, Jr, Timoney AG. Characterization of urinary symptoms in patients with ureteral stents. Urology. 2002;59:511–9.

POST PROCEDURE PAINWHAT TO EXPECT AFTER ESWL.Patients may experience some degree of discomfort for a day or two after ESWL. The pain is usually described as a dull ache over the kidney, and is typically at its worst the evening following the procedure. The pain lessens over the following days.AFTER ENDOSCOPYPatients may experience abdominal pain and a burning sensation when urinating. These symptoms are generally mild and gradually decrease after the procedure. If a Stent is inserted a patient may have flank pain, especially at the end of voiding.AFTER BPH Patients may feel an urgent or frequent need to urinate, or may have to get up more often during the night to urinate. Generally most men experience burning, especially at the tip of their penis, near the end of urination.AFTER PROSTATE BIOPSYPatients may feel soreness/pressure/throbbing in rectal area

Acute pain begins suddenly and is usually sharp in quality. It serves as a warning of disease or a threat to the body. Acute pain may be caused by many events or circumstances, such as:

• Surgery• Broken bones• Dental work• Burns or cuts• Labor and childbirth• Muscle injury

Acute pain may be mild and last just a moment, or it may be severe and last for weeks or months. In most cases, acute pain does not last longer than six months and it disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, may lead to chronic pain

ACUTE PAIN

CHRONIC PAIN

PAIN ASSESSMENT SCALE• Scale

– Numeric Rating 0 -10– Faces– Non-English Speaking

Patients– Pediatric Patients

0 1 2 3 4 5 6 7 8 9 10

0= No Pain

1-2= Mild Pain

3-4= Discomforting

5-6= Moderate Pain

7-8= Distressing

9-10=Severe Pain

ASSESSING PAIN

• PreProcedure Phone Call

• Day of Procedure

• Post Procedure Phone Call

• Thirty Day Follow-Up/Patient Survey

PRE-PROCEDURE• Phone Call

Up to 7 Days Pre-ProcedureMedical HistorySurgical HistoryCurrent MedicationsUrological HistoryPresent Symptoms Policy C.22.A (Pre-Procedure Call)

DAY OF PROCEDURE• Peri Operative Nursing Assessment

Status day of procedurePain Score - Pain Algorithm Aldrete Scoring System Discharge Instructions

• Anesthesiologist AssessmentPain medication if necessary Policy C.40.A (Anesthesia General Policy)

POST PROCEDURE24 – 48 Hours Post Procedure Phone CallPain ScorePatient SurveyPost Follow-Up with UrologistPolicy C.23.A (Post Procedure Call)Thirty Day TextInfection Control survey

JOINT COMMISSION STANDARDS

• RI.01.01.01 - The organization respects patients rights.

• PC.01.02.07 – The organization assesses and manages the patient’s pain.

JOINT COMMISSION STANDARDScont’d

These standards include:

•Assessing the patient’s pain within age and ability to

understand

•Pain reassessed and responded to by the organization

•The organization treats the patient’s pain or refers the

patient for treatment

WHAT TO DOCUMENT?• Location• Pain Score• Onset• Frequency• Pain Medication • Vital Signs

– After Pain Medication, q. 5-15 min & prior to discharge

• Effectiveness

PATIENT EDUCATION• Website

• Brochure– Pain Management Techniques For Patients

• Discharge Instructions– Family or other caregivers

• Policy C. 22. A & C. 23. A Pre and Post Procedure Phone Calls

• Policy C.24.A (Patient Education)

STAFF EDUCATION

• Orientation

• Annual Inservice