Back pain management and interdisciplinary treatment approaches

Pain Management

HOW TO MAKE IT GO AWAY

Recent health records show that more than 86 million Americans suffer pain of some sort at any given time (Thomas, 2009). These records also reveal that approximately 80% of all Americans suffer from back pain at least once in their lifetime. Back pain is the most common reason for seeking medical care. Among the causes of acute or chronic back pain are back strain, spinal stenosis and osteoarthritis (Thomas).

Pain is broadly classified as acute or chronic (Thomas, 2009). Acute pain begins suddenly and the body's signal that something is wrong. Causes include broken bones, burns or cuts, dental procedure, labor and childbirth, injury on soft tissues, and surgery. In most cases, acute pain quickly resolves. At other times, it lasts up to 3 to 6 months. But acute pain is usually predictable so that the doctor can develop a plan to treat it. The aim is to prevent it from becoming chronic or long-standing. Chronic pain, on the other hand, lasts longer than 6 months, persists and often severe. It is usually difficult to treat and require many specialists of different disciplines at the same time. Chronic pain produces draining physical and emotional effects. Physical symptoms include muscle tension, immobility, lack or loss of energy or appetite. Emotional symptoms include depression, anger and anxiety. Chronic pain often develops from arthritis, cancer, degenerative disc disease and other spinal disorders, nerve dysfunction, soft tissue injury or trauma from fall or accident, unresolved disease or injury (Thomas).

Review of Literature

Kortesluoma, Riitta Liisa, Merja Nikkonen and Willy Serlo. "You Just Have to Make the Pain Go Away"- Children's Experiences of Pain. 9 (4); 143-9. Pain Management Nursing: Elsevier Science, Inc., 2008. Retrieved on April 15, 2009 from http://www.medscape.com/viewarticle/585567

The authors discuss the findings of a study conducted on 44 young children's expectations from pain management interventions while they were hospitalized. The motivation behind the study was the new concept that health care providers should listen to children's perspective in their own treatment. They should be viewed as experts on their own pain experience. These participants from a university hospital used multiple strategies in dealing with pain while in the hospital. They also expected health care professionals to competent. At the same time, they valued the care and attention given by those close or important to them, like family members.

The authors see children in great pain as presenting a challenge for nurse education and health car personnel. Not only should their perceptions be recognized and appreciated. Nurses should also enter a working partnership with them and incorporate the partnership into their practice and research. Children's expectations about pain interventions in the hospital should be further explored so that the care would be more child-centered. Children's views could provide a more comprehensive understanding of issues surrounding pain management in hospitals. Nurses could also investigate the effects of child-initiated self-help methods and non-pharmacologic approaches to pain.

McDonald, Deborah Dillon, et al. Older Adult Pain Communication and the Brief Pain Inventory Short Form. 9 (4); 156-159. Pain Management Nursing: Elsevier Science,

Inc., 2008. Retrieved on April 15, 2009 from http://www.medscape.com/viewarticle/585568

McDonald and her co-authors report the findings of a randomized study on how 106

older adult community dwellers communicated their pain experiences through the short form and open-ended questions. Almost all of them communicated the location of their pain and more than half of them communicated the intensity of their pain. Few described their treatments and fewer communicated the effectiveness of these treatments. Although the participants were afflicted with osteoarthritis, they only slightly reported information on their illness. They need support to communicate more information about their pain beyond the location and intensity.

The authors point to factors, such as low expectations for pain relief and reliance in the know-how of health care providers, as suppressing older adults from communicating their pain more comprehensively. Health care professionals, especially nurses, should explain to older adults with chronic osteoarthritis pain about their role responsibility to provide more information on their pain. Completing the prescribed short form did not help the participants discuss their pain condition or experience or reveal more details about it. Findings of the study suggested the use of open-ended questions, such as "tell me about your pain." Then the multidimensional pain measurement, such as the short form, should be used.

Vallerand, April Hazard; Collis-Bohler, Deborah; Templin, Thomas; and Hasenan, Susan M. Knowledge of, and Barriers to, Pain Management in Caregivers of Cancer Patients Receiving Homecare, 2007. 30 (1):31-7. Cancer Nursing: Lippincott Williams & Wilkins. Retrieved on April 15, 2009 from http://www.medscape.com/viewarticle/552132

The authors point to pain as the most frequent and distressing symptoms in cancer patients, especially those in outpatient settings. Managing their pain necessarily falls into the hands of caregivers. The extent of the caregivers' knowledge on pain management comes into question, as insufficient knowledge accounts for inadequate pain management. A group of 46 primary caregivers responded to the Barriers Questionnaire and the Family Plan Questionnaire. The questions dealt basically on reporting pain and using analgesics. Almost all of them agreed that barriers to reporting pain and using analgesics existed. Their greatest common concern consisted of opioid-related side effects, fears of addition and the view that pain meant disease spread.

The tests found that caregivers with high-level of knowledge about pain management encountered significantly fewer barriers to cancer pain management. They were less likely to under-treat the patients' cancer pain. Consequently, they had significantly less apprehension that increased pain meant progression of the cancer. They were also less bothered that reports of pain would interfere with or disturb treatment of the cancer by the physician. Findings compared with that of a previous study on hospice caregivers. That earlier study found that caregivers with lower educational levels and older caregivers tended more to believe that reporting would distract the physician from treating the cancer. A large percentage of these hospice caregivers harbored misconceptions and concerns about reporting the patients' pain and the use of analgesics.

In this current study on primary caregivers of cancer patients also expressed fear about opioid side effects, pain as an indicator of cancer progression and the fear of addiction to pain-killers.

Both studies underscored the importance of increasing knowledge about pain management in cancer patient, especially for those extending home care for these patients. Findings and other information from this study could be of help in planning future educational interventions to improve pain management for nurses, patients and caregivers in various settings and various pain syndromes.

Kirk, Timothy W. Managing Pain, Managing Ethics, 2007. 8 (1):25-34. Pain Management Nursing: Elsevier Science, Inc. Retrieved on April 15, 2009 from http://www.medscape.com/viewarticle/557072

Kirk writes that the non-compliance of family caregivers to the rules can create difficult ethical choices for home hospice nurses. This happens when family members do not adequately do their part in palliating the sick person's pain. Hospice caregivers have moral obligations to the patient and the patient's caregivers. The author clarifies that in the hospice, the patient's family members are, in fact, the primary caregivers under the situation. The best that nurses can do is to use strategies, which will incorporate family members into delivering the best palliative care possible. Failure to achieve the best results can create much moral anguish and sense of failure in nurses. Nevertheless, nurses who resort to this step should be convinced that they do what is right and worthy of praise.

Summary and Conclusion

Managing the pain experience of hospitalized children, cancer patients in home care or older adults in community dwelling is the responsibility of health care professionals. The nurse is a mainstay and front liner in the health care team in all settings.Therefore, it is her primary responsibility to know and perform the most and the best she can to reduce or alleviate her client's pain according to the rules. #