Pain Management

This position statement was archived on 11/7/2012.  AMSN prefers to endorse the position statements of the  Hospice and Palliative Nurses Association (HPNA) and the American Society of Pain Management Nurses (ASPMN).

IT IS THE POSITION OF AMSN THAT:

  • Pain management should be a priority of care for every patient, with freedom from pain as a basic human right.
  • Pain management is a collaborative effort between the caregiver and the patient that must include consideration of the patient's individual needs in selecting the most appropriate intervention. The nurse should promote understanding of pain management measures.
  • The patient's self-report is the most reliable indicator of pain. If the patient is unable to describe pain (e.g., due to cognitive impairment), the nurse should anticipate pain with procedures or conditions that are known to cause it (e.g., hip fracture) and intervene appropriately.
  • Reassessment of pain is needed after intervention or change in the treatment regimen. The medical-surgical nurse should encourage the patient to report inadequate pain management, and should in turn immediately report this finding to the physician.
  • Analgesics should be administered regularly, with around-the-clock dosing used as indicated to optimize pain management.
  • Analgesic side effects should be identified and treated aggressively for patient comfort.
  • Full and effective doses of analgesia are indicated for effective pain management in the dying patient. Increasing the dose of medication to achieve adequate symptom control, even at the expense of life, is justified ethically.
  • Placebos should not be used for assessment or management of pain of the medical-surgical patient. To protect the patient and nurse from moral, ethical, and legal compromise, use of placebos should be limited to approved clinical trials in which informed consent is obtained.
  • The medical-surgical nurse should be knowledgeable regarding signs of tolerance, addiction, pseudoaddiction, or dependence, and should respond appropriately to ensure effective pain management.

OVERVIEW:

Care of the patient with pain is a rapidly expanding science that utilizes pharmacology, technology, and complementary therapies to provide safe, comprehensive treatment. Optimal pain management promotes healing, comfort, and a feeling of well being. Effective pain management permits performance of critical activities, improves quality of life, and reduces the length of hospital stay.

Fear of addiction, tolerance, and treatment side effects contributes both to practitioner and patient hesitation to fully utilize proven analgesics. Although addiction to opioids may occur despite appropriate pain therapy in some susceptible individuals, research has shown addiction as a result of using opioids for pain management occurs in less than 1% of patients (American Pain Society, 2004; McCaffery & Pasero, 1999). The presence and persistence of pain contribute to patient perception that pain may mean a worsening of the disease process or health condition. Assessment inconsistencies and reluctance to accept patient reports of pain result in inadequate treatment and unsuccessful pain management.

RATIONALE:

AMSN supports effective pain management as an essential element of quality patient care.

DEFINITIONS:

Pain is described in sensory and emotional terms primarily associated with tissue injury or described in terms of such damage. No exact pain perception center exists in the brain. Physiological manifestations are not reliable indicators of the total pain experience. Objective measures do not adequately quantify pain; subjective descriptors attempt to qualify pain. Thus, pain is defined as whatever the experiencing person says it is, existing whenever the patient says it does. Self-report is the standard for pain assessment.

Tolerance is a process characterized by decreasing effects of a drug at its previous dose or the need for a higher dose.

Physical dependence is evidenced by withdrawal symptoms when an opioid is stopped or an antagonist is administered.

Addiction is a pattern of compulsive use characterized by continued craving for an opioid and the need to use the opioid for effects other than pain management.

Pseudoaddiction is an iatrogenic syndrome created by the under treatment of pain; it often is characterized by patient anger and demands for more or different analgesics. It can be distinguished from addiction by the resolution of patient behaviors when effective pain management is achieved.

REFERENCES:

American Society for Pain Management Nursing (ASPMN). (2002). ASPMN position statement: Pain management in patients with addictive disease. Retrieved October 12, 2009, from http://www.aspmn.org/Organization/documents/addictions_9pt.pdf

American Society for Pain Management Nursing (ASPMN). (2003). ASPMN position statement on pain management at the end of life. Retrieved October 12, 2009, from http://www.aspmn.org/Organization/documents/EndofLifeCare.pdf

Herr, K., Coyne, P.J., Manworren, R., McCaffery, M., Merkel, S., Pelosi-Kelly, J., et al. (2006). Pain assessment in the nonverbal patient: Position statement with clinical practice recommendations. Pain Management Nursing, 7(2), 44-52.

McCaffery, M., & Pasero, C. (1999). Pain: Clinical manual (2nd ed.). St. Louis: Mosby.