Reducing barriers to pain management

Reducing barriers to pain management

BarrierNursing Consideration
Fear of addiction
  • Explain that addiction is uncommon in patients taking opioids for pain.
Fear of tolerance
  • Teach that tolerance is a normal physiologic response to chronic opioid therapy. If tolerance does develop, the drug may have to be changed (e.g., morphine in place of oxycodone).
  • Teach that there is no absolute upper limit to pure opioid agonists (e.g., morphine). Dosages can be increased, and patient should not save drugs for when the pain is worse.
  • Teach that tolerance develops more slowly to analgesic effects of opioids than to side effects (e.g., sedation, respiratory depression). Tolerance does not develop to constipation. Thus a regular bowel program should be started early.
Concern about side effects
  • Teach methods to prevent and to treat common side effects.
  • Emphasize that side effects such as sedation and nausea decrease with time.
  • Explain that different drugs have unique side effects, and other pain drugs can be tried to reduce the specific side effect.
Fear of injections
  • Explain that oral medicines are preferred.
  • Emphasize that even if oral route becomes unusable, transdermal or indwelling parenteral routes can be used rather than injections.
Desire to be “good” patient
  • Explain that patients are partners in their care and that partnership requires open communication by both patient and nurse.
  • Emphasize to patients that they have a responsibility to keep you informed about their pain.
Desire to be stoic
  • Explain that although stoicism is a valued behavior in many cultures, failure to report pain can result in under treatment and severe, unrelieved pain.
Forgetting to take analgesic
  • Provide and teach use of pill containers.
  • Provide methods of record keeping for drug use.
  • Recruit caregivers to assist with the analgesic regimen.
Concern that pain indicates disease progression
  • Explain that increased pain or the need for analgesics may reflect tolerance.
  • Emphasize that new pain may come from a non–life-threatening source (e.g., muscle spasm, urinary tract infection).
  • Institute drug and nondrug strategies to reduce anxiety.
  • Ensure that patient and caregivers have current, accurate, comprehensive information about the disease and prognosis.
  • Provide psychologic support.
Sense of fatalism
  • Explain that pain can be managed in most patients.
  • Explain that most therapies require a period of trial and error.
  • Emphasize that side effects can be managed.
Ineffective medication
  • Teach that there are multiple options within each category of medication (e.g., opioids, NSAIDs), and another medication from the same category may provide better relief.
  • Emphasize that finding the best treatment regimen often requires trial and error.
  • Incorporate nondrug approaches in treatment plan.