Discussion
Pain is a prevalent symptom among patients in general and in cancer patients. The treatment and control of pain have been through the years one of the most significant concerns of health workers and a constant inspiration for the scientific community in the search for the ideal drug to treat pain with the least possible amount of adverse reactions.
The implementation of pain management based on the best available evidence implies the comprehensive assessment of pain with a reliable and valid assessment instrument, the application of pharmacological and non-pharmacological interventions based on the findings of the evaluation, the frequent re-evaluation of pain to know the level of response to treatment (Samuels, 2010). Although
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evidence-based pain management guidelines are available, the implementation of the guidelines has been a significant challenge due to the inconsistency of their application in daily practice next to the bed of the patients, increasing the gap every time between what is known, what must be done and what is done. The use of pharmacological and non-pharmacological treatments for the management of pain is recommended, although there is a marked imbalance between the investigations that have been carried out and those that are being carried out at present, to evaluate the effectiveness of these two groups of strategies. Evidence from various research studies indicates that new and extensive studies every day are designed to demonstrate the advantage of one drug over another or the adverse effects of one drug compared to another (Wandner et al. 2013). However, the same intensity of the studies does not apply when trying to compare variants of non-pharmacological strategies. Furthermore, the pharmacological methods of pain control suggested are very varied and depend on the different scientific societies that participate in the research, writing, and dissemination of the different treatment guidelines. In this sense, the so-called World Health Organization (WHO) pain ladder is one of the most popular among health professionals. The pain ladder involves the use of analgesics in a rational and stepwise manner, avoiding abuse in the use of powerful drugs for pain that does not require that type of treatment (WHO, 2009). Special mention deserves cancer patients who can benefit from any of the analgesic treatments regardless of the degree of potency of the same, although it has also encouraged the rational use and a step-by-step strategy to avoid the depletion of the strength of those medicines. Pharmacological interventions are still by far the most common mode of treatment for chronic non-malignant pain. The patient with chronic pain needs an evaluation that includes the history, the physical examination and the review of the diagnostic studies carried out by a pain specialist. The association of many disorders, such as diabetes, post-traumatic injury has been associated with chronic pain and, therefore, requires a pain management specialist evaluation. The documentation is essential to provide sufficient and accurate information for future decision making on some issues including the course of treatment for the patient (Nassau, 2015). It is also important to emphasize the research to incorporate evidence from research into actual practice in the hospice setting because the prediction of the ideal time to begin palliative care services is deficient in evidence. Non-pharmacological techniques for pain treatment, although insufficiently used, have undergone rapid development in recent years due to the impossibility of controlling pain with drugs alone (Garg, Joshi, Mishra & Bhatnagar, 2012). These include traditional Chinese acupuncture, various forms of physiotherapy and different psychological treatment techniques that more than relieve pain contribute to reduce or control pain-related anxiety and sometimes increase the effectiveness of drug treatment in these patients. Many patients with cancer or non-cancer pain according to their etiology and see their activities of daily living affected by pain. It is then that a comprehensive treatment is needed to give them back the ability to take care of themselves and the functionality of the patient and their family. Practical Implications The most significant challenge in the field of medicine is the fact that despite evidence on various interventions being available, they have just been documented and not put into practice.
This trend dramatically impacts the quality of patient care given (Wandner et al. 2013). The factors that are attributed to the low acceptance of evidence-based pain management interventions include the invincibility or reluctance to change by the primary caregivers. Additionally, organizational or personal concerns may deter the primary caregivers from incorporating evidence-based pain management interventions (Rogal et al. 2013). Therefore, this is a problematic aspect where researchers must evaluate, and generate possible solutions to the problem associated with lack of acceptance or adherence to implementing evidence-based strategies in medical practice. Besides, it is crucial that organizations or different socio-economic strata evaluate reasons for not implementing evidence-based guidelines and develop effective strategies to achieve the set guidelines. Personal commitment and the commitment of the organizations is key in emphasizing the necessity for performing evidence-based practice (Rogal et al. 2013). High-quality studies that are well designed and equally controlled can be conducted that emphasis on the management of pain for both cancer and non-cancer
patients. Conclusion In conclusion, pain management among cancer and non-cancer patients is a topic that has been under extensive research over the past few decades. Various interventions, which are evidence-based, have been recommended for chronic pain management and the cancer patients. Through the evolution of medicine, attention has been given to the cancer patients as they experience pain attributed to cancer itself and from the treatment interventions for cancer. The use of both pharmacological and non-pharmacological treatments, for pain management, has been recommended despite the non-pharmacological strategies being poorly documented. However, existing methods of documentation lack sufficient detail to document non-pharmacological interventions, which has undermined the significant role played by non-pharmacological interventions in the evidence-based management of pain. Also, the assessment and reassessment of the pain are also fundamental aspects that researchers have focused on and its importance in effecting successful pain management. These aspects enable professionals to re-evaluate the course of medication and ultimately achieve the necessary change. While data and information reflect considerable evidence-based pain management interventions, their execution or implemented into actual practice is a major challenge. Further research is recommended in the implementation of the evidence-based practice in medicine.
A. Chronic pain signifies a developing public health issue of huge magnitudes, mainly in view of aging populations in developed countries (Russo).
Institute of Medicine Report from the Committee on Advancing Pain Research, Care and Education. (2011). Relieving Pain in America A Blueprint for Transforming Prevention, Care, Education and Research. Retrieved from http://books.nap.edu/openbook.php?records_13172
Assessing and managing pain is an inevitable part of nursing and the care of patients. Incomplete relief of pain remains prevalent despite years of research due to barriers such as lack of kn...
In medical school/pharmacology school, medical professionals are taught to treat severe pain with opioids. However, opioids should be prescribed with the possibility of future dependency in mind. Physicians often struggle with whether they should prescribe opioids or seek alternative methodologies. This ethical impasse has led may medical professionals to prescribe opioids out of sympathy, without regard for the possibility of addiction (Clarke). As previously stated, a way to address this is use alternative methods so that physicians will become more acquainted to not not treating pain by means of opioid
Potent pain medication contains the aspects of utilizing medications such as morphine or demerol, how the medications are dispensed, and t...
Conclusions. An adequate and clear understanding of the concept of pain and implementing interventions of pain treatment and management is essential in the clinical settings. Understanding the concept of pain is necessary for its relationships with other concepts that are related and similar to the pain experience for theory building. The in the end, understanding the concept of pain will ultimately benefit the patient and lead to better and approp...
Effective treatment of cancer pain is essential for ensuring the best outcomes for cancer patients, in terms of physical, psychological and social aspects. Although there are no NICE guidelines for management of cancer pain, WHO guidance should be used to inform clinical practice. Careful assessment is a critical element of the process to ensure that patients are offered the treatment which is likely to offer the best outcomes, yet without providing a greater than necessary risk of complications such as tolerance and addiction to opioids. The main outcome that this paper highlights is that “Pain is what the patient says it is and exists when he says it does” (McCaffery 1983
The concept of pain management will be explored in relationship to patients that are post-operative. A problem has been identified on one of the floors in a hospital that I work on with patients that are post-operative after having joint replacement surgery. The patients are coming to the floor with pain and it is difficult to control their pain level. The result is patients that are unsatisfied with their pain management during their hospital stay.
Ferrell, B., Levy, M. H., & Paice, J. (2008). Managing pain from advanced cancer in the
2015). To increase the pain management for patients, solutions were raised on how to do so by providing nurses and other health professionals with more education around assessments and interventions that are appropriate, also the care for the patient needs to be more patient-centred and less generalised, and lastly an update or change in current protocols and policies regarding pain
...t by non-specialty providers. Pain management by oncologists was slightly more effective, but still managed the pain of only 55% of patients. By the Cancer Weekly editors from staff and other reports.
The researchers looked at the issue of postoperative pain assessment and management. With gathered information they have observed that more and more patients are leaving health facilities without their pain needs being met and has now become a common occurrence. They analyzed the barriers affecting healthcare professionals and how these barriers could lead to errors thus causing patients to experience postoperative pain.
The National Health and Medical Research Council (NHMRC) 1999, Acute Pain Management: Scientific Evidence, viewed 14th April 2011,
The three articles selected for review were related to pain management in the older adult. The research shows that about eighty percent of the older adult patients experience chronic pain that is poorly controlled. Two of the articles identified nurse’s lack of knowledge and education as the key element for lack of or inadequate pain control. It is evident that awareness and understanding is an important critical thinking skills for nurses to assess and address patient's pain. Identified in this research is the nurse's personal perception of pain as a barrier to render adequate pain control for this patient population. All three articles focused on an inadequate assessment of pain as a factor in pain control. The nurse is responsible for
The purpose of this study was to “identify barriers to optimal pain management in LTC from a nursing perspective” (Egan & Cornally, 2013, p. 26). This study focused on caregiver, patient, and organisational-related barriers. Patient related barriers had the highest overall mean score, with the highest of 56% of respondents reporting that ‘difficulty assessing pain in older people due to problems with cognition (delirium, dementia)’ occurred ‘frequently’ ‘very frequently’ or ‘always’ interfering with pain management (Egan & Cornally, 2013). Another interesting fact taken from this article is that ‘antipsychotics are considered before pain medications in agitated patients’ was the variable that is perceived as interfering most often (Egan & Cornally, 2013) under ‘caregiver-related barriers.’ Additionally, it was noticed that pain management education significantly affects the way nurses’ perceive patient-related barriers. Nurses, who have education on pain management, have a higher perception of patient-related barriers (Egan & Cornally, 2013). Identifying and eliminating barriers to pain management in long-term care would allow healthcare workers to better address and relieve patient’s pain. If nurses were able to quickly identify pain, the major physical and psychosocial consequences of unresolved pain would be reduced, leading to an increase in quality of