The Common Sense Guide to Improving Palliative Care : Preventing, Assessing, and Treating Pain : Give Them Something to Talk About

Give Them Something to Talk About

Pain management presents an area where improvement can have dramatic effects. Remember the following:

Promise your patients comfort but explain that they are not likely to be completely pain-free.

Prescribe opioids whenever needed, but monitor the effects.

Empower patients and their families to manage pain by giving them a range of doses that are under their control.

Do not use meperidine (which can cause seizures and hallucinations and often does not last long enough to control pain adequately).

Have anesthetic and nonpharmacological approaches readily available.

Watch for side effects of opioids, such as constipation.

Assume that patients on pain medication will need adjustments. Follow up at appropriate intervals, both soon after change and in other regularly scheduled intervals.

Make sure that the conversion of drugs and the mode of administration are done correctly.

Team Faith

Once Team Faith met its goal, the team made sure that its progress did not slip. The team trained all current and new providers on the new processes. They also posted the new processes at every nursing workstation and on field notepads. They placed the new forms in an appropriate place so that everyone remembered to use them. With everyone's help, the team sustained the changes and made them permanent. Eventually, other healthcare professionals began to use the new approach, and it soon became part of a system-wide pain management initiative.

Frequently Asked Questions

What Are Some Nonpharmacologic Ways to Treat Pain?

Neurostimulation: Transcutaneous Electrical Nerve Stimulation (TENS), acupuncture.

Anesthesiologic: nerve block.

Physical therapy: exercise, heat, cold.

Psychological approaches: cognitive therapies (relaxation, imagery, hypnosis).

Biofeedback: behavior therapy, psychotherapy.

Complementary therapies: massage, art, music, aromatherapy.

Distraction.

What Are Some of the Common and Uncommon Side Effects of Opioids?

Common Side Effects

Constipation

Dry mouth

Nausea/vomiting

Sedation

Sweats

Uncommon Side Effects

Bad dreams/hallucinations

Dysphoria/delirium

Myoclonus/seizures

Pruritus/urticaria

Respiratory depression

Urinary retention