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Pain and
Symptom
Management
cerah.lakeheadu.ca
Palliative Care Education
for Front-Line Workers
in First Nation
Communities
A few assumptions
• A good care plan can almost always alleviate
pain
• Every member of the care team has a
responsibility to participate in pain management
• It is impossible to have high quality end-of-life
care when a person is in pain
• People facing death have a profound fear of
pain
“Pain is whatever the person
experiencing it says it is, and it
exists wherever the person
says it does”.
- Margo McCaffery, nurse and pain
management expert
Pain
• Belongs to the person
• Is enough to make them uncomfortable
Caring for the Terminally Ill: Honouring the Choices of the People,
p. 55-57
Acute pain
• Easier to recognize than chronic pain
• Examples: broken bones, sudden
abdominal pain
CHPCA, 2008
Chronic pain
• Examples: arthritis, tooth decay,
osteoporosis
• Often more challenging to diagnose
and treat than acute pain
Breakthrough pain
• Pain that re-emerges before the next
dose of pain medication
• A spontaneous episode or manifestation
of pain experienced by the person even
though s/he is taking regular pain
medication
www.cerah.lakeheadu.ca
Perception of and response to
pain will vary depending on:
• The meaning of pain to the individual
• Prior experience with pain
• Cultural background
• Age and gender
Total pain
An individual may experience total pain from:
• the actual physical pain of the disease process
• intellectual pain from knowledge (or lack of
knowledge) of her/his condition and prognosis
• emotional pain from feelings of anger or
loneliness
• spiritual pain arising from the awareness of
impending death
Myths and misconceptions
(1 of 2)
• Health care providers are the experts on
assessing pain and determining if pain is real
• Opioids should only be used for the
management of cancer pain
• Opioid addiction (psychological dependence)
is common in people taking opioids for
treatment of moderate to severe pain
Myths and misconceptions (2
of 2)
• Opioid tolerance develops rapidly,
necessitating progressively higher doses
• If one opioid doesn’t work for a patient,
none of them will
Emotional pain
• Symbolizes threats the individual is facing
• Is a constant reminder of the seriousness of
the situation
• Change in the pain may mean the disease is
progressing
• Pain may lead to fears
Klee, 2004
Psychological pain
• Pain may cause depression
• The stress of pain may cause anxiety
• Anxiety and depression often aggravate pain
Klee, 2004
Existential Pain (1 of 2)
• It is not unusual for pain to provoke existential
questions regardless of the individual's religious
and spiritual background
• Pain may make it difficult to find the peace of
mind needed to think through complicated issues
Klee, 2004
Existential Pain (2 of 2)
• The pain may be seen as a punishment
• Existential suffering may provoke strong
emotions that aggravate the pain, making it
more difficult to alleviate
Klee, 2004
Social pain
• The family will be affected by the individual’s
pain
• They may experience feelings of
helplessness, hopelessness
• Pain may result in social isolation
• Unresolved family issues may surface
(Klee, 2004)
www.cerah.lakeheadu.ca
Some barriers to treating pain
• The myth that pain is to be expected and that
pain cannot be managed
• Patient factors
• Caregiver factors
• System factors
• The most common barrier is caregiver
failure to ask about and assess pain
Three pain myths
• Addiction
• Tolerance
• Hallucination
Caring for the Terminally Ill: Honouring the Choices of the People, p.
58-59
Pain Characteristics
Ways to describe pain
• Aching
• Dull
• Sore
• Shooting
• Burning
• Stabbing
www.cerah.lakeheadu.ca
Signs of pain (1 of 2)
• Grimacing or wincing
• Bracing (i.e. holding an arm)
• Guarding/protecting painful area
• Rubbing
• Changes in activity level
• Sleeplessness, restlessness
• Resistance to movement
• Withdrawal/depression
• Decreased appetite
www.cerah.lakeheadu.ca
CHPCA, 2008
Signs of pain (2 of 2)
• General body tension (clenched hands,
hunched shoulders, etc.)
• Tense facial expressions
• Constant fidgeting or nervous habits
such as lip-biting
• Unexplained withdrawal
• Strained or higher-pitched tone of voice
• Increased agitation, anger, etc.
www.cerah.lakeheadu.ca
Vocalized pain cues
• Words or statements such as “ouch,”
or “that hurts”
• Verbal protests during care or
transfers
• Moans
• Cries
When to observe for pain
• During personal care
• During transfers and walking
• Following activities
• At appropriate intervals after
administering pain management
interventions
Support Worker role in pain
management
• Ask the individual if they are experiencing pain
• Watch for signs of pain
• Observe for side effects of medications
• Re-assess to evaluate the effectiveness of
therapies
• Administer non-drug treatments
• Advocate for persons in pain
Caring for the Terminally Ill: Honouring the Choices of the People, p. 57
Non-drug Interventions
Physical (1 of 2)
• Massage
• Cold
• Heat
• Complementary Therapy (i.e.. massage)
• Positioning
• Exercise
Caring for the Terminally Ill: Honouring the Choices of the People, p. 6164
Non drug interventions
Psychological (2 of 2)
• Distraction
• Relaxation
• Music
• Comfort foods
• Imagery
• Controlled breathing
Advantages of non-drug
interventions
• Low cost
• Less potential for negative side effects
• Decreases emotional response to pain
• Provides clients with a sense
of control or involvement
“Pain
is a more terrible
lord of mankind than
even death itself.”
- Albert Schweitzer