Pain Management Assignment: Impact Of Pharmacological And Non-Pharmacological Therapies

Question

Task: Specialist nurses play an integral role in the provision of education to patients that is essential to reducing morbidity and mortality associated with treatment effects and symptoms of an acute illness. Critically review evidence related to the management of a selected health care problem encountered. You will prepare a literature review and a self-management plan for an individual and their family/carer experiencing the selected health problem. Justify your plan with contemporary evidence.

Answer

Management of Pain
Introduction: As per the information provided in Pain management assignment, pain is one of the health care problems that patients in acute care commonly present with which are mainly caused due to the damaging stimuli. The patients who are getting acute care often experience pain during their treatment procedure (Muhammad, 2019). There are two types of pain, which are acute and chronic pain. Acute pain remains for a shorter period and caused by a sudden onset injury, disease, or inflammation. On the other hand, chronic pain remains for a longer duration and can be root for other severe problems ("What Is Pain?", 2019). Nurses must know the management plan for treating pain and provide an educational session for the patient to self-manage their pain ("Pain and pain management – adults", 2019). There are many ways to treat this symptom. This essay is based on a case study of a man of age fifty-five years. His name was Mr. Wilson. He presented to emergency department with severe abdominal pain and was later, admitted to general surgical ward during the night. The pain scale showed a score of 9/10 pain score. When the ultrasound scan and CT scan performed, it was confirmed that he had pancreatitis. This essay will critically discuss how pain is managed pharmacologically and non-pharmacologically through the use of utilizing opioid medication and meditation. In this essay, there will be a critical discussion on several educational plans that will help in treating and managing pain symptoms in the patient. Additionally, self-management strategies will be discussed to prevent worsening pain symptoms. This Pain management assignment will also cover different strategies to plan educational sessions for the patient for better outcomes. Furthermore, the psychological, physiological, and sociocultural learning requirements that affect the educational session plan for the patient to manage pain in acute care like impact of social background on patient’s behaviour will be discussed.

Literature Review
Interventions (pharmacological and non-pharmacological therapies): Pain can be felt physically or emotionally. Pain cannot be felt by brain, but brain can actually interpret pain. Distraction is a good way to reduce pain sensation. Chronic pain affects the functioning of the patient, quality of life, productivity, and relationship with the family and friends. Pain can lead to disability, decline function and impact of daily activities and mostly can be managed with pharmacological and non-pharmacological therapies ("Evidence-Based Update on Pain Management and NSAIDs", 2013). The pharmacological interventions include certain non-steroidal anti-inflammatory drugs (NSAIDs). These drugs play an important role in reducing most types of pain symptoms. NSAIDs reduce irritation by converting arachidonic acid to prostaglandins through the cyclooxygenase pathway. When the arachidonic acid is breached, it releases from the cell membrane. The most commonly used NSAIDs include diclofenac, ibuprofen, naproxen, and meloxicam. One non-steroidal anti-inflammatory that can be used both orally and intravenously is ketorolac. The side effects associated with these drugs mentioned in this Pain management assignment consist of gastric irritation, dysfunction of renal organs, and bleeding disorders in the cyclooxygenase pathway. These drugs should be avoided in patients who have inflammatory bowel disease as there are possibilities of relapse or onset of inflammatory bowel disease in the patient after consuming these drugs (Mathew, Kim & Zempsky, 2016). According to some researches prolonged use of NSAIDs cause several side-effects like adverse gastrointestinal and cardiovascular issues. NSAIDs are mostly acidic in nature and therefore, it is recommended to use small doses of NSAIDs (Ho et al., 2018).

NSAIDs are given to treat mild pain symptoms. However, if the patient suffers severe pain, it is recommended to administer strong opioid. The most preferred drug for the treatment of severe pain is Morphine (World Health Organization, 2019) However, several other strong opioids are also available. It is important to have other options if the patient faces some side-effects after consuming morphine. The selection of alternative for Morphine should be considered on the basis of the availability of the drug, its cost, safety, and suitability based on the factors related to the patient’s medical history. Most of the clinicians follow the two-step treatment approach in which they prescribe low doses of strong opioids to the patient to treat moderate kind of pain (World Health Organization, n.d.).  Morphine tablets are available as immediate-release as well as prolonged-release which must be consumed orally. The immediate-release drugs are best for the management of periodic pain. Prolonged-release drugs are helpful in reducing the frequency of dosages of the drugs (World Health Organization, 2019). Opioid drugs can also be administered in the patient’s body through the intramuscular route. However, in the case of children, this route must be avoided. There are several side-effects discussed in this Pain management assignment that are associated with an opioid drug overdose, which includes respiratory disorders and withdrawal symptoms (World Health Organization, 2019). 

Certain drugs which are recommended by the WHO to the patients for managing the symptoms of neuropathic pain are tricyclic antidepressants and antiepileptic drugs. It is important for patients to understand they are prescribed with these drugs, not because of epilepsy but to manage troublesome pain symptoms. Several topical analgesics can also be utilised to control the pain symptoms in certain areas. These topical analgesics include topical NSAIDs, rubefacients, and local anaesthetics. These analgesics cause erythema of the skin in some patients (Jenner, et.al., 2019).

Non-pharmacological pain management therapies refer to those ways in which the pain can be managed without any medication. These therapies include certain ways to enhance the thought process and concentration so that the pain can be managed and reduced in a better way ("Management of pain without medications", 2019). Certain interventions that included in this type of pain management therapy are practices for mind-body health, exercises, multidisciplinary rehabilitation, psychological therapies, musculoskeletal manipulation, physical modalities, and mindfulness practices. Exercise is a therapy which is most effective on pain for short-term function. Based on several studies, there was no evidence of its effects on intermediate-term or long-term function (Skelly, 2018).

Another method utilized as a non-pharmacological pain management therapy is transcutaneous electrical nerve stimulation. This method utilizes electric current which has been generated by a portable device. This electric current stimulates the nerves for the management of pain. The effectiveness of this method has been proved in many studies including a study in which patients suffering from acute posttraumatic hip pain were treated with this therapy. They felt reduced pain and anxiety after this intervention as compared to other interventions (Pak, Micalos, Maria & Lord, 2015).

Non-pharmacological therapies mentioned in this Pain management assignment include physical interventions to treat the pain of the patient. In this type of intervention, the patient must be asked to change his position and massage will be applied to the portion where the patient is feeling pain. This will relax the tense muscles and enhance the blood flow which results in decreasing pain (Chang, Fillingim, Hurley & Schmidt, 2015). Many patients are also advised to apply a hot and cold compress to reduce pain. This is the best way to manage pain with minimal side effects. Acupuncture is another non-pharmacological therapy which must be recommended to the patients for the management of pain. This therapy has been used by many individuals for around five thousand years. Needles are used in this approach in the specific area where the treatment is required and it excites the nerve (Geziry, Toble, Kadhi, Pervaiz & Nobani, 2018).

Education Plan
Learning needs: There are certain factors discussed in this Pain management assignment that must be considered in order to educate patients’ self-management of the pain in a better way. These factors include psychological, physiological, and psycho-social needs of the patients that affect the learning process and pain management to a great extent (Relieving pain in America, 2011). If these factors cannot be considered and managed properly, these factors can lead to unnecessary suffering and chronicity of the pain (Allcock & Mishra, 2018). It is important for the nurse to understand that every patient is different and so are their pain symptoms. Additionally, the nurse should consider social and psychological factors with biological factors that can impact the pain of the patient while planning an education session. Patients’ past experiences are important and should be considered when planning a session for the patients to understand their learning requirement. Another factor that must be considered is the communication method and behaviour of the clinician as it can have a greater impact on the learning process of the patient (Allcock & Mishra, 2018). It is also to be considered that every patient follows different coping strategies for reducing pain in which some of the strategies will be adaptive and some will be maladaptive. Also, another factor that must be considered in this Pain management assignment is that the patient may have negative psychosocial consequences due to the pain which have affected the roles and responsibilities of the patient. The nurse must understand the consequences caused due to the pain which results in distress and disability of the patient in performing physiological activities (Allcock & Mishra, 2018). According to a study conducted on a few patients of age more than eighteen years, when these patients were provided with a group-based self-management education session for pain included with a psychological component. The qualitative research showed the participants enjoyed the relaxed and valued interaction and the location of the course. This has impacted positively on the management of the pain (Carnes et al., 2013). Thus, pain management education must be provided in a relaxed and calm environment to improve learning of the patient.

Working environment: There are several factors which must be considered regarding the organizational culture which include physical, human, and financial resources while planning an education session for the patient. According to a study explored in this Pain management assignment, for providing any kind of education value plays an important role. Many organizations do not consider the education of the patient comprehensively (Farahani, Mohammadi, Ahmadi & Mohammadi, 2013). They provide education regarding pain just through a pamphlet, which is not patient-focused and holistic. Another important factor that should be considered is the availability of sufficient nurses to provide patient-focused education session to the patient for pain management. It is important the nurses should interact with each other as lack of interaction may lead to a decrease of trust in patients and their families (Farahani, Mohammadi, Ahmadi & Mohammadi, 2013). Another major factor to be considered while scheduling an education session for pain management is to improve communication skills. When physicians and nurses work in collaboration, this will impact in a positive manner on the patient’s health and improve his symptoms. It is also important to consider the patient’s rights when educating them about self-management of the pain. Ignoring patient’s rights is an unethical behaviour which must be considered (Farahani, Mohammadi, Ahmadi & Mohammadi, 2013). Additionally, the organization must consider providing internal or external rewards to the nurses to motivate them for planning such sessions and improving the way of treatment. One of the major reasons discussed in this Pain management assignment behind the ineffective education of the patient is the lack of motivation of the nurses. Additionally, it is also necessary to consider the supervision and control of the education session to ensure it is performed appropriately. This will help in the conduction of the program perfectly and will help in improving the management of the pain of the patients effectively (Farahani, Mohammadi, Ahmadi & Mohammadi, 2013). When the patient will be provided with the proper educational session, it will help him to understand the ways of pain management and he will be able to help himself.

Short- and long-term goals: While arranging an education session for the patients for pain management, the short-term goals or the objectives which must be achieved after the end of the session are the satisfaction of the patient with a proper understanding of the self-management. The long-term goals after the completion of all education sessions include acceptance of the pain, psychological distress, pain-related interference, improvement in the quality of life, healthcare utilization, reduced severity of the pain, and reduction in an exaggeration of the symptoms (Gay, Chabaud, Guilley & Coudeyre, 2016). According to a study which was conducted on three hundred and forty-six adults who were invited for an educational session on self-management and engagement of life in spite of dealing with the pain. After the end of the session, these patients’ satisfaction levels were moderate to high and after the end of two weeks of the sessions, they had accepted the pain and improved quality of life. Additionally, after six weeks of the sessions, they have increased the physical and psychological therapies to improve symptoms (Burke, Denson & Mathias, 2016). Another study which has been conducted on sixty cancer patients concluded in a significant decrease in pain after four weeks of the education session on pain management. However, this study of Pain management assignment showed no improvement in pain after two weeks of the session (Sharif, Ansari & Mosalaee, 2012).

Self-management behaviours/directions: The most important factor to be considered for an education session is to prepare the patients to accept the chronic nature of their pain. It is also important that the clinicians must support patients in self-management by answering their queries, providing them with valuable advice, encouraging their efforts for self-management, and acknowledging the limitations and facilitators of the self-management therapies (Mann, LeFort & VanDenKerkhof, 2013). According to a study, the interventions and strategies involved in the self-management of the pain of the patient include the improvement in the patients’ skills, confidence, and knowledge so that they can manage their condition effectively. This can be performed by healthcare professionals by providing customised information and enablement strategies to the patients, which leads to the enhancement in quality of life and reduction in the intensity of the pain. Another effective intervention discussed in this Pain management assignment to improve the quality of life of the patients is to interfere with the pain by performing daily activities. When the patients will be engaged in performing daily activities, their concentration will shift from pain to daily tasks. This will help in the improvement of the pain symptoms (ElMokhallalati, Mulvey & Bennett, 2018).

Strategies to prevent deterioration, exacerbation or recurrence of Symptom: There are several strategies to prevent deterioration, exacerbation or recurrence of pain in the patients. These strategies include exercise programs including stretching, general strengthening for preventing the recurrence or onset of the pain. However, this strategy is purely based on the condition and requirement of the patient. The patients must be asked to come for follow up so that the recurrence of the pain can be identified and prevented (Sowah et al., 2018). Another strategy that can prevent the deterioration or recurrence of the pain in patients is to enhance the psychological factors. It can be performed by decreasing distress, reducing the use of opioid, and improving their anxiety. This will reduce the intensity of the pain and anxiety level. Additionally, education provided before any treatment procedure regarding the procedure, expected pain, and expected medication to reduce pain is also considered a useful strategy to prevent deterioration or recurrence of pain in patients. According to some studies, relaxation therapies, clinical hypnosis, and guided imagery are also important strategies that can be followed to prevent pain recurrence or onset in the patients (Weinrib et al., 2017).

It has been recommended in this Pain management assignment to discuss reduction of pain, the plan of expected recovery course, and experience of the patient at every step of the treatment. This helps in reducing the recurrence of pain and promote their quality of life. It has also been recommended to connect the patients with pain. This will help in reducing their stress level or posttraumatic stress and improving self-efficacy of the patients (Hsu, Mir, Wally & Seymour, 2019). Additionally, the study performed by Hsu and his colleagues recommend using strategies to reduce anxiety levels in patients dealing with pain. This can be performed by using music therapy, aromatherapy, or cognitive behavioural therapy. These therapies will enhance the self-efficacy of the patients and promote peace of mind in the patients. Also, to prevent pain recurrence in the patients, it has been recommended to limit psychological distress and enhance their comfort level and ability to perform daily activities. This will also result in improved results in regard to pain in the patients (Hsu, Mir, Wally & Seymour, 2019).

Transitional Pain Service is a service which was developed to deliver effective treatment to patients dealing with chronic pain on time. According to the objectives of this service, it focuses on the management of the pain for the patients who are at high risk of developing pain. It helps patients in coping with pain and improving their quality of life (Katz, Weinrib & Clarke, 2019). Acceptance and commitment therapy are one of the therapies used under TPS service to help patients. According to this therapy, the patient can manage their pain by tracking it on their smartphones on a daily basis. This service has helped a large number of patients in managing the pain after any procedure. This is another strategy which can be followed to prevent recurrence or exacerbation of the pain in the patients (Katz, Weinrib & Clarke, 2019).

Early signs and symptoms of deterioration/potential medical emergency discussed in Pain management assignment
To understand the deterioration in patients’ condition, it is important to understand the early signs and symptoms. The early signs and symptoms for a potential medical emergency of the patients, it is significant to assess a few things on a daily basis. The assessment of respiratory on a regular interval is important to know about the deteriorating condition of the patients. Any abnormalities in respiratory rate is the sign of clinical deterioration of patients’ health. Pulse oximetry is utilized to measure oxygen saturation and any abnormality in that is another indicator of the deteriorating condition of the patients (Buzzi, 2016). If internal body temperature fluctuates, it indicates the sign of a medical emergency. In the case of acute deterioration, the systolic blood pressure level will be abnormal. Heart rate is another assessment method that can be considered to understand the condition of the patients. Any difference in its rhythm or its palpitation gives the signal of patients’ deteriorating condition. If the patient does not respond to voice or unresponsive to pain symptoms, this indicates deterioration in the patient’s condition. Assessing and documenting these early signs can be helpful in improving patients’ condition before it goes to critical condition (Buzzi, 2016).

Teaching strategies
Based on the learning needs of the patients, it has been observed that psychological, physiological, and psychosocial factors affect the intensity and frequency of the pain in the patients. Therefore, the nurse must plan an education session considering several factors. One of the strategies discussed in this Pain management assignment that must be followed by the clinicians while planning education session is to motivate, listen, and coach every patient dealing with pain. This will enhance and strengthen the interaction between patients and clinicians. Ultimately, this will result in improving the self-management techniques used by the patient in coping with the pain. Additionally, the nurses must gather all the information and previous medical data of the patients before starting the session. They must set objectives of the session so that they can explain everything to the patients in a better way. They should help patients in setting goals for the improvement of health. When planning for an education session, the nurses should develop some action strategies, which help patients in tracking health outcomes. They should also motivate patients to link with community programs to understand more ways of self-management.

According to a study carried out by Choi, Song, Chang and Kim in 2014, the strategies utilized for motivating and enhancing information and skills of the patients are very helpful in improving the medical condition of the patients. The motivation and skills are considered as key factors for the modification in self-management behaviour of the patients. Additionally, the nurses should provide detailed knowledge about pain self-management, the present status of the health of the patients, and other factors, which are required to improve the quality of life of the patients. The nurses must explain to the patients about the importance of taking responsibility of one’s health and how it will impact on their day to day life (Choi, Song, Chang & Kim, 2014).

Criteria used to evaluate the outcomes of the session
It is important to understand for scheduling an education session that the patients have a different medical history and different level of pain intensity. These factors mentioned in the study of Pain management assignment affect the outcomes of the session. If the intensity of pain in any patient is very high, they will not be able to attend the education session or they will not be able to understand the teachings provided in the session. Hence, they will not be able to implement it in the future (Oldenmenger et al., 2018). Psychosocial background of the patients may also affect the understanding of the patients in regard to the education session. According to Oldenmenger, the education sessions on pain management plays a significant role in improving the pain condition in the long-term. However, short-term goals are difficult to achieve. This implies that only a few patients show signs of understanding the objective of the session (Oldenmenger et al., 2018). According to Bonkowski, the targeted pain management with a continuing education session on self-management of the pain is very helpful in improving the quality of life and reducing the intensity of the pain after a longer period. It will also enhance understanding of the patient regarding self-management after the session which is useful in coping and accepting the pain (Bonkowski, Gagne, Cade & Bulla, 2018).

Conclusion 
In conclusion, it has been observed in this Pain management assignment that pain is a symptom which can affect the quality of life of the patients. Therefore, its management is extremely important. There are various pharmacological and non-pharmacological therapies that help in reducing pain intensity. These therapies include medications, yoga, and other therapies. It has been concluded through this essay that the nurses should consider psychological, physiological, and psychosocial factors that affect the learning requirements of the patients while planning the education session for the patients. After the education session, the understanding of the patient for accepting the pain has been improved. At the end of the education sessions, the intensity of the pain and quality of life of the patients has also been improved.

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