Pain is one of the most common reasons patients end up in the hospital. Which is why educating your patients on how to effectively manage both acute and chronic pain in and out of the hospital is so important.
Acute Versus Chronic Pain
Let’s first start off with understanding the difference between acute and chronic pain.
Acute Pain
Acute pain is a new sharp pain that starts suddenly. Whether it’s internal and of unknown cause, or external and of known cause, the fact that it is sudden and hasn’t been felt before is what makes it acute.
An example of acute pain is when a patient arrives at the hospital complaining of severe abdominal pain that has been going on only for the past week or so. Another example may be injury from a recent motor vehicle accident, aka MVA. Acute pain does not last longer than 6 months.
Chronic Pain
A pain is considered chronic when the patient has experienced it before on and off, or continuously, for at least 6 months. Chronic pain is usually an internal pain, not visible to the naked eye.
An example of chronic pain is arthritis, neck and back pain, and muscle pain such as fibromyalgia. Let’s reference back to the motor vehicle accident patient, aka MVA patient. If the patient broke their back in the accident and the pain persists for years later, it is now chronic pain, even though it was once classified as acute.
It is important to note that patients with chronic pain may never be able to fully treat their pain, it’s more of a management rather than a treatment or cure. Because of this, it is important to address the patients pain baseline and what their acceptable level of pain is. A person who has never felt pain before may have an acceptable pain level of 0 whereas a patient with chronic pain might now be able to endure a higher threshold.
For example, if the patient has rheumatoid arthritis, then their baseline pain level may be a 6 and their acceptable level of pain is a 7. Meaning anything over a 7 causes them enough discomfort that it needs to be addressed with medication and/or a non-pharmaceutical remedy.
Treatment
While some treatments for acute pain may cross over with chronic pain, it is important to understand that these different types of pain need to be treated, or managed, individually.
To better understand the nursing role in pain management, visit Nursing Fundamentals: A Guide to Pain.
Acute Pain
A patient with acute pain is likely going to be stressed, as they are going through something they’ve never gone through before. They are likely going to require either oral or IV pain medication. With extreme acute pain such as a MVA (aka motor vehicle accident), non-pharmaceutical remedies such as heat or ice packs are likely not going to cut it.
Chronic Pain
A patient with chronic pain is probably going to be well versed in their own personal pain management. They are going to know exactly what helps ease the pain and what doesn’t. Patients with chronic pain may be at the hospital for an unbearable level of pain or for something completely different. If they are at an unbearable level, they are likely going to have new orders for different pain medications to try something new. Whereas if they are at the hospital for a different reason, say a hyperglycemic episode, then the chronic pain they are feeling is something they already have an adequate pain plan for.
Always ask your patients with chronic pain what they usually do at home to treat their discomfort. See if you can provide the same comforts in the hospital. For example, the patient might treat their chronic back pain with a heat pad at home, and while we don’t have plug in heat pads at the hospital, we do have instant hot compresses. So provide them with one to use now and a couple to use when that one stops being hot. It’s all about thinking ahead as a nurse.
Hospital Pain Education
Whichever treatment plan you devise with your patient, make sure to educate on how it’s going to work. If the patient is using heat packs, have them call you when they’d like a new one. If the patient is getting PRN (as needed) medication for pain, make sure to educate them on breakthrough pain. Remind them to not let their pain level reach a 10 before they call you in severe pain. It’s always easier to treat a pain level of 5 with medications than it is to treat a level 10 pain.
Let the patient know how long their current medication should last, if there is another medication for breakthrough pain, and when their next scheduled pain medication can be given. Write all this information up on the patients’ whiteboard and on your own nursing brain so that everyone is on the same page.
Visit Organizational Brain Template for New Nurses for more of what to put on your nursing brain.
Discharge Pain Education
Before the patient leaves the hospital, make sure to go over what their treatment plan for at-home looks like. Are they leaving with a new mediation order? Do they have a medication for breakthrough pain? Is there a different medication to take for moderate versus severe pain? Do they know what non-pharmaceutical remedies work for them? Are they able to call the doctor or come back into the hospital if the pain becomes worse?
All of these questions are important for you to go over with your patient. Provide verbal and written instructions on what to do and what medications to take. Make sure their pharmacy is updated in the system and they know when and where they can pick up any new medications.
For more information on pain and shift organization, visit:
- How to Organize Your 12-Hour Nursing Shift
- Tips for New Nurses on Calling the Doctor
- Nursing Fundamentals: An Intro to Pharmacology
- Nursing Fundamentals: A Guide to the 10 Rights of Medication Administration
And be sure to follow along with the Patient Education Series:
- How to Spot a Stroke and Save a Life
- A Guide to Treating and Managing Type 1 Diabetes
- A Guide to Treating and Managing Type 2 Diabetes
- Identifying Sepsis and Understanding its Care and Treatment
- What is Hypertension? Causes, Symptoms, and Treatments
- What is Heart Failure? Risk Factors, Symptoms, and Treatments
- What are Urinary Tract Infections? UTI Prevention and Treatments
- What is Asthma? Risk Factors, Symptoms, and Treatments
- What is COPD? Risk Factors, Symptoms, and Treatments
- What is Pneumonia? Symptoms, Labs, and Treatments