Principles and Practice of Managing Pain: A Guide for Nurses and Allied Health Professionals

215 Pages·2010·4.17 MB·English

by  Gareth Parsons

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Principles and Practice
of Managing Pain

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Principles and Practice of
Managing Pain
A Guide for Nurses and
Allied Health Professionals
Gareth Parsons and Wayne Preece

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Open University Press
McGraw-Hill Education
McGraw-Hill House
Shoppenhangers Road
Maidenhead
Berkshire
England
SL6 2QL
email: [email protected]
world wide web: www.openup.co.uk
and Two Penn Plaza, New York, NY 10121-2289, USA
First published 2010
Copyright © Parsons and Preece 2010
All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this
publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher or a licence from
the Copyright Licensing Agency Limited. Details of such licences (for reprographic reproduction) may be obtained from the
Copyright Licensing Agency Ltd of Saffron House, 6–10 Kirby Street, London, EC1N 8TS.
A catalogue record of this book is available from the British Library
ISBN-13: 978-0-33-523599-5 (pb)
ISBN-10: 0335235999 (pb)

Library of Congress Cataloging-in-Publication Data
CIP data applied for
Typeset by RefineCatch Limited, Bungay, Suffolk
Printed in the UK by Bell & Bain Ltd, Glasgow
Fictitious names of companies, products, people, characters and/or data that may be used herein (in case studies or in
examples) are not intended to represent any real individual, company, product or event.
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For Ann, Becca, Tom, Rhodri and Mum
and
For Sue, Aimee, Beth, Nia, Molly, Marc, James and Mam and Dad

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Praise for this book
ªThe recent survey of undergraduate pain education in the UK for health professionals highlights the limited
pain education that many receive and makes this a very timely and welcome text. The book is written by
experienced pain educators and reflects their wide knowledge and understanding of the key issues in relation to
pain and its management which are addressed in the book. The use of a variety of reflective activities as well as
clear aims and summaries of the key learning points makes this an excellent resource for health care
professionals aiming to become informed carers of those with pain.º
Dr Nick Allcock, Associate Professor, University of Nottingham School of Nursing,
Midwifery and Physiotherapy, UK
ªI enjoyed reading this book immensely. It is written in an easy to understand style, has a logical progression
and contains interesting `real life' scenarios. Each chapter encourages the reader to explore the background
issues followed by useful information to assist in an understanding of the complexity surrounding pain and its
effective management.º
Eileen Mann, Previously Nurse Consultant, Poole Hospital NHS Trust and Lecturer,
Bournemouth University, now retired.

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Contents
List of figures xi
List of tables xii
About the authors xiii
Acknowledgements xiv
Introduction xv
1. What is pain? 1
Introduction 1
The importance of defining pain 2
Classifications of pain 4
Perspectives on pain 10
Summary 17
Reflective activity 17
References 17
2. Dilemmas in pain management 19
Introduction 19
Principles 20
Moral and ethical principles 20
Effects of illness on moral behaviour 20
Morals and pain 22
Deontology 23
Utilitarianism 25
Performing a moral calculus 25

Rights and duties 28
Bioethics 28
The best way to organize pain management 33
Considering the particular nature of pain in developing principles of managing pain 34
Summary 34
Reflective activity 35
References 35
Further reading 36
3. Communicating the experience of pain 37
Introduction 37
Intrapersonal perspective of pain 38
Biopsychosocial model and communication 39
The intrapersonal nature of pain 40
Detection and modulation 42
Cutaneous receptors 42
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Contents
Visceral receptors 43
Inflammation and primary hyperalgesia 43
Action potentials 43
Sensory nerve communication 44
The pain gate 44
Ascending pathway 46
The brain 46
Differing pain experiences 48
Interpersonal pain 52
Influences on pain responses 53
The pain experience 55
Something lost in the translation 57
Iatrogenic communication 57
Summary 58
Reflective activity 58
References 59
4. Pain assessment 61
Introduction 61
Pain assessment 62
Assessment as part of care planning 63
Problems associated with pain assessment 63
The pain management process 64
Why assess acute pain? 68
Pain assessment tools 70
Pain assessment in children 73
The assessment of chronic pain 75
The character of pain 77
Psychosocial assessment 77
Functional assessment 78
Pain history assessment 78
Questionnaire methods 78
Pain diaries and journals 81

Chronic pain assessment in children 81
Summary 82
Reflective activity 82
References 83
Further reading 85
5. The pharmacology of pain control 87
Introduction 87
Mechanisms for drug action 88
Choice of analgesia 88
Drug effectiveness 89
Drug delivery 91
Routes of administration 93
Different routes 93
Plasma concentration 95
Duration of action 96
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Contents
The three main groups of analgesics 99
Other drugs used in the treatment of pain 105
Summary 107
Reflective activity 107
References 107
Further reading 108
6. Delivering pain management 109
Introduction 109
The organization of pain management 110
Development of chronic pain services 110
The palliative care service 111
The acute pain service (APS) 111
Patient education 113
Risk management 115
Staff support and development 120
Summary 121
Reflective activity 122
References 122
7. Acute pain management: planning for pain 125
Introduction 125
The physical effects of unmanaged acute pain 126
The surgical stress response 127
Balanced analgesia 128
Patient-controlled analgesia (PCA) 128
Person-centred pain management 131
Ensuring adherence to care 134
The pain management plan 136
Summary 139
Reflective activity 140
References 141
8. Chronic pain management 143

Introduction 143
The problem of chronic pain 144
The prevalence of chronic pain in the UK and Europe 144
Chronic pain and chronic pain syndrome (CPS) 146
Specific treatment approaches 149
The chronic pain management plan 149
Dealing with pain behaviours 154
Summary 157
Reflective activity 158
References 158
9. Pain management in palliative care – by Maria Parry 161
Introduction 161
Definition of key concepts 162
Life-limiting conditions 164
Defining pain in life-limiting conditions 165
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Contents
Cancer pain 165
Multiple sclerosis (MS) and pain 166
HIV/AIDS and pain 168
Pain assessment 169
Pain assessment tools in palliative care 170
Psychosocial factors influencing the pain experience 171
Barriers to pain assessment and management 174
Pharmacological and non-pharmacological management of pain in palliative care 175
Approaches to pain management in patients who have cancer 175
Drug management 176
The analgesic ladder 177
Immobilization 180
Rehabilitation – modification of daily activities 181
Summary 181
Reflective activity 182
References 182
Further reading 184
Appendix 185
Glossary 187
Index 193

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