A Patient Guide to Managing Pain during a Hospitalization

May 11, 2016

We all know what pain feels like, but communicating how much discomfort we are experiencing can be much easier said than done, especially in the hospital setting. Pain is different for everyone. Pain can be acute, typically sharp and sudden, or chronic, which persists over a period of time – weeks, months and even years. Pain that may be unbearable to one person may be mild to another. While we are our own best judge of pain, BSA doctors, nurses and staff are trained to work with patients to more accurately identify and communicate their pain level to help manage it as soon as possible. BSA Palliative Care Nurse Practitioner Alana Link, ACHPN, A/GNP-C, says understanding the best approach to pain management is essential for patients. “They are their best advocates for pain management,” she says. “We want them to tell us how they are feeling.”

Don’t Wait to Communicate

Pain is an indication that something is wrong. Our natural reaction is to respond in a way that lessens the pain. It is our human nature. However, there are several reasons patients may not communicate their pain level to doctors and nurses. Some may fear the side effects of pain medication. Some may think pain medication will slow their recovery. While others may think their pain will get better. Link says it is important to recognize the early signs of pain when treatment is most effective. “Our nurses are assessing patient’s pain every four hours,” she says. “They want to treat patient’s pain when it is a three, four or five - before it gets above a five.”

Link is referring to a widely-used pain level scale from zero (no pain) to ten (unbearable pain) that is available in every patient room at BSA. This numerical and visual pain level scale helps patients better quantify their discomfort to communicate that to doctors and nurses. Link admits it is still a tough call for patients – what may be a three to one patient could be an eight to another patient. “Therefore, our nurses are trained to identify where patients are on that scale based on their communication and the nurse’s observations of the patient.”

Additionally, Link advises patients to continue to communicate the effectiveness of their pain medication with their nurse, so that if any changes need to be made, they will have the opportunity to communicate those needs. “Doctors prescribe medication,” shares Link. “Nurses administer the medication. If needed, nurses can communicate with the doctor to make adjustments or try a different medication or approach.”

Realistic Pain Management Expectations

“We want to treat acute pain and help manage chronic pain, but we need to communicate realistic expectations with patients,” Link shares. Communication is again the cornerstone to a patient’s experience in the hospital with regards to what they can expect when it comes to reducing their pain. Referencing the pain level chart, it would be unrealistic for a patient in unbearable pain (at a 10 on the scale) to expect to reduce their pain to a zero through pain medication. “We may never be able to get a patient’s pain to go away completely, due to the source of the pain. We work to get a two-point reduction in the patient’s pain, so that we can keep the pain at bay, allowing the patient to do their therapy and aid in all efforts to speed their recovery.”

This is an important point Link makes – the goal of pain management is to allow the body to heal. For every patient that may be different. In general, successful pain management allows post-op patients the ability to go to rehabilitation, take the first steps after knee surgery and take deep breaths to reduce the risk of pneumonia from developing, for example. “Our bodies are meant to move,” Link adds. “Actually getting up and moving around will help blood flow and the body heal itself.”

Understanding Pain Management Options

Opioids (narcotics) are medications, such as hydrocodone, morphine and oxycodone that relieve pain by reducing the intensity of pain signals to the brain. When taken as prescribed, opioids can be safe and effective. However, they also come with the potential side effect of dependence and addiction. Non-opioid medications are non-steroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen and aspirin. NSAIDs may be used in combination with opioids to reduce the use of opioids and better treat pain, which can be complex.

BSA pain management specialists, doctors and nurses work to identify what works best for the individual patient.  “We want people to also know that serious side effects are expected with opioids such as respiratory depression, nausea, vomiting and constipation,” explains Link. “Opioids can lead to serious health complications. By reducing opioid use, we can reduce side effects and possibly the length of stay in the hospital. Non-opioid pain treatments (modalities) can effectively improve their pain level and their overall stay at the hospital.”