El-Jawahri A et al. Does palliative care improve outcomes for patients with incurable illness? A review of the evidence.
J Support Oncol. 2011 May-Jun;9(3):87-94. [PMID: 21702398] Temel JS et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug 19;363(8):733—42. [PMID: 20818875]
PRiNCiPLES OF PAiN MANAGEMENT
The experience of pain includes the patient’s emotional reaction to it and is influenced by many factors, including the patient’s prior experiences with pain, meaning given to the pain, emotional stresses, and family and cultural influences. Pain is a subjective phenomenon, and clinicians cannot reliably detect its existence or quantify its severity without asking the patient directly. A useful means of assessing pain and evaluating the effectiveness of analgesia is to ask the patient to rate the degree of pain along a numeric or visual pain scale (Table 5-1).
General guidelines for management of pain are recommended for the treatment of all patients with pain (Table 5-2). Clinicians should ask about the nature, severity, timing, location, quality, and aggravating and relieving factors of the pain. Distinguishing between neuropathic and nociceptive (somatic or visceral) pain is essential to proper tailoring of pain treatments. The goal of pain management is properly decided by the patient. Some patients may wish to be completely free of pain even at the cost of significant sedation, while others will wish to control pain to a level that still allows maximal functioning.
Table 5-1. Pain assessment scales.
A. Numeric Rating Scale
1 1 1
Worst pain і 1
0 1 2
3 45 6789 10
B. Numeric Rating Scale Translated into Word and Behavior Scales
Relaxed, calm expression
Stressed, tense expression
Guarded movement, grimacing
Increased intensity of above
C. Wong Baker FACES Pain Rating Scale1
О No hurt
1 Hurts Little Bit
2 Hurts Little More
3 Hurts Even More
4 Hurts Whole Lot
5 Hurts Worst
‘’Especially useful for patients who cannot read English and for pediatric patients.
Reprinted, with permission, from Hockenberry M, Wilson D, Winkelstein ML. Wong’s Essentials of Pediatric Nursing, ed. 8. Copyright © 2009, Mosby, St. Louis.
Chronic severe pain should be treated continuously.