Descriptive language key in pain management

Teach patients to convey symptoms to physician

A good pain management program for any patient must be built on a sound assessment. Without the assessment, physicians might not be able to determine what kind of pain they are treating and which medication is best suited for relief of the pain. Therefore, patients need to be taught how to talk to their physician about pain.

"People need to be able to describe their pain, because pain that is caused from nerves may be described as a burning pain or a sharp shooting electric shock pain, whereas pain from a bone may be a dull, achy pain. Treatment for those two types of pain might be totally different," explains Pamela Bennett, BSN, RN, director of external affairs for the American Pain Foundation in Baltimore and an independent pain management consultant.

Other details that are important for determining the appropriate treatment include the location of the pain; if it is constant, or comes and goes; if it radiates or stays in one spot; when it started and if it has changed over time; if there are other symptoms associated with the pain, such as nausea; and what relieves the pain or makes the pain worse. Patients could keep diaries to track every detail about their pain to aid in discussions with their physicians.

Another important area of education is to teach patients how to advocate for themselves, says Bennett. "If the treatment is not working, patients need to be able to convey that to their provider. They need to know that they have a right to have their pain managed," she says.

This education would include teaching patients how to advocate for good pain management while in the hospital, even to the point of contacting the patient representative if the health care team isn’t listening. The goal is to get good pain relief, not to get people in trouble, explains Bennett.

Terminally ill patients and their family members have special issues regarding pain medication education that must be addressed. (For information on the special needs of terminally ill patients, see article above.)

There are many barriers to good pain management, but one of the most common is misinformation about opioids. "Our society as a whole tends to be opioid-phobic. We have done a good job at teaching people how to just say no to drugs,’ but not at teaching them when to say yes and why," says Bennett.

Patients who are at an adequate comfort level can have good function and heal faster, yet often they are not taught that. They also are not taught the difference between addiction, dependence, and tolerance, and their fears hamper their adherence to a medication regimen.

Patients also need adequate information about the drug they are taking so they can understand how long it might take before the medication begins to work and will not assume it is ineffective. If they are given a medication that is usually used for another condition such as seizures, they need to know why they are being given an adjunctive medication so they won’t be surprised by the knowledge and quit taking the drug.

Education on pain management must include information on complementary therapies such as hypnosis, because what works for one person won’t necessarily work for another. This is especially important when people suffer from chronic pain. "It’s important to tell people that there is a lot of needless suffering going on and there are things that can be helpful; it’s not necessarily just a single pill," says Bennett. (For information on complementary therapies, see Editor’s note at the end of this article.)

It’s important to put tools in patients’ hands so they have the best information when they talk to their health care provider. This would include information on how to discuss pain, factors that contribute to pain such as psychosocial and spiritual issues, and how to obtain financial aid to pay for expensive pain medications. (For more information on resources, see article on p. 79.)

[Editor’s note: Patient Education Management frequently runs articles on complementary therapies, many of which help with pain management. Past articles have addressed therapeutic touch (April 1999), massage therapy (May 1999), music therapy (June 1999), acupuncture (July 1999), acupressure (October 1999), imagery and visualization (February 2000), and reflexology (May 2000).]