patient reluctacne to report pain

Patient reluctance to report pain has been shown to be a primary reason for inadequate pain control among cancer patients. Very little is known about whether patients' self-reports of pain vary by treatment settings.

Full Answer

Why are patients reluctant to tell their caregivers when they have pain?

Patients may be reluctant to tell their health care providers when they have pain, may attempt to minimize its severity, may not know they can expect pain relief, and may be concerned about taking pain medications for fear of deleterious effects.

What happens when pain goes unrecognized during clinical encounters?

If patient pain goes unrecognized during clinical encounters, patients may also be at greater risk for pain-related crises, use of hospice/palliative care on-call services, and in-patient transfers. This is an evidence-informed development of a practice-oriented conceptual model to understand and address patient reluctance to admit pain.

How to assess acute pain in a nursing assessment?

Acute Pain Nursing Assessment 1 Quality (e.g., burning, sharp, shooting) 2 Severity (scale of 0 or no pain to 10 or most severe pain) 3 Location (anatomical description) 4 Onset (gradual or sudden) 5 Duration (how long; intermittent or continuous) 6 Precipitating or relieving factors

What do patients in pain want to tell?

Patients in pain want to tell their stories, and clinicians need to take time to listen. Stories are narratives that provide meaning in our lives. They can teach, heal, validate, offer reflection, and shape how patients are cared for. Storytelling provides a different lens through which an experience can be viewed.

What are barriers to pain assessment?

Patient-related barriers to pain assessment and management include reluctance to report pain, fear of side effects, fatalism about the possibility of achieving pain control, fear of distracting physicians from treating cancer, and belief that pain is indicative of progressive disease [3, 40–46].

What is the standard for pain assessment?

Since pain is subjective, self-report is considered the Gold Standard and most accurate measure of pain. The PQRST method of assessing pain is a valuable tool to accurately describe, assess and document a patient's pain.

How often should pain be assessed and why?

The most critical aspect of pain assessment is that it is done on a regular basis (e.g., once a shift, every 2 hours) using a standard format. The assessment parameters should be explicitly directed by hospital or unit policies and procedures.

Why do we assess pain?

In the medical field, pain assessment is defined as a process that physicians conduct to assist with creating a diagnosis by detecting and evaluating pain symptoms described by patients, with the idea that by assessing pain, physicians are able to understand the patient's condition more so that they can come up with a ...

What should a nurse assess regarding a patient's pain?

Measuring pain Pain should be measured using an assessment tool that identifies the quantity and/or quality of one or more of the dimensions of the patients' experience of pain. This includes the: intensity of pain; intensity and associated anxiety and behaviour.

What are the 11 components of pain assessment?

Patients should be asked to describe their pain in terms of the following characteristics: location, radiation, mode of onset, character, temporal pattern, exacerbating and relieving factors, and intensity. The Joint Commission updated the assessment of pain to include focusing on how it affects patients' function.

How do you ask a patient about pain?

History of Your PainWhat caused my pain in the first place?Did my pain start suddenly or gradually?How long have I been in pain?What am I currently doing to manage my pain?Is there anything I'm doing that's reducing my pain?What pain medications have I taken in the past, and how did they work for me?More items...

Why is pain management a priority?

Uncontrolled pain can lead to catastrophic consequences on physical, mental, social, and financial levels. In the postoperative period, serious complications such as poor wound healing, infections, cardiac ischemia, and ileus might occur due to inadequate pain management.

Why does a nurse perform a pain assessment?

Pain measurement quantifies pain intensity and enables the nurse to determine the efficacy of interventions aimed at reducing pain.

Why is managing pain important?

Managing pain is key to improving quality of life. Pain keeps people from doing things they enjoy. It can prevent them from talking and spending time with others. It can affect their mood and their ability to think.

Why is pain management important in palliative care?

Pain management is a key part of end of life and palliative care. If pain is well managed, quality of life will be better. The person is likely to sleep better and have more energy during the day. If they feel less pain, they can be more active, which also reduces the risk of complications.

Is pain objective or subjective?

Pain is defined as a subjective experience,1 which means that it cannot be directly observed by those who are not experiencing it. Yet, clinicians and researchers rely upon observations and measures to assess and infer the pain experienced by other people.

Why are patients reluctant to disclose pain?

However, the reasons for this, such as stoicism and concern about being a bother to others, are poorly understood. If patient pain goes unrecognized during clinical encounters, patients may also be at greater risk for pain-related crises, use of hospice/palliative care on-call services, and in-patient transfers. This is an evidence-informed development of a practice-oriented conceptual model to understand and address patient reluctance to admit pain. We used a review of the available evidence to better understand the various factors that contribute to an unwillingness to disclose one’s pain, create a conceptual model, and identify relevant assessment measures that may be useful to practitioners. Our review identified six primary attitudes and beliefs that contribute to patient reluctance to openly admit pain: (a) stigma; (b) stoicism; (c) cautiousness; (d) fatalism; (e) bother; and (f) denial. Four assessment measures that address elements of barriers to pain-related communication and four measures of nonverbal signs of pain were also identified and reviewed. Based on the model, social workers and other palliative care providers should consistently and vigilantly inquire about how comfortable patients are about discussing their own pain. Implications for practice and research are presented.

What is QST in pain?

Objectives: Quantitative sensory testing (QST) may help predict treatment responses in individuals with chronic pain. Our objective was to determine if evoked pain sensitivity at baseline predicted preferential treatment responses to either emotional awareness and expression therapy (EAET) or cognitive behavioral therapy (CBT) in individuals with fibromyalgia. Methods: This was a secondary analysis of a previous randomized clinical trial, in which individuals with fibromyalgia were randomized to EAET, CBT, or Education as a control intervention. Only females who completed baseline and post treatment assessments were analyzed (n=196). The primary outcome was change in overall clinical pain severity from pre-treatment to post-treatment, and the primary predictor of interest was pressure pain tolerance at baseline. Results: Among patients with low pain tolerance at baseline (n=154), both EAET and CBT led to small but significant improvements in clinical pain severity (CBT mean [95% CI]=0.66 [0.24, 1.07]; EAET=0.76 [0.34, 1.17]). Conversely, in patients with normal pain tolerance (n=42), there was no significant improvement in clinical pain after CBT (0.13 [-0.88, 1.14]), a small improvement after FM Education (0.81 [0.14, 1.48]), but a much larger and statistically significant improvement after EAET (2.14 [1.23, 3.04]). Discussion: Normal levels of pressure pain tolerance at baseline predicted greater improvement in clinical pain severity following EAET than CBT. QST may provide insights about individual responses to psychologically-based therapies for individuals with chronic pain.

Is low back pain a health issue?

Low back pain is a prevalent military and veteran health problem and individuals injured on deployment may be at particularly high risk of pain conditions. Given that increasing numbers of active duty and veteran military personnel are seeking care in community settings, it is critical that health care providers are aware of military health issues. The current study examined the prevalence of low back pain among individuals with deployment-related injuries, compared their self-reported pain intensity and interference ratings, and assessed the relationship between low back pain, self-reported pain ratings, and quality of life. Almost half of participants had low back pain diagnoses, and individuals with low back pain reported significantly higher intensity and interference due to their pain than individuals without low back pain. Finally, the relationship between low back pain and quality of life was explained by self-reported pain indices, underscoring the importance of patient-centered metrics in pain treatment.

They believe that pain is a normal part of ageing

If the resident holds this belief, they may accept the pain as being normal rather than asking for help and pain relief.

They believe that their pain cannot be relieved

Some older people struggle with their pain because they think there is no other option. They may not know what pain relief can be offered to them and what their options are.

Fear of disease progression

They may fear that the pain is a sign of disease progression or decline, for example if the resident has cancer or some other terminal condition.

Fear of side effects or addiction to strong medications

Pain management can include, but not always, some form of drug therapy. Though most older people may already be on some sort of medication – maybe for blood pressure or diabetes, or other conditions – the idea of pain treatment can make people worry that they could get addicted to the medication.

Different vocabulary for pain

Some older people may not acknowledge pain, because they use other words to describe what they are feeling.

Stoicism

They may have attitudes which makes them reluctant to complain when struggling with pain, and therefore choose not to ask for help.

Impaired verbal communication

They may have reduced communication skills due to sensory and/or cognitive impairment, this could be for any number of reasons, but the most common is dementia.

Highlights

Listen attentively to the patient telling his/her story and then share benefits, risks, and alternatives to various treatments, while giving the patient the dignity of making his/her own choice.

Margaret Chisolm, MD, Johns Hopkins University School of Medicine

For years I was mystified that whenever I was seeing a new patient for the first time, he/she would begin the meeting by announcing, “I have no interest in being on an antidepressant medication and am here for psychotherapy only.”

Mike Fingerhood, MD, Johns Hopkins University School of Medicine

1.) Ask, “Is there something I can do to help us work together on this?”

Panagis Galiatsatos, MD, Johns Hopkins University School of Medicine

A reluctant patient has more concerns then what’s currently visible in the immediate situation.

Michael Crocetti, MD, Johns Hopkins Community Physicans

When I sense reluctance the first thing I do is stop talking, relax my body, sit at the level of the patient, and simply listen.

How to assess acute pain?

Nurses play a crucial role in the assessment of pain, use these techniques on how to assess for Acute Pain: 1. Perform a comprehensive assessment of pain. Determine via assessment the location, characteristics, onset, duration, frequency, quality, and severity of pain.

What are the physiological signs of acute pain?

The physiological signs that occur with acute pain emerge from the body’s response to pain as a stressor. Other factors such as the patient’s cultural background, emotions, and psychological or spiritual discomfort may contribute to the suffering of acute pain.

What is the nonpharmacologic treatment for pain?

Restriction of movement of a painful body part is another nonpharmacologic pain management. To do this, you need splints or supportive devices to hold joints in the position optimal for function. Note that prolonged immobilization can result in muscle atrophy, joint contracture, and cardiovascular problems.

How long does it take for analgesics to peak?

Oral analgesics typically peak in 60 minutes, intravenous analgesics in 20 minutes. Performing nursing tasks during peak effect of analgesics optimizes client comfort and compliance in care. 8. Evaluate the effectiveness of analgesics as ordered and observe for any signs and symptoms of side effects.

What questions should a nurse ask during a pain assessment?

Additionally, the nurse should ask the following questions during pain assessment to determine its history: (1) effectiveness of previous pain treatment or management; (2) what medications were taken and when; (3) other medications being taken; (4) allergies or known side effects to medications. 4.

How long does acute pain last?

The unexpected onset of acute pain reminds the patient to seek support, assistance, and relief. It has a duration of fewer than 6 months.

What are the other coanalgesics?

Other coanalgesics. Include anxiolytics, sedatives, antispasmodics to relieve other discomforts. Stimulants, laxatives, and antiemetics are other coanalgesics that reduce the side effects of analgesics.

Why is pain management training so poor?

poor training in pain management, or training against using opioids for chronic pain because, despite reassuring words, his state medical board takes a hard line on physicians who prescribe them. feedback from a pharmacist that the physician is prescribing too much pain medicine.

What to do if a doctor is in a clinic setting?

If the physician is in a clinic setting, ask the head of the clinic if another physician there will take over your care. Speak to other health care professionals who know you well enough to be comfortable calling to explain that you are genuinely in pain and are a reliable, conscientious person.

What did the pharmacist tell her when she came to pick up her medication?

A physician at the clinic told her she was drug seeking. A clinic pharmacist yelled at her when she came to pick up medications and told her not to come back for “her drugs.”. It took an HMO appeal, a complaint to the state insurance commissioner, and filing a complaint in a local court to get her relief.

How long can a physician terminate you?

An oral message is insufficient. The physician. must also agree to continue your care for at least 30 days and he should also provide a referral.

What is the tort of emotional distress?

Additionally, there is a tort called “infliction of severe emotional distress,” which requires (a) an action taken by the defendant (b) which was reasonably foreseeable to cause severe distress; and (c) that it did in fact cause severe emotional distress.

Can a physician take a pain contract personally?

Good physicians will have some practice management tools in place, so don’t take it personally if you are asked to sign a pain “contract” and to submit to blood or. urine monitoring.

Can you abandon a patient on opioids?

However, if you are at a critical or important point in your treatment, abandonment by notice and 30-day care is not permissible under common law. This restriction should apply to a patient taking opioids for pain because the consequences of withdrawal for a person who has a chronic illness could be significant.