patient reluctance 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 should a patient's statement describe their pain?

A patient's statement, “I have pain,” is not descriptive enough to inform a health care professional about pain type. Asking patients to describe their pain using words will guide clinicians to the appropriate interventions for specific pain types. Patients may have more than 1 type of pain. The following questions should be asked of patients:

What is a pain signature checklist?

These checklists are useful in identifying the patient’s “pain signature,” that is, the pain behaviors unique to the individual. 73

Why are patients reluctant to report pain?

Patients are reluctant to report their pain for reasons including 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.

What can influence a patients self reporting of pain?

Pain reporting in general may also be influenced by internal factors such as negative affect, and contextual factors such as interpersonal trust, expectations of biased physician perceptions and treatment, or an aversion to certain stigmas associated with pain (Koller et al., 1996; Slade et al., 2009; Buchman et al., ...

What are two barriers to managing pain?

The [Institute of Medicine] committee [has] identified several important barriers to adequate pain care in the United States. These include the magnitude of the problem, provider attitudes and training, insurance coverage, cultural attitudes of patients, geographic barriers, and regulatory barriers.

How do you assess the pain of a non responsive patient?

A set of simple questions can elicit pain presence and intensity. Simply ask the patient, "Are you having pain?" (yes/no). Then ask a patient to rate on a scale of zero (no pain) to 10 (worst pain ever) to get an idea of intensity. If able, have any alert patient point to where the pain is located.

What are the 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].

Why is pain assessment important in nursing?

Introduction. Pain assessment is crucial if pain management is to be effective. Nurses are in a unique position to assess pain as they have the most contact with the child and their family in hospital. Pain is the most common symptom children experience in hospital.

What are 4 barriers to managing pain?

Several barriers (system-related, staff-related, nurse-related, physician-related, and patient-related) have been identified that hinder the health care professionals from achieving optimal pain management.

What are three major barriers to effective pain management?

Barriers to the provision of effective pain managementPain assessment. Pain is often underestimated and under-treated. ... Patient self-reporting. ... Assessment tools. ... Prescribing analgesics. ... Dosing of analgesic drugs. ... Dosing intervals. ... Mode of delivery. ... Iatrogenic problems and opioids.More items...•

What are the barriers to obtaining help when it comes to chronic pain management?

What experts do know is that there are significant barriers to managing these patients' pain adequately. These "roadblocks to relief," as the American Pain Society calls them, range from lack of reimbursement for pain treatment to physicians' inexperience to patients' own attitudes about pain and painkillers.

What is nonverbal pain assessment?

Quantifies pain in patients unable to speak (due to intubation, dementia, etc). One can also use the Behavioral Pain Scale (BPS) for Intubated Patients as an alternative to the NVPS.

How can you tell if a person is in pain or distress if they don't tell you?

a look of pain on the person's face • hand movements that show distress • guarding a particular body part or reluctance to move • moaning with movement • small range of movement or slow movement • increased heart rate or blood pressure, or sweating • restlessness • crying or distress • making more or fewer sounds • ...

What strategies can be implemented to support pain management comfort and dignity?

Key pain management strategies include:pain medicines.physical therapies (such as heat or cold packs, massage, hydrotherapy and exercise)psychological therapies (such as cognitive behavioural therapy, relaxation techniques and meditation)mind and body techniques (such as acupuncture)community support groups.

What is end stage restlessness?

End-stage restlessness, or terminal agitation, is experienced by some patients during their final days and is characterized by physical, emotional, or spiritual distress, agitation or anxiety . End-stage restlessness negatively affects the patient’s death experience and can be distressing to the family and care team. Using the 2007 National Home and Hospice Care survey, this study examined factors associated with experiencing end-stage restlessness among non-Hispanic white and Hispanic hospice patients deceased at time of discharge. Results showed that being Hispanic/Latino, experiencing dyspnea, pain, and receiving palliative sedation treatment were risk factors for experiencing end-stage restlessness. The association between pain and restlessness was stronger for Hispanics compared with non-Hispanic whites. The Hispanic population remains underrepresented and little is known about the patient-centered experiences of Hispanic hospice users. Findings indicated that dying Hispanic patients continue to experience pain and other negative symptoms, even when hospice care is in place. Thus, it is important that social workers provide education to interdisciplinary team members about culturally competent practices, and advocate for a patient-centered approach to care.

What is neurogenic orthostatic hypotension?

Background: Neurogenic orthostatic hypotension (nOH) results from impaired vasoconstriction due to dysfunction of the autonomic nervous system and is common ly associated with Parkinson disease (PD), multiple system atrophy (MSA), and pure autonomic failure. nOH can increase the risk of falls due to symptoms that include postural lightheadedness or dizziness, presyncope, and syncope. The purpose of this study was to obtain information from patients and caregivers regarding the symptoms and burden of nOH to expand on limited knowledge regarding the impact of nOH on quality of life. Methods: This author-designed survey included questions regarding nOH (e.g., frequency and impact of symptoms, management) and was conducted online by Harris Poll via distribution to individuals who agreed to participate in Harris Poll online surveys or who were members of relevant disease advocacy organizations. Eligible patients were aged ≥ 18 years with PD, MSA, or pure autonomic failure and ≥ 1 of the following: orthostatic hypotension (OH), nOH, low blood pressure upon standing, or OH/nOH symptoms. Eligible caregivers cared for such patients but were not necessarily linked to any patient participant. Results: Survey responses were received from 363 patients and 128 caregivers. PD was the most frequent underlying disorder (90% of patients; 88% of individuals managed by the caregivers). Despite meeting survey diagnosis criteria, a formal diagnosis of OH or nOH was reported by only 36% of patients and 16% of caregivers. The most frequent symptoms of nOH were dizziness or lightheadedness, fatigue when standing, and difficulty walking. A negative impact on patient quality of life caused by nOH symptoms was reported by 59% of patients and 75% of caregivers. Most respondents (≥87%) reported that nOH symptoms adversely affected patients' ability to perform everyday activities (most frequently physical activity/exercise, housework, and traveling). Falls (≥1) in the previous year due to nOH symptoms were reported by 57% of patients and 80% of caregivers. Conclusions: These survey results support the premise that nOH symptoms have a substantial negative impact on patient function and quality of life. The relatively low rates of formal nOH/OH diagnosis suggest the need for heightened awareness regarding the condition and its symptom burden.

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.

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.

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.

Background

At some point in life, virtually everyone experiences some type of pain. Pain is often classified as acute or chronic. Acute pain, such as postoperative pain, subsides as healing takes place. Chronic pain is persistent and is subdivided into cancer-related pain and nonmalignant pain, such as arthritis, low-back pain, and peripheral neuropathy.

Scope of the Problem

Almost 35 million patients were discharged from U.S. hospitals in 2004; of these patients, 46 percent had a surgical procedure and 16 percent had one or more diagnostic procedures. 1 Pain is common, and expected, after surgery.

Assessment of Pain

Assessment of pain is a critical step to providing good pain management. In a sample of physicians and nurses, Anderson and colleagues 21 found lack of pain assessment was one of the most problematic barriers to achieving good pain control.

Monitoring the Quality of Pain Management

Establishing and maintaining an institutional pain performance improvement plan is a Joint Commission requirement. 5 Institutions should develop interdisciplinary approaches to acute pain management with clear lines of responsibility for achieving good acute pain control.

Current Guidelines

Many State and professional organizations have developed clinical practice guidelines to direct health care providers in adequate management of acute pain. The 1992 Acute Pain Clinical Practice Guideline22 lays the foundation for the more current guidelines.

Research Evidence

Analgesics, particularly opioids, are the primary treatment for acute pain. It is estimated that up to 90 percent of cancer pain can be adequately managed with analgesics using the World Health Organization (WHO) analgesic ladder.

Evidence-Based Practice Implications

Lack of adequate assessment and inappropriate treatment remain the major factors of undertreatment of pain. There is ample evidence that the appropriate use of analgesics—the right drug (s) at the right intervals—can provide good pain relief for the majority of patients.

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.