___________________________________________________ Pain Assessment and Management, 2nd Edition
tion of performance over time. Meesters et al. (2016) used the COPM to identify performance problems and linked them to the International Classification of Function (ICF). This study identified 801 functional activities/problems from the COPM, which linked to 706 unique ICF components. Of the 706 unique ICF components, 621 (or 88%) of them were “activities and participation.” Areas impacted for the adults in this study included activity of daily living, instrumental activ- ity of daily living, work, leisure, and social participation. In a study by Alves et al. (2019), the COPM identified limitations in self-care, functional mobility, and productive activities as compared to the ICF, with mobility having the highest number of categories cited and personal care the highest number of complaints. Geurts et al. (2017) found that clients have a high expectation for pain reduction after treatment, and up to 79% of those with chronic pain are unsatisfied with the outcome.
• Clients must say they are in pain or show physical evidence of pain before other people can believe it: False. ‒ People may not express their pain willingly or may downplay its presence for many
reasons. One study found that people with osteoarthritis had difficulty expressing their pain because of the “perception that nobody wants to hear about it,” the “necessity to preserve one’s self and social image,” and “self-imposed stoicism” that caused patients to attempt to cope with the pain by not thinking about it (Cedraschi et al., 2013, p. e79988). Another study by Noroozian et al. (2018) found that people want to be considered compliant, so many do not report pain. Gingras et al. (2023) report that cultural factors may result in the differences people have about how pain is expressed.
PAIN MYTHS
• Taking a narcotic will lead to addiction: False. ‒ A number of studies have found that when
The following are just some of the myths that remain as bar- riers to effective pain management. • Narcotics always take away the pain: False. ‒ There are significant individual differences in
pain is relieved, the need for narcotics abates (McCaffery & Robinson, 2002; Portenoy & Dahl, 2004). According to Vowles et al. (2015),
client response to medications. There may be interference from interactions with another drug or the cognitive process involving the action of the drug, or there may be a difference in how a drug is metabolized. Some people, for example, have a different allele that requires less of a medication where others may not find it to be effective at all (Aroke & Kittelsrud, 2020).
between 8% and 12% of those prescribed opiates for chronic pain develop an addiction disorder. Those who take opioid medication for chronic pain are found to continuously balance between not wanting to take them and feeling they have no choice because of the pain. They report feeling stigmatized, leading to being secretive about usage. Martorella et al. (2019) report that 64.4% of nurses agreed that chronic pain patients become dependent on their medications. • If clients can sleep or be distracted by visitors, their pain cannot be very bad: False. ‒ In 2019, Martorella et al. found that 25% of
• Pain is a result of aging: False.
‒ Too often older adults endure chronic
pain, believing it is part of the aging process (Thielke et al., 2012). However, pain in the absence of disease is not part of the aging process. Older adults often hold the same misconceptions about pain as those held by healthcare providers (Auxier et al. 2020). According to multiple studies reviewed by Hallingbye et al. (2011), “Older adults themselves may in fact believe that pain is something to be tolerated because it is an inevitable part of aging and may show increased stoicism when reporting pain” (p. 815). Others, who subjectively feel older than their chronological age, are more likely to report more pain (Wettstein et al., 2024).
the nurses surveyed agreed that chronic pain patients complain about the pain but are able to continue to perform their activities, so “their pain should not be that bad” (p. 6). The erroneous expectations of some health professionals that clients must act as if they are in pain can encourage clients to be manipulative (McCaffery & Robinson, 2002). A study by Twigg and Byrne (2015) suggests that pain is assessed often using intuition and biased information to fill in where medical evidence is missing.
Cultural beliefs among both clients and health professionals can play a large part in sustaining myths about pain. One of these beliefs is the myth, mentioned earlier, that clients must express and exhibit pain and pain behaviors.
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