Pain Assessment and Management, 2nd Edition _ _________________________________________________
Leadership 1. Develop, implement, and monitor performance improvement activities specific to pain management. 2. Provide nonpharmacologic pain treatment modalities. 3. Provide staff and practitioners with education and resources on pain management and safe use of opioid medications. 4. Provide staff and practitioners information on available services (internal or external) for consultation and referral of clients with complex pain management needs. 5. Identify opioid treatment programs for clients who need referrals. 6. Provide access to prescription drug monitoring program databases. 7. Develop a system to monitor patients following sedation or anesthesia (continuous intravenous opioids). Performance Improvement 8. Analyze data collected on pain assessment and management to identify areas for improvement around safety and quality. Provision of Care, Treatment, and Services 9. Ensure appropriate screening and assessment tools are available and used appropriately to measure client pain. 10. Educate client and family about discharge plans related to pain management. The concept of pain management and access as a human right continues to grow internationally (Ogston-Tuck, 2022). It is widely recognized that fatigue, anxiety, and depression can make pain worse. Healthcare organizations now place added emphasis on accurate assessment of pain and methods of alle- viating it. Planning and teaching for discharge must include a plan for continued care, including pain management, based on the client’s condition at the time of discharge (Acello, 2000). INTERVENTIONS Practitioners use diverse practices to achieve the goal of improv- ing function and participation (Reeves et al., 2022). These authors identify intervention approaches that practitioners can use when treating pain as part of a comprehensive pain rehabilitation program (see Table 6 ). Preparatory methods are, more specifically, modalities, devices, and techniques that are used to help a client engage in life. These are often done to the client without their active partici- pation. Preparatory tasks are activities that target performance skills. The client is often actively engaged in the activity; however, the task does not hold inherent meaning or value for the client.
VIGNETTE Frank, a construction worker, came to an interdisciplinary pain program after sustaining a back injury 5 years ago at work. He ini- tially presented as guarded and distant. Frank described his negative experiences at work and his feeling of abandonment by his former coworkers, who no longer speak to him because of the injury and pending compensation case. He also described feeling “abused” by the workers’ compensation system and poorly understood by his case manager. In this system, depending on the state or federal statute, outside forces (employer and reimbursement systems) control the treat- ment options. Frank felt that he had no power over his care and felt anxious that at any moment his treatment, medication, or financial assistance would be withdrawn. This anxiety caused him to tense up, which further aggravated his back pain. Through collaboration with Frank’s psychologist, the practitioner learned that Frank had had an abusive childhood and that this injury experience was eliciting unhealed emotional wounds. The practitioner thoroughly explained the available treatment options to Frank, and together they created goals using an assessment tool (COPM) that allowed Frank to identify his individual goals and rate their importance to him. By involving Frank as an active participant, the practitioner was able to build rapport and develop trust right from the start. Based on the data gathered from the evaluation, an interven- tion plan is developed cooperatively with the client. The plan should be grounded in the client’s goals, values, beliefs, and needs; performance skills and patterns; and the influence that contexts, demands, and client factors have on the individual. The client’s health and well-being, context of service delivery, and best available evidence should provide additional guidance to ensure an intervention plan and subsequent interventions are appropriate for the client. Interventions may include the occupations or activities themselves, interventions to sup- port occupations (physical agent and mechanical modalities, orthotics/prosthetics, assistive technology, wheeled mobility, self-regulation), education and training, advocacy, and group and/or virtual interventions (AOTA, 2020). With the current concern around narcotic pain medication, the Joint Commission (2018) revised their standards on pain, and this in turn changed the beliefs and actions of the health profession. The Joint Commission’s Standards Interpretation Group developed 10 pain standards (Joint Commission, 2018).
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