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. 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: 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. (Joint Commission, 2018) Clients who have been reluctant to express their need for pain relief are taught that it is their right (and responsibility) to be actively involved in pain management (Acello, 2000). It is now 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 alleviating 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).
SPECIFIC PAIN DIAGNOSES
Many diagnoses that involve pain are familiar to most practitioners (e.g., back pain, arthritis, and carpal tunnel syndrome). However, some pain diagnoses are more rare or specific and therefore more difficult to diagnose and/or treat. Cancer pain According to the National Cancer Institute PDQ cancer information summary, pain is common for those diagnosed with cancer (PDQ® Supportive and Palliative Care Editorial Board, 2018). Between 20% and 80% of clients diagnosed with cancer experience pain (Bruera & Kim, 2003; Fischer, Villines, Kim, Epstein, & Wilkie, 2010). Pain related to cancer can be from the tumor itself or the therapies that are used to treat it, and it often can manifest in multiple areas. Frequently, the pain affects the individual’s ability to function and in turn their overall quality of life. Pergolotti et al. (2017) reported that African American race (p < 0.05), comorbid conditions (p < 0.02), and gastrointestinal cancers (p < 0.05) were independently associated with a poor health-related quality of life (HRQOL). For 33% of clients diagnosed with cancer, the pain continues even after finishing a curative treatment (van den Beuken-van Everdingen et al., 2007). Complex regional pain syndrome CRPS is a rare and difficult disease. Disagreement on a set of diagnostic criteria has made it difficult to determine the actual prevalence of CRPS. It is estimated that approximately 26.2 out of 100,000 people have this condition; incidence of CRPS after distal radius fractures varies from 1% to 37% (Ortiz-Romero et al., 2017). CRPS was once referred to as reflex sympathetic dystrophy (RSD ), among many other terms over the years. Diagnostic criteria for CRPS has changed over the past several
The following diagnoses, which warrant additional explanation, are cancer pain, complex regional pain syndrome (CRPS), fibromyalgia, and pain across the life span.
There are times that clients with cancer are not heard when reporting pain. One study found that 86% of clients reported pain with chemotherapy treatment. Only 36% of the oncologists and 51% of the oncology nurses involved believed the pain occurred (Williams, Bohac, Hunter, Cella, & Williams, 2016). Lasheen, Walsh, Sarhill, and Davis (2010) proposed a new classification system for cancer pain. In their study of 100 individuals, 27% had intermittent pain alone and 11% had continuous pain alone. However, 60% had combined continuous pain with intermittent pain. The researchers identify the etiology of the intermittent pain as being somatic (58%), visceral (24%), neuropathic (7%), or mixed (11%). Knowing if the pain is continuous or intermittent is helpful when providing care. It is also important to know if the intermittent pain happens because of a specific precipitant to allow for planning pain management techniques. years. Currently, the Budapest CPRS Diagnostic Criteria are the most reliable. These criteria improve the sensitivity to 0.70 and specificity to 0.94, thereby reducing the false-positive diagnoses (Harden et al., 2010). This newer diagnostic criteria reflect sensory, vasomotor, sudomotor/edema, and motor/ trophic clusters seen in CRPS. Table 3 shows the Budapest CRPS Diagnostic Criteria.
Table 3: Budapest CPRS Diagnostic Criteria All of the following statements must be met:
● The patient has continuing pain that is disproportionate to any inciting event. ● The patient has at least one sign in two or more of the categories below. ● The patient reports at least one symptom in three or more of the categories below. ● No other diagnosis can better explain the signs and symptoms. No. Category Signs/Symptoms 1 Sensory
Allodynia (pain to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement) and/or hyperalgesia (to pinprick).
Vasomotor
2
Temperature asymmetry and/or skin color changes and/or skin color asymmetry.
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