Doing More to Assist with Pain Management
Pain management is a prominent issue in long-term care. For many years providing pain medication on a regular basis was irrationally feared based on risking a potential addiction to the resident. As we have become more enlightened, the fear of addiction has abated and our focus has become more rationally directed toward maintaining resident comfort. However, are we doing all we can to assist in pain management?
For sure we are using important pharmacological agents that have important pain killing effects to enhance the comfort of our residents. Also, providing a pill often provides a quick remedy to the situation. However, is pain management dependent on more than just pharmacological intervention? Does providing a pain medication always enhance the best practice in addressing pain? Moreover, does this type of pain management in exclusivity enhance the quality of life that is sought for long-term care residents?
Although monitoring and assessing pain has become a greater focus in long-term care and although many individuals are much more skilled today in detecting pain than was often the case in years past, there still exists a considerable dearth of knowledge and skill in pain management. In nursing care facilities the nurses are often the key individuals that are suppose to be responsible for pain management. In reality, pain management is the responsibility of all individuals who work in the nursing home. This may be controversial, but it is a very important mindset to be put in place.
Many nurses today are still ill trained in pain assessment and management.Furthermore, many other individuals such as nurse assistants and rehabilitation specialists are even in need of more training in this area. In addition, individuals such as administrators, housekeepers, maintenance, social workers, and business office staff get little, if any, training in this area. Since pain can often manifest itself suddenly, such as breakthrough pain, frequently when other members who are not part of the clinical staff are with residents, this makes it even more important that all staff is trained in recognizing and assisting in the pain management process.
Currently the pain management process is almost exclusively the purview of the medical staff. We have strongly medicalized pain management and subsumed this important topic under the physician and nurse. As a result it should be no surprise that we have so many individuals that can contribute to the process, yet fail to receive any training in pain management whatsoever. As many parents know, you do not have to be a physician or nurse to know when your children are ill or in pain. Furthermore, as many parents will tell you as well, they have often managed their children's pain and sickness without the intervention of physicians or nurses. This is in no way to deny the importance of physicians and nurses in the pain management process, but to say that these are the only two professionals that should be involved in pain management prevents the pain management process from being fully actualized.
We need to accept the pain management process as not just a medical intervention, but a social intervention as well. How can this be a social process? One may state that pain is a biological and biochemical process, and since it is a biochemical process, a type of biochemical intervention, especially pharmacologically based, is the only sensible approach to address this type of issue. However, pain in itself is far from an objective process, which can be empirically measured with pinpoint accuracy. Individuals experience pain differently, and pain is not just influenced by a person's biological threshold, but is also influenced by their perception, their culture, and their psychological state of being. Therefore, pain in itself is often quite subjective in its nature, and how it is perceived, reported and demonstrated is strongly individual, predicated upon the phenomenological nature of each person.
We have all heard of the "placebo effect," in which a patient is provided with a supposed medication and experiences results that are highly efficacious. The person often subjectively creates pain, and the same subjective process often abates it. I am not contending that pain is not real for many of the residents that we service. In fact, I am arguing for the exact opposite: since pain is highly individualized among all individuals, including long-term care residents, we need greater intervention to deal with this important problem, more than just intervention by a physician, nurse and a pill.
Because the phenomenology of pain is so complex and multifaceted, the way that it is addressed also has to complement this complexity. In limiting the nature in which we treat pain, using only the medical model of physician, nurse and pill, we continue to fall short in treating the resident holistically. As the placebo effect has demonstrated, pain is more than just a biological and biochemical feature of the body. It is based on the subjective and phenomenological states of the resident that we cannot always reach with medicinal agents. All heath care centers underutilize the range of approaches that can be used to address pain, but the long-term care industry is not doing much to enhance their productivity in this area.
Many complementary nondrug methods such as acupuncture, biofeedback, distraction, imagery and visualization and meditation are very seldom, if ever, used in these types of environments. One may say that is because of the type of clientele found in nursing homes, which often have a large number of fail, dying, and demented individuals. However, this type of argument is often weak. Many long-term care residents can be quite receptive and workable with these types of interventions and yet they often never get the opportunity to benefit from these types of intervention. Others argue that these types of therapies should not exist in a medical environment. Yet again, this argument is just the same type of rhetoric that needs to be disposed of in regards to resident pain, especially if we want to address this important resident concern in a holistic manner.
In conclusion, this author is arguing for a greater breadth and depth of pain management and intervention by the staff. Pain is more than just a biological process than can only be targeted by medical personnel who are able to write prescriptions or dispense medications. Pain management is a social enterprise. It is a uniquely subjective state that needs to be recognized, and because of the social factors involved in pain, pain management should also become a process of social intervention. Currently, too many nursing homes continue to treat pain one-dimensionally, failing to recognize the multidimensional makeup of this complicated process.