Chronic Pain
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."
Home Care Interventions for Chronic Pain
- Review with client and caregivers the cause(s) of pain and the medical regimen specific to the cause. Assess client knowledge and teach disease process as necessary. Compliance with the medical regimen for diagnoses involving pain improves the likelihood of successful management.
- Develop a full medication profile, including medications prescribed by all physicians and all over-the-counter medications. Assess for drug interactions. Instruct client to refrain from mixing medications without physician approval. Pain medications may significantly impact or be impacted by other medications and may cause severe side effects. Some combinations of drugs are specifically contraindicated.
- Assess client and family knowledge of side effects and safety precautions associated with pain medications (e.g., use caution when operating machinery when opioids are initiated or dose has been increased). The cognitive effects of opioids usually subside within a week of initial dosing or dose increases. The use of long-term opioid treatment does not appear to affect neuropsychological performance. Pain itself may deteriorate performance of neuropsychological tests more than oral opioid treatment.
- Collaborate with health care team on an ongoing basis (including client and family) to determine optimal pain control profile. Identify the most effective interventions and the medication administration routes most acceptable to the family and client. Success in pain control is partially dependent on the acceptability of the suggested intervention. Acceptability promotes compliance. Dosages vary among routes and will need to be adjusted accordingly to avoid breakthrough or transitional pain.
- If administering medication using highly technological methods, assess home for necessary resources (e.g., electricity), and ensure that there will be responsible caregivers available to assist client with administration. Some routes of medication administration require special conditions and procedures to be safe and accurate.
- Assess knowledge base of client and family for highly technological medication administration including the use of PCA pump. Teach as necessary. Appropriate instruction in the home increases the accuracy and safety of medication administration.
- Support the client and family in the use of opioid analgesics. Well-intentioned friends and family may create added stress by expressing judgment or fears regarding the use of opioid analgesics.