Pain Management: Assessment & Plan
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When you arrive at CTCA at Eastern Regional Medical Center (Eastern), you will have an opportunity to meet with a pain specialist during your initial evaluation period.
Your first visit with a pain specialist involves an accurate assessment of your pain experience. A comprehensive assessment includes information about some of the following dimensions of your pain: location, intensity, what makes it better or worse, observed behaviors during pain, and psychosocial variables.
Your pain specialist will help you fill out an assessment form. The assessment form includes a list of your current medications and any side effects related to the medications. The form also includes information about the intensity and nature of your pain.
The severity and prevalence of your pain may depend on many factors, including the type of cancer, the site (location) and stage (extent) of the disease, and your pain threshold (or tolerance for pain). The assessment form provides an analog scale in which you will rate your pain on a level of 0 (no pain) to 10 (worst possible pain).
Another scale is the Wong-Baker Faces Scale (also knows as a “Comfort Scale”), in which you rate your pain level using different facial expressions.
The assessment form also includes questions to help you describe your pain. You will pinpoint places in your body where you are experiencing pain, select words that best describe your pain, and provide information about how pain affects your daily routine.
Some causes of cancer pain include: the tumor putting pressure on tissues, bones, nerves or organs, poor blood circulation, metastasis, infection, inflammation, or inactivity. In addition, psychological, financial and social stresses can also influence your experience of pain. You may also have pain that is completely independent from cancer or its treatment, such as arthritis.
Your pain specialist will use information from the assessment to determine the nature of your pain, including where it is, how long you have had it, and what makes it better or worse.
The team will also work with the Department of Radiology/Imaging to use results from your imaging tests to determine sources of pain.
A clear understanding of the dimensions of your pain provides a basis for various pain management techniques. For instance, if you indicate burning, tingling, stinging, or stabbing, your pain specialist may determine that you have neuropathic pain and recommend certain agents specific to this symptom.
Pain management plan
Following the assessment, your pain specialist will work closely with you to develop your individualized pain management plan. The plan will include recommendations for pain control methods best suited to you. The team takes as much time with you as needed to fully understand your situation.
Since the best way to control pain is to prevent it from starting or to address it right away, your pain specialist will follow up with you as often as necessary throughout your cancer treatment to stay on top of your pain. For instance, they will try to anticipate and plan for breakthrough pain.
Unlike other hospitals in which a nurse may see you only once a day because of time constraints, your pain specialist at Eastern will visit with you two or three times a day to reassess your pain and make adjustments. They are also on call 24/7.
Your pain specialist will reassess your pain and adjust your medications to fit your schedule and lifestyle. For instance, if you take care of children during the day, you may benefit from a short-acting medication and then a long-active pain control later in the evening when your spouse gets home. The team strives to empower you by giving you choices.
In addition, some medications cause side effects, such as constipation, that require other medications to address. The pain team is constantly re-evaluating your plan to find an appropriate balance of pain relief methods.
“Everybody is different. A lot of people have mixed pain. We see what the patient is willing to work with,” says Nye.