Pain is always subjective and cannot be proved or disproved. The client's report of pain is the most reliable indicator of pain (Acute Pain Management Guideline Panel, 1992). Clients with cognitive abilities who can speak or point should use a pain rating scale (e.g., 0 to 10) to identify their current level of pain intensity (self-report) and determine a comfort/function goal (McCaffery, Pasero, 1999).
Expressions of pain are extremely variable and cannot be used in lieu of self-report. Neither behavior nor vital signs can substitute for the client's self-report (McCaffery, Ferrell, 1991, 1992; McCaffery, Pasero, 1999). However, observable responses to pain are helpful in its assessment, especially in clients who cannot or will not use a self-report pain rating scale. Observable responses may be loss of appetite or the inability to ambulate, perform activities of daily living (ADLs), work, or sleep. Clients may show guarding, self-protective behavior, self-focusing or narrowed focus, distraction behavior ranging from crying to laughing, and muscle tension or rigidity. In sudden severe pain, autonomic responses such as diaphoresis, blood pressure and pulse changes, pupillary dilation, and increase or decrease in respiratory rate and depth may be present but are usually not present with chronic pain that is relatively stable. Clients with chronic, cancer, or nonmalignant pain may experience threats to self-image; a perceived lack of options for coping; and worsening helplessness, anxiety, and depression. Chronic pain may affect almost every aspect of the client's daily life, including concentration, work, and relationships.
Actual or potential tissue damage; tumor progression and related pathology; diagnostic and therapeutic procedures; nerve injury (neuropathic pain)
NOTE: The cause of chronic nonmalignant pain may not be known because pain is a new science and an area of diverse types of problems.
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
Pain: Disruptive Effects
Uses pain rating scale to identify current level of pain intensity, determines a comfort/function goal, and maintains a pain diary (if client has cognitive abilities)
Describes the total plan for drug and nondrug pain relief, including how to safely and effectively take medicines and integrate nondrug therapies
Demonstrates ability to pace self, taking rest breaks before they are needed
Functions on an acceptable ability level with minimal interference from pain and medication side effects (if pain is above the comfort/function goal, takes action that decreases pain or notifies a member of the health care team)
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
Pain Management, Analgesic Administration
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Nursing Interventions and Rationales for Chronic Pain