- To increase awareness of common misconceptions in the management of pain
- To accurately describe strategies to overcome such misconceptions
- To increase self awareness and reduce risk of bias when performing pain assessments clinically.
Key issues and misconceptions in pain assessment
Complete this survey (in .PDf file format, reproduced with permission from McCaffery & Ferrell 1997).
Now read the article by McCaffery & Ferrell: Nurses’ Knowledge of Pain Assessment and Management: How Much Progress Have We Made? .
Whatever method of assessing pain is utilised, it is important to remember the opportunity that exists to cause bias in the results. The observer can influence the response by asking leading questions and by altering the way in which questions are asked. The patient may bias the result by saying what he or she thinks the observer wants to hear or by not admitting to the real intensity of pain, particularly in front of family members or even the health care staff. Many patients feel that they can only request analgesia during the drug round or they don’t like to bother the nurses because they are always busy. Others think that if they complain of pain they would have to stay in hospital longer and if they keep still, their pain will resolve.
Carr  described barriers to patients reporting pain and those that affect how receptive the health care team are to what patients report verbally and what they display non verbally. Some of these barriers include worries about being unpopular, the assumption that they are in the hands of the professional who has authority, fear of injections and belief that the pain is not harmful and is to be expected. Patients’ self-report can also be influenced by current mood, the effect the medication has on the person reporting pain, and lack of sleep .
There are many misconceptions, held by both healthcare professionals and by patients, that affect pain assessment and management which also need to be considered.
Misconceptions about assessment of patients who indicate they have pain (adapted from McCaffery & Beebe ).
|The health care team is the authority on the existence and nature of the patient’s pain sensation||The person with pain is the only authority since only he or she can feel that pain|
|Our personal values and intuition about the trustworthiness of others constitutes a valuable tool in identifying whether a person is lying about pain||The patients credibility is not on trial and out values and intuition do not constitute a professional approach to the patient with pain|
|Pain is largely an emotional or psychological problem especially in patients who are highly anxious or depressed||The emotional and physical elements cannot be separated. Anxiety and depression can heighten the pain experience and so must be managed effectively|
|Lying about the existence of pain and malingering is common||Outright fabrication of pain and lying is considered very rare|
|The patient who obtains benefits or preferential treatment because of pain is receiving secondary gain and does not hurt as much as he/she says||We all can use secondary gain, it is part of the sick role and should not be misconstrued as malingering. It only may become problematic in a chronic pain setting|
|All real pain has an identifiable cause||All pain is real regardless of its cause and psychogenic pain is rare and is only able to be diagnosed by specialists e.g. psychiatrists|
|Visible signs, either physiological or behavioural, accompany pain and can be used to verify its existence and severity||Even with severe pain, periods of physiological and behavioural adaptation occur, leading to periods of minimal pain or not signs of pain. Lack of expression does not necessarily mean lack of pain|
|Comparable physical stimuli produce comparable pain in different people. The severity and duration of pain can be predicted accurately for everyone on the basis of the pain stimulus||Pain is a multidimensional phenomenon and is psychosocial factors are hugely important in pain perception and so it is not possible to predict pain as there is no invariant relationship between the physical stimuli and level of pain|
|People with pain should be taught to have a high tolerance for pain. The more prolonged the pain or the more experience a person has with pain, the better the tolerance for pain||Pain tolerance is the individual’s unique response, varying between patients and varying in the same patient from one situation to another. People with prolonged pain tend to have an increasingly low pain tolerance and if left unmanaged or badly manage could lead to chronic pain|
|Patients who clock watch and demand analgesia are addicted||Patients who clock watch and demand their regular analgesia are in pain or are afraid that previous severe pain will return. Poor assessment and management on our part lead to this scenario. Addiction is also extremely rare in patients who have acute pain.|
Now complete original survey again.
Consider the following:
- Have your views changed at all?
- What prompted this change?
- How can this new knowledge be integrated into your clinical practice?
- McCaffrey, M., Ferrell, B.R., 1997. Nurses’ knowledge of pain assessment and management: How much progress have we made?. Journal of
- Pain and Symptom Management, Journal of Pain and Symptom Management 14, 175 – 188.
- Carr, E., 2007. Barriers to effective pain management.. J Perioper Pract, J Perioper Pract 17, 200-3, 206-8.
- Rowbotham, D.J., Macintyre, P.E., 2003. Clinical pain management : acute pain. Arnold, London.
- McCaffery, M., Beebe, A., Latham, J., 1994. Pain : clinical manual for nursing practice. Mosby, London.