Making connections to understand and manage pain

Are you in pain?
How’s your pain today?
On a scale of zero to ten, ten being the worst pain, how would you rate your pain?

These are all fairly common questions for those who work in healthcare and treat patients on a daily basis. For patients, being in pain or experiencing a high degree of pain is often a new – and very scary experience.

Pain can be described as “… an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”  It’s something that no one likes to experience, but that is a reality for many people. Some people live with chronic pain and others experience pain as a result of an injury, accident, surgery or illness.

No matter what the cause of the pain – it is fair to say that most people want to get rid of their pain in the easiest, fastest way.

Managing pain is particularly important in a health-care setting. In an effort to develop increased knowledge and skill in relation to pain assessment and management, an interprofessional team from Markham Stouffville Hospital, including Kim Adel, advanced practice nurse, acute pain service; Sonya Malcolm, physiotherapist; and Michele Mcdonald, occupational therapist, created a workshop to share pain concepts and pain management strategies. The goal of the workshop was to ensure patients receive the best possible care related to pain management. Over 30 health-care providers attended, including physiotherapists, occupational therapists, nurses, pharmacists, recreational therapists, social workers and members of the spiritual care team.

“I learned so much about assessing and treating pain,” says Sandi Lofgren, professional practice leader, Markham Stouffville Hospital. “It helped me to be more effective with patients who are in pain and also more knowledgeable for the nurses I interact with in my role.”

The workshop provided baseline information about pain from a physiological perspective and also addressed age-related, psychological, and pharmacological considerations. Cultural and ethical considerations were discussed as key factors in meeting pain assessment and management approaches. Participants learned that it is important to acknowledge that their own experience and attitudes have a huge impact on effective pain management and quality patient care. Self assessments of pain-related competencies were completed by the attendees prior to and at the end of the day-long workshop. Most indicated improvement in their self ratings following the education session.

The workshop, led by Adel, was designed to make people aware of the importance of managing pain and was based on the concept that as a group, everyone could learn from their colleagues and be aware of what each profession can offer to pain management.

“As clinical professionals, we tend to understand that pain is a common experience in illness,” says Adel. “We need to do a better job of including our patients in the conversation about their pain management and understanding how being in pain can greatly effect a person and their recovery, and to be comfortable and knowledgeable in responding to patients self reports of pain.”

The workshop blended knowledge-based presentations with practical hands-on learning. The day began with a story of an elderly patient arriving in the emergency room with an acute onset of pain that had been poorly controlled for the past two weeks and new onset delirium. Participants were encouraged to consider how they would assess this patient and identify treatment options.  This story was used to highlight the multifaceted impact of pain on an individual. Participants learned how to use a variety of pain assessment tools, as they considered hypothetical patient situations and used problem-based learning and case studies as approaches to learning.

“Following the workshop, it was very encouraging to see and hear participants more confidently addressing pain in their elderly patients, using the interprofessional team to provide a more encompassing approach to pain management,” says Adel.

Many of the attendees at the workshop were pain champions. The use of pain champions is part of Markham Stouffville Hospital’s ongoing commitment to using a best practice champion network to support the introduction and sustainability of best practice strategies for staff. The interprofessional pain champions at the hospital are prepared using a three-pronged approach that begins with developing a foundational understanding of what being a best practice champion involves, followed by targeted education on the specific topic of focus. After the initial introduction, the champions are engaged in ongoing support and education so that they can be the “go-to” resource at the point of care.

Pain champion education and ongoing support is led by Adel and Ann Marie Havery, who is also an advance practice nurse with the acute pain service. The pain champions are active participants in supporting pain-related initiatives such as the introduction of new policies, products and processes. Recently, Havery and the pain champions successfully rolled out education about a new assessment tool.

“I developed confidence and expertise in pain when I attended the workshop,” says Rebecca Robbins, registered practical nurse and pain champion. “It gave me an opportunity to share my passion for helping patients by managing their pain effectively. My teammates look to me as a resource when it comes to pain management.”