Educating Patients About Pain Management

About This Nursing Tool

Major deficiencies in the management of cancer-related pain are well documented and impact all dimensions of the patient's life, including physical, psychological, social, and spiritual well-being. These patient education materials on pain were created by researchers at City of Hope in Duarte, Calif, for a 5-year NCI-­funded study (R01 115323), Reducing Barriers to Pain & Fatigue Management. The Principal Investigator for the project is Betty Ferrell, PhD, FAAN. Tami Borneman, RN, MSN, CNS, is the Project Coordinator and Senior Research Nurse Specialist, and Virginia Sun, RN, MSN, NP, is also a Senior Research Nurse Specialist involved in patient education. The study is conducted in collaboration with Medical Oncology and an Internal Advisory Board including disciplines of Chaplaincy, Nutrition, Medical Oncology, Patient Education, Psychology, Social Work, Rehab, and Patient Care Services.

This information is provided to all patients accrued to the study, in a notebook along with educational tip sheets on Energy Conservation and Exercise, Strategies to Help Promote Sleep/Wake Patterns, Nutrition to Manage Fatigue, Preventing and Managing Constipation, and, Coping With Emotional and Social Impact of Pain and Fatigue. The NCCN Patient Guidelines on pain and fatigue are provided as well.

The content of the patient education sessions is derived from the NCCN patient guidelines. The teaching materials are presented in a question and answer format for ease of reading and facilitation of discussion. Each session lasts between 30 and 40 minutes; however, the time may vary depending upon the complexity of the patient's pain or fatigue. The patients are then followed up with phone call reinforcement every 2 weeks, primarily to maintain the patient's interest and participation in the study and to decrease attrition.

Following are teaching points for the Patient Pain Assessment and Management sessions.

Session 1: Pain Assessment

1. Is there a benefit to having pain or suffering with pain?

Continuing to be in pain affects all aspects of your life (appetite, function, emotions, mood, sleep, and other areas).

It is best to stop pain before it becomes severe and harder to control.

2. Do patients have a right to expect adequate pain treatment?

Yes, patients deserve the best pain relief possible.

3. Is it important to describe your pain so your physician can better understand and treat it?

Your health care providers will want you to describe your pain in order to treat it effectively-Is it sharp? Shooting? Dull? Constant? Burning? Aching?

Describing your pain will help in selecting the best medications and treatments for your specific pain.

4. Is it helpful to use a scale to measure your pain and communicate it to others?

Just as we use a thermometer to check your temperature and know your exact temperature, we use pain scales, such as a rating of 0 = no pain to 10 = worst pain, to best capture your pain experience.

5. Can doctors and nurses tell how much pain you have?

Pain is a very individual experience so it is important for you to help doctors and nurses know if you are in pain. Please be sure to describe your pain and rate it on the 0 = no pain to 10 = worst pain scale.

6. How much pain relief can be expected?

While not everyone will have a pain score of “0” all the time, it is important to seek the most relief of pain and side effects possible. Relieving your pain or side effects may not happen immediately. Sometimes several adjustments are needed to help you achieve the best relief possible.

7. Do you have any special questions about pain or pain assessment?

Following are teaching points for the Patient Pain Assessment and Management sessions.

Session 2: Pain Management

1. Can pain usually be well controlled with medications taken by mouth?

Yes, the vast majority of patients have pain relieved through taking medicines by mouth.

2. If these medications do not work, are many other options available?

There are many kinds of medications and many ways of giving these medications. If oral medications are not effective, there are other routes available.

3. When morphine and morphine-like medications are used to relieve pain, is addiction a problem?

The same pain medications used in cancer care, such as morphine or oxycodone, are rarely, but sometimes, abused. Addiction occurs rarely in people who are taking medications for pain.

4. If you take strong pain medications now, will they still work later?

Yes, pain medications can be taken over months and years and doses can be adjusted as needed.

5. Do patients often take less medication than is prescribed?

Patients often take less pain medication in order to reduce the side effects.

The best approach is to balance the best pain relief with the fewest side effects possible.

Patients may also take less medication than is prescribed for other reasons, such as lack of money to pay for them or other issues.

6. What kinds of medications are used for pain?

Treatment of pain may include a combination of non-opioids (such as Motrin or Tylenol), opioids (such as morphine, oxycodone, or hydrocodone), and other medications.

7. Do pain medications cause side effects?

The most common side effects of pain medication are constipation and sedation.

Side effects of medicines for pain must be aggressively treated. Tell your doctor or nurse before side effects become severe.

8. Are treatments other than medications also helpful for pain?

Many things can help your pain beyond just taking medications. Heat, cold, or exercise may help, or relaxation, imagery, and distraction may be of use.

9. Do you have any special questions about pain management?

10. Please tell your doctor or nurse if you are having any difficulty getting your medications or concerns about taking them. They have dealt with these issues before and will help you.