Creating a Pain Management Program

People often suffer from worries about undertreating their pain in various medical settings.  Doctors have the ethical responsibility to treat their patients’ pain and suffering to the degree that it can be managed.  There is an increasing need for pain management programs to help people with varying degrees and quality of pain.

There are four key components to creating a successful pain management program.  They include:
  1. An institutional commitment to relieving pain
  2. An interdisciplinary team to handle all aspects of pain
  3. Education of patients and staff around pain management
  4. Continuous quality improvement of pain management
The first step is to identify those institutional leaders in the system who can set the commitment level of the entire program.  These will help identify a philosophy around pain management.  A task force of interested people should be developed to help create a proper pain management program.

The program needs a mission statement that reflects its opinion and goals regarding the management of pain. Ideally, a mission statement can help define the goals of maximally treating pain to the patient’s benefit.

Standards of pain must be established, which include the various plans of care, such as:
  • Recognizing that all patients have the right to appropriate assessment and management of pain.
  • Finding out the nature and intensity of a patient’s pain
  • Recording the results of pain interventions over time
  • Determining and assuring that all staff members are on board with pain relief and prevention
  • Assuring that staff members are competent in understanding and treating pain
  • Teaching new staff members how to deal with pain
  • Having established policies and procedures in place when it comes to dealing with pain
  • Making sure that pain doesn’t interfere with rehabilitation of patients
  • Educating patients and family regarding pain care and management
  • Collect data regarding the effectiveness of pain management in all cases
  • Address patient’s needs for homecare management of pain after discharge from a facility
Pain is multidimensional and so needs a multi-disciplinary team to manage it.  Successful pain management addresses the psychological, physiological, spiritual, cultural and social needs of the patient when dealing with pain.

A multi-disciplinary team has several functions, including:
  • Assisting the organization when it comes to developing policies and procedures around pain management so that all types of pain can be managed.
  • Serving patients by recognizing and integrating all the different dimensions of pain.
  • Providing support to families dealing with a family member who is suffering from chronic pain.
  • Addressing community needs when it comes to education around pain management, drug addiction, communication with health professionals, and holistic approaches to managing pain.
A good pain management team includes professionals that meet together to discuss pain issues and includes social worker, pastoral care professionals, physical therapists, occupational therapists, dieticians, pharmacists, nurses, physicians and educators.   The role of the team includes the following:
  • Identify needs of patients, families and staff when it comes to pain management
  • Collaborating with providers to maximally treat pain
  • To assure that pain relief goals are met
  • To promote  changes as defined by continuous quality improvement and monitoring.
Team members each have a role in dealing with a patient’s pain, which include assessing the needs of the patient in all modalities, using standardized tools to define pain, summarizing findings for the physician, reviewing the treatment plan, including both pharmacological and non-pharmacological management of pain, communicating the plan of care to others, visiting the patient to assess progress, assessing for ongoing pain-relieving needs, and measuring outcomes of pain-relieving practices.

Developing an Educational/Action Plan

To address an educational/action plan around an individual’s pain, the following core areas need to be addressed:
  • The physiology of pain
  • The assessment of pain
  • The various rating scales of pain
  • The types of analgesics used
  • Management of symptoms
  • Issues related to spirituality and psychosocial needs
  • Pain management in elderly persons
  • Barriers to pain management
  • Ethics of pain management
  • Non-pharmacological interventions
Ways of assuring that the organization fully understands the impact of pain on the individual can be undertaken, including having a special week designed around understanding pain management, having poster presentations on pain management, or having a portable educational cart that helps teach patients and staff about pain management.  A bulletin board can be used to address pain management issues so that the team is always reminded of the ways in which pain can be managed.

The team must always practice continuous quality improvement so that changes can continually be made that addresses patient needs when it comes to pain management.  This means that there should be ongoing data gathering to make sure that pain is constantly being handled.
 
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