Therapy Involvement with Pain Assessment

Pain is a debilitating side affect that many LTC patients battle during the recovery process.  The Rehab department team members can be a comrade with nursing to combat the signs and symptoms of pain. Upon evaluation of a patient, when therapy identifies pain as a problem, a plan of care should be designed to address this pain. Harmony includes the following guidelines regarding pain management that apply to therapy as well as to nursing.

The interdisciplinary team (nurses, therapists, pharmacists, etc.) is responsible for developing a pain management regimen that is specific to each patient who has pain or who has the potential for pain (such as during a treatment).

•  Recognize when the patient is experiencing pain and identify circumstances when pain can be anticipated. Patterning PRN utilization of pain medication may assist the facility in anticipating pain.

•  Evaluate the existing pain and the causes. Consider a detailed pain assessment that identifies causes and sets goals. Given the acute nature of the patient population, this may need to be repeated throughout the patients stay.

•  Manage or prevent pain, consistent with the comprehensive assessment and plan of care, current clinical standards of practice, and the patient's goals and preferences. Consider Non-pharmacologic interventions which could involve the skill of a therapist.

•  Re-assess pain and adjust the plan of care. The patient may be experiencing acute pain on admission due to an acute episode (fracture, surgery). As the patient's condition improves, there may be less reliance on pharmacologic interventions and the potential to reduce or eliminate the need for pharmacologic interventions.

Non-pharmacologic interventions may help manage pain effectively when used either independently or in conjunction with pharmacologic agents. Examples of non-pharmacologic approaches may include, but are not limited to:

• Altering the environment for comfort (such as adjusting room temperature, tightening and smoothing linens, using pressure redistributing mattress and positioning, comfortable seating, and assistive devices)

• Physical modalities, such as ice packs or cold compresses (to reduce swelling and lessen sensation), mild heat (to decrease joint stiffness and increase blood flow to an area), neutral body alignment and repositioning, baths, transcutaneous electrical nerve stimulation (TENS), massage, acupuncture/acupressure, chiropractic, or rehabilitation therapy.

•  Exercises to address stiffness and prevent contractures.

• Cognitive/Behavioral interventions (e.g., relaxation techniques, reminiscing, diversions, activities, music therapy, coping techniques and education about pain).

Note that it is critical that therapists document the presence of pain by describing the location of the pain complaint, the degree of pain, using an objective pain assessment tool, and the intervention taken. The intervention may be to notify nursing so that the appropriate pain medication can be administered. Nursing should then document as to the follow-up pain assessment. However, the therapist may address the pain using the appropriate pain control modality as identified in the therapy plan of care. In this case, the therapist needs to document a follow up pain assessment.

Pain may be difficult for the therapist to assess when a patient is cognitively impaired or if there is a language barrier. In addition to the traditional visual analogue scale in which patients are asked to rate their pain on a scale of 0 - 10, there are other pain assessment tools available that work with pictures and verbal descriptions.