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District Nursing Student gives common sense advice on pain management

We are grateful to Juliet Shaw, District Nursing Student (a trained nurse who is doing an additional course), who was inspired by a lecture on pain management and sent us her thoughts.

The information below may well seem obvious to many medical practitioners and carers but, at KISSING IT BETTER, we receive many e-mails that reveal that these simple, thoughtful reflections do not always happen as often as they should.

This is what she wrote...

'Pain Management is about REALLY listening, observing and spending that little bit of extra time picking up on the cues that our patients are giving us. They may not be telling us in words, it could be a grimaced facial expression, they may be restless, agitated or physically guarding the area of pain. They may just think that they have to put up with pain, and it is their lot! But it really shouldn't be this way. Why should anyone have to put up with pain? Whilst we may not always manage to make someone pain-free, the medical profession should be able to do something to relieve their suffering in some way.

So, I started thinking about the little things that might make a difference.

Medical staff should spend time assessing the pain, listening and giving the patient time to express their feelings. Recognising individual needs and working in partnership with the patient is the key to successful pain management.

Check with trained staff first but... a change of position, an extra pillow, or a more comfortable mattress or cushion could make a difference.

Complementary therapies such as massage, or reflexology could make a difference, but seek advice from medical staff first.

It may seem obvious but, always check that patients and their carers understand their medication, know what it is for and how long it takes to work, how to take it, how long they need to take it for and what the possible side effects are.

If the medication is not working, make sure it is reviewed.

Ensure patients realise the benefits of using some kind of pain relief prior to a procedure that may be painful.

Is the medication in a formulation that they can manage? Some patients just can't swallow tablets or hate the taste of some medicines. Sometimes, a change in prescription could make a big difference.

Sometimes patients just can't open the bottles. If that is the case, ask the pharmacist if it is possible to dispense the medication in a container that is not child resistant, but always tell them to store them out of the reach of children.

Some patients have poor eyesight, hearing or communication difficulties that make understanding the prescription and administration difficult. A new pair of glasses or a hearing aid could make the difference, or maybe a carer to help administer the medication.

Medication charts and medication boxes with the tablets organised into days of the week can make a big difference, if clearly explained, they may help people to take their medication regularly. Medical staff should be able to advise which of these devices are best suited to their needs. Some are much more sophisticated than others.

Sometimes patients worry about taking the full prescribed dose of pain killers. A nurse, doctor or pharmacist should find out why they are worried, and, if appropriate, they may need to reassure them that it will be more effective if they take their medication regularly.

Some patients don't want to take medication because they worry about side-effects. So, trained medical staff should spend time explaining about this. In some instances, it may be possible for the patient to be prescibed another medication that helps reduce some side-effects. Or, it may be possible to ask the doctor for an alternative prescription which may have fewer side-effects. Always check.

Sometimes patients don't want to take medication because of a past experience or something a friend or relative might have said. Medical staff should always take time to appreciate their anxieties, and help them work through it, so that they can come to a decision that they are happy with.

Trained medical staff should take time with the patient to determine how the effective the medication has been.

Medical staff, whenever possible should try and empower patients; work in partnership with them, establish their health beliefs and give them the information, but then allow them to make their own decisions where possible.

Always check the expiry date of medicines, store them as advised in the patient leaflet, and take anything that is out of date ir not being used to the chemist for disposal'.

All these common sense thoughts are the personal thoughts of Juliet Shaw, District Nursing Student.

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