Acute Pain: Assessment and Treatment

Elsa Wuhrman, MS, FNP; Maureen F. Cooney, DNP, FNP

Disclosures

January 03, 2011

In This Article

Acute Pain Overview

In recent decades, technological advances have refined the clinical assessment and management of adult patients in the acute care setting. However, nurses must rely heavily on knowledge, interviewing techniques, and physical assessment skills to competently assess and manage patients with acute pain, because these skills have not been replaced by technology. Pain is a common reason for patients to seek healthcare and be admitted to hospitals. According to the National Center for Health Statistics, 46 million Americans undergo inpatient surgical procedures each year and experience acute surgical pain.[1] In 2006, pain was a frequent "chief complaint" for adults who presented to emergency departments (EDs), and pain severity was reported as moderate to severe by 45% of patients in the ED.[1]

Such organizations as the American Society for Pain Management Nursing (ASPMN), the American Pain Society (APS), the American Society of Anesthesiologists (ASA), and the American Society of PeriAnesthesia Nurses (ASPAN) have attempted to improve the quality of pain management in the United States through formulation and publication of pain-related position statements and clinical practice guidelines.[2,3,4,5] Accreditation agencies, such as the Joint Commission, have developed standards for the assessment and management of pain.[6] Despite recognition of the widespread prevalence of pain and increased efforts to promote effective pain management, numerous studies document that pain remains inconsistently and inadequately addressed.[7]

In a national telephone survey about postoperative pain, 59% of patients reported concern about experiencing postoperative pain and 80% of patients rated acute pain as moderate to severe in the first hours to days following surgery.[8]

"Pain" is defined by the International Association for the Study of Pain as "an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage"[9] Although this is a technical description of pain, it recognizes both the physiologic and affective nature of the pain experience. Pain is a highly personal, subjective experience which can only be accurately described by the individual who is experiencing pain. Recognition and acceptance of the subjectivity of pain are among the most challenging aspects of patient care; concepts that have evolved since 1968 when Margo McCaffery first defined pain as "whatever the person experiencing says it is, existing whenever he says it does."[10,11] This definition, which has endured for more than 40 years, has allowed healthcare providers to intervene and treat patients on the basis of the self-report of the pain experience. In recent years, definitions of pain have been further refined to include the fact that a person's inability to verbally communicate does not preclude the possibility that pain is present or negate the responsibility of healthcare providers to treat it.

Acute pain is "the normal, predicted physiologic response to an adverse chemical, thermal, or mechanical stimulus ... associated with surgery, trauma, or acute illness."[12] Acute pain results from activation of the pain receptors (nociceptors) at the site of tissue damage. This type of pain generally accompanies surgery, traumatic injury, tissue damage, and inflammatory processes. Acute pain plays the vital role of providing a warning signal that something is wrong and in need of further examination. Acute pain is typically self-limited and resolves over days to weeks, but it can persist for 3 months or longer as healing occurs. Acute pain can activate the sympathetic branch of the autonomic nervous system and produce such responses as hypertension, tachycardia, diaphoresis, shallow respiration, restlessness, facial grimacing, guarding behavior, pallor, and pupil dilation.[11] Although pain in response to tissue damage is a normal phenomenon, it may be associated with significant, unnecessary physical, psychological, and emotional distress.[8,13] Inadequate relief of acute pain can contribute to hypercoagulability and impaired immunity, leading to such complications as venous thromboembolic disease and infections.[14,15] Inadequately controlled acute pain can be a factor in the development of chronic pain,[12,13,15,16,17,18,19] extended hospital stay, readmission, and patient dissatisfaction.[8,20,21]

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