The International Association for the Study of Pain (IASP) defines pain as an unhealthy sensory and emotional experience due to tissue damage that has either occurred or has the potential to occur or as described when the damage occurred. Acute pain is pain that lasts for less than 30 days.
Delayed treatment will prolong the suffering and may result in damage to non-treatable levels. Here are some complications of acute pain:
- Functional disturbance: Old citizens may need help in managing their daily activities. Many cannot move freely due to pain.
- Delirium: Especially common in the elderly, pain can cause mental disturbance. This is especially among those with cognitive problems.
- Increases the cost of treatment and the use of health services.
Untreated acute pain will eventually turn into chronic pain and cause psychological pain. Psychological pain leads to long-term suffering. Emotional changes are uncertain and a person becomes easily restless. Pain also interferes with healthy sleeping patterns. Some patients become marginalized, less sociable and eventually become depressed.
It is important for us to understand that the assessment process for the pain problems of senior citizens is not an easy process. At times, the cause of pain cannot be identified even after a careful assessment is due to the following:
- The cause of pain is rarely found by a doctor. Therefore, more time and investigations may be required before the cause of the pain is identified.
- More than one disease in a senior citizen can cause pain.
- Symptoms of atypical pain are caused by the lack of patient sensory potential, eg due to vision and hearing problems.
- There is a cultural barrier where patients and caregivers tend not to tell exactly the pain they are experiencing.
- Lack of cognitive abilities, such as dementia patient who cannot explain the condition of his/her pain well.
Careful assessment or strategy is important to enable the nurse to get a complete picture of the patient’s pain at the end of his assessment. This will help to control the pain and improve the quality of life. The strategies include:
1) Location of the pain. Whether it’s painful soft tissue, bones, nerves, internal organs and so on.
2) The severity of pain. Using a visual analog scale or facial expressions chart, the severity of pain can be illustrated and determined accurately. Possible causes of pain and ultimately, treatment options to reduce headache and pain can be ascertained.
3) Acute pain will stop when the injury is cured or when the cause can be treated. The success of treatment relies heavily on the success of curing the cause and the problems associated with it.
4) Patient And Guardian Health Education
- Patients and guardians should get appropriate health advice and education.
- Methods of changing behavior to reduce pain.
- Non-medicated treatments such as physiotherapy. Treatment of medicines suitable for the type and degree of pain. The doctor will consider the risks of side effects and the benefits of a drug before being given to control the pain.
Factors that determine the suitability of painkillers:
5) Take into account all the medical problems experienced.
6) Interactions with other drugs used to treat existing medical problems.
7) Compatibility of medicine and drug costs. Among the things to be aware of when your doctor is prescribing medication is as follows:
- Medicines follow the cause of pain. For example COX2 inhibitors for gout attacks, carbamazepine or gabapentin for nerve pain such as trigeminal neuralgia or pain after herpes infection.
- Medicines matched to the level of pain. Examples: painkillers are stronger for severe pain such as morphine injections for acute myocardial infarction.
- Frequency and type of painkillers: According to WHO advise, painkillers must be given by mouth regularly and periodically (by an hour) and use WHO ladder 3-step model guidelines as a guide in matching painkillers which corresponds to the patient’s level of pain. Other additional painkillers may be required. Examples of additional drugs are anti-depressants, anticonvulsants, local anesthetics, and steroids.
According to the WHO ladder 3-step model guidelines, the choice of painkillers according to the level of pain is as follows:
- Paracetamol medication (with or without supplementary medicine) for mild pain.
- Light opioid medication (with or without supplementary medicine) for moderate pain.
- Powerful opioid medications such as morphine (with or without supplementary medicine) for severe pain.