Acute and Chronic Pain: Best Management Approaches in Resource Limited Setting, Cameroon ()
1. Introduction
Pain is a very collective phenomenon observed in medical care environment [1], contributing enormously to morbidity, mortality, disability and a lot of burden in the healthcare system [2] [3]. Pain is often categorized as acute or chronic (See Table 1) where acute has been defined as “the physiologic response and
experience to noxious stimuli that can become pathologic, is normally sudden in onset, time limited, and motivates behaviors to avoid actual or potential tissue injuries.” [4] Chronic pain occurs as a result of inadequate management of the latter. As such, every member of the healthcare team must be committed to their role as they help patient’s relief pain. Resnick et al. [5], reported that undertreated or untreated pain can been linked to an individuals’ overall satisfaction with life. This review seeks to identify different types of approaches used to manage pain in patients within the healthcare setting.
2. Method
From the inception of each database, the study made use of electronic searches on MEDLINE®, Ovid® and PsycINFO in April 2021. To search the relevant articles in the above search engines we used keyword like “acute pain”, “chronic pain”, “pain management”, “approaches in pain management”, “pharmacologic pain management” and “nonpharmacologic pain management”. This paper made use of cohort studies, randomized control trials, and cross-sectional studies in its review.
3. Management
Generally acute pain is effectively managed by resting the affected part of the body [6] in combination with different approaches such as medication (Table 2) and non-pharmacologic methods (Tables 3-5). The management of chronic pain is as diverse as the causes. It ranges from over-the-counter to prescription therapy to mind/body techniques to acupuncture. As a matter of fact, no single technique can guarantee complete pain relief. Consequently, relief can be effectively achieved through a combination of a series of approaches outlined below (Tables 2-5).
3.1. Medication
Generally, pain is best managed following a multidisciplinary approach [7]
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Table 2. Medications used to manage and treat acute and chronic pain.
including the use of opioids and non-opioids medications [8] (see Table 2).
3.2. Restorative Therapies
Following a comprehensive assessment, restorative therapy can be highly effective in pain management especially if it is part of a multidisciplinary treatment plan [9].
3.3. Interventional Procedures
Interventional pain medicine uses minimal invasive procedures and minimizes the use of oral medication. Intervention therapy is offered as part of a comprehensive treatment program [10]. The different interventional therapies are as seen below (See Table 4).
3.4. Behavioral Health Approaches
In recent decades, experts have found a strong connection between psychological health and pain [11]. Psychological factors play an important role in a person’s response to pain [12]. It affects treatment adherence, disability status, pain chronicity [13]. It increases the risk for physical inactivity related to fear of fear of reinjury, maladaptive coping and psychological distress [14]. Table 5 highlights some of the behavioral health approaches that have been proven to be effective in alleviating pain.
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Table 3. Restorative therapies used to manage pain.
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Table 4. Interventional procedures used to manage pain.
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Table 5. Behavioral health approaches.
4. Discussion
Proper pain management and the way it is assessed remains an important aspect in the provision of quality care. During their stay in the hospital, patents experience pain resulting from different medical procedures, surgical interventions or as a result of the disease condition [15]. Different approaches are used to manage pain in the healthcare facility. They include the single use of pharmacological approach using opioids and NSAIDs or in combination with non-pharmacological approaches.
Pain is an important sensitive nursing indicator, consequently nurses play a central role on how pain is assessed and managed. Unfortunately, there is under-treatment of pain because of social stigma associated with pain, fear of becoming addicted to the use of some pain medications and knowledge deficit demonstrated by some clinicians in the management of pain. There is lack of complete evidence whether increasing knowledge and improving attitudes about pain can influence or improve pain relief.
Some studies reported healthcare professionals intentionally trained to manage pain known as Pain Resource Nurse (PRN) have actually improved quality of pain care [16]. Here, the nurse demonstrates leadership commitment, recognizes pain management barriers and identifying overcoming strategies, collaborative multidisciplinary teamwork and communication. So far literature on pain management is filled with inadequate knowledge and attitudes about pain and poor practices among healthcare providers, including nurses. Even though the American Society of Pain Management Nurses strongly recommend the use of opioids, ignorance about its use has pushed many who now relate it to addiction [17].
Assessing and managing pain are essential components of nursing practice. Physical therapy, psychotherapy, multidisciplinary rehabilitation in primary, specialized care settings and conservative medical treatment are very effective options for short term treatment of pain [18]. The most important factor to consider when choosing intervention for in pain management is selecting interventions that will provide adequate pain relief by improving quality of life, function, and facilitate recovery while minimizing prescription of opioids and their side effects.
In general literature, pain is principally understood as biological phenomenon. As a result, most studies focus more on clinical or medical approach to pain management. Just like the clinical approach, this study lays emphasis on the extent to which pharmacological and non-pharmacologic approaches are effective cultural competence in managing pain.
5. Conclusion
Pain is ubiquitous in pre-clinical and clinical settings and easily verbalized by adults. It is the nurse’s responsibility to provide the best management approaches during pain care for different patients. Healthcare providers should consider integrating international guidelines and employ the use of nonpharmacologic interventions as well as nonopioid-based multimodal analgesic regimens when managing patients are with pain. Factors such as astute pain assessment, involving families in decision making, understanding effective treatment and patient advocacy must be considered in order to prevent acute from becoming chronic.
6. Recommendations
From the above presentation, the following recommendations can be made:
· Considering the ubiquitous nature of pain in healthcare facilities, all healthcare professionals involved in patients should be offered specialized courses on how to manage pain.
· Healthcare professionals should make use of internationally recognized guidelines in practice.
Implication for Practice
Healthcare professionals (doctors, nurses and physiotherapist) play an essential role while caring for patients with acute pain. They help prevent its transition to chronic pain. Nurses have the duty to advocate for patients. They much collaborate with other members of the healthcare team to design and administer the most effective treatment and care that will restore physical, emotional, and social health, facilitate recovery and lead to the best possible outcomes for patients with pain. They must involve and respect both patients and their families as partners in decisions regarding care.