PAIN: CLINICAL MANUAL, 2ND EDITION
This revised edition of the manual includes both new and expanded content. Chapter 1 gives an update on current problems and progress in the field of pain management, emphasizing that much remains to be done to improve the care of patients with pain. Chapter 2 presents basic pain mechanisms that underlie the causes and effects of pain, pointing out the danger of assuming that pain has no harmful consequences. Chapter 3 covers a variety of practical assessment tools that are immediately useful in clinical practice, including some tools that are translated into foreign languages. Chapters 4 through 7 are devoted to pharmacology, covering the three analgesic groups (nonopioids, opioids, and adjuvants) and how to combine them. Chapter 9 covers practical nondrug approaches to pain management, including distraction techniques, relaxation strategies, and methods of cutaneous stimulation. Chapters 11 and 15, respectively, provide updates on the care of patients with chronic nonmalignant pain and management of pain in the elderly.
New additions to this manual include Chapter 8 on procedural pain, Chapter 10 on care of patients with both pain and substance abuse problems, Chapter 12 with brief descriptions of selected pain problems, Chapter 13 on the use of analgesics during pregnancy, childbirth, the postpartum period, and breast feeding, and Chapter 14 on special considerations in the management of pain in infants. The manual concludes with Chapter 16 which provides the information and tools needed to establish a multidisciplinary approach to building and maintaining institutional commitment to improving pain management.
Features of the text include:
As with all publications, authors make certain assumptions that guide selection and presentation of content. One of our assumptions is that the care of patients with pain is best accomplished by a team approach. Therefore this manual presents information that is useful to most disciplines represented on the team. Content also aims to establish basic elements of collaborative practice. These include a common knowledge base shared by the patient, family members when appropriate, and all clinicians caring for the patient. Patient information forms and other patient teaching materials are included for this reason. A common language is necessary, and the use of pain rating scales by the patient and clinicians and adoption of standardized documentation forms are emphasized to facilitate communication. Common goals are essential to collaborative practice, and toward this end establishing comfort/function goals with patients is incorporated into assessment tools and patient teaching forms.
While the care of patients with pain ideally is a team approach, another one of our assumptions is that, in most cases, nursing care is the cornerstone. The nurse spends more time caring for people with pain than any other health team member. The nurse's role in this care most often includes implementing pain relief methods with and for the patient, identifying the need for change or the use of additional methods, obtaining them, and once again assessing the impact on the patient. The nurse is in a key position to tailor the application of pain relief approaches to meet the needs of the individual patient, regardless of where the approaches originate (e.g., with a physician's prescription for an analgesic or with the patient's desire for self-management techniques such as relaxation). We are convinced that it is through the efforts of the nurse that most patients with pain will receive assistance.
Both of us frequently speak on the topic of pain and have extended to our audiences an open invitation to write, fax, or telephone us regarding their views on patients with pain. We have learned much from this approach and invite our readers to contact us for assistance or to make comments and suggestions to us personally (no e-mail, please).
Margo McCaffery, RN, MS, FAAN