PAIN: CLINICAL MANUAL, 2ND EDITION

Margo McCaffery, RN, MS, FAAN; Chris Pasero, RN, MSNc


PREFACE

The science of pain is expanding rapidly and the care of patients with pain has become a specialty. At the same time, assessing and relieving pain is also the responsibility of all clinicians who care for patients with pain. The purpose of this manual is to provide current, scientifically based, practical information for nurses, physicians, pharmacists, and others who must manage pain in patients they encounter in their daily practice. Information is presented in a manner that can be readily applied to patients of all ages in all clinical settings. Through patient examples, practical guidelines, and reproducible forms, the manual teaches the reader how to use techniques and tools to provide the best possible pain management.

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:

• Terminology introducing each chapter to facilitate comprehension of content.
• Misconception tables that immediately identify and correct common misinformation.
• Pediatric icons that help the reader readily locate information pertinent to the care of children with pain.
• Guideline boxes that summarize recommendations at a glance.
• Reproducible materials that can be used in clinical practice.
• Patient examples that illustrate key points.
• Forms completed with patient information related to selected situations, illustrating how to use the forms.
• Numerous ready-to-use materials, such as patient medication information forms and instructions for nondrug pain management.
• Assessment forms and pain rating scales for all age groups that may be duplicated for use in clinical practice.
• Pain rating scales for children and adults in foreign languages that may be duplicated for use in clinical practice.
• Forms for numerous situations, such as monitoring IV, PCA, epidural analgesia, and pain care in the home.
• Forms and recommendations for pain care committees to use in improving pain management within the institution and to ensure ongoing continuous quality improvement, helping to meet JCAHO standards.
• Resources listed at the ends of most chapters so patients and clinicians can obtain additional information.
• Laminated equianalgesic charts to help with dose calculations when changing routes of administration or analgesics.

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
Consultant in the Nursing Care of Patients with Pain
8347 Kenyon Avenue
Los Angeles, California 90045
Phone: (310) 649-2219
Fax: (310) 649-0011

Chris Pasero, RN, MSNc
Pain Management Educator and Consultant
5045 Concord Road
Rocklin, California 95765
Phone: (916) 624-3928
Fax: (916) 624-4330