An Overview of Pain Control for the Rehab Patient

Myth: “I don’t want to take narcotics because I will become addicted to them.”

Truth: While studies vary widely regarding the risk of addiction for people taking narcotics for short-term pain relief, it appears the risk is less than 8%–and may be as low as 1%.

Myth: “I have a high pain tolerance and don’t need that stuff.”

Truth: Some studies show delayed recovery and a longer time away from home when pain control is inadequate.

In fact, controlling pain is a critical part of recovery from illness or surgery.  Having pain saps energy and decreases motivation to fully take part in a program of therapy.  That’s why it is a focus for ARMS providers during your stay in rehab.  Likewise, Medicare has recognized how important pain management is by routinely reporting pain control scores on their Nursing Home Compare website.

Health care providers think of pain management in three groups—scheduled medications, as needed (“prn”) medications, and non-pharmacological approaches.

Scheduled Medications—For people having moderate-to-severe pain, dosing medications on a regular basis may provide the smoothest pain control.  With better symptom management, people not only feel better more of the time, but they may be less likely to experience periods of out-of-control pain.  As pain diminishes during the recovery period, the doses of the scheduled medications can be reduced.  In some cases, the amount of medication given at each administration time can be reduced. This approach is common when pain occurs throughout the day, but is still lessening overall. In other cases, such as when pain is more common with movement, the physician or nurse practitioner may reduce the medications by scheduling it only during waking hours, but keeping the dose the same.

As Needed “PRN” Medications—Occasional dosing of pain medications is used for people with mild or intermittent pain or those with more severe pain that require boosts over-and-above their scheduled medications. Medications give as needed are sometimes called “p-r-n” by nurses.  They are not given on a regular schedule but, instead are given when requested.  Sometimes, however, nurses might offer them because they realize a patient is experiencing pain, but has not requested a dose.

Woman and ChildNon-pharmacologic Approaches—Most of us recall from childhood the amazing pain-reducing powers our parents seemed to possess!  Comforting words, an ice pack or a back rub could do wonders for us back then.  The good news is that there are many ways to modify pain that can boost the effectiveness of pain medications or help reduce required doses.

Danville Regional Rehabilitation excels with pain management.  According to Medicare’s Nursing Home Compare website, only 9.5% of Danville Regional’s rehab patients report moderate-to-severe pain during their stays (versus the Indiana average of 16.1%).  In fact, Danville Regional also excels for pain management in long term residents with only 2.8% reporting moderate-to-severe pain versus an Indiana average of 7.1%.  So, I asked Leslie Anderson, the Executive Director, and Hillary Croy, the Director of Nursing Services, what they did to achieve such good performance.

They emphasize several things they do that help their patients and residents be as comfortable as possible.  They encourage all staff members to be responsive to people’s needs—to listen carefully and then take actions quickly.  For example, helping a person into a new position or grabbing a few extra pillows can make a big difference—without any side effects.  Second, they work to provide a calm, low stress environment for people experiencing discomfort.

They also empower staff members to utilize other non-pharmacological interventions, including:

  • Focused, deep breathing to promote relaxation
  • Use of aroma therapy or the addition of music to provide alternative mental focus
  • Involvement in activities as tolerated to encourage social interaction and a different environment from the resident’s room
  • Back rubs and focused massage
  • And, of course, encouraging work with therapy to speed recovery and prevent post-hospital complications

Finally, Ms. Anderson and Ms. Croy emphasize that patients themselves should feel free to communicate their needs.  In other words, help the nursing staff help you!

Ultimately, pain control and recovery go hand-in-hand.  The judicious use of medications can speed recovery with minimal risk of addition.  Non-pharmacological approaches are important to augment the pain relief all along the way.  ARMS encourages patients to vocalize their needs so that discomfort can be alleviated and suffering avoided.

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