PURPOSE OF THIS EDUCATIONAL GUIDE

The purpose of this document is to assist the
licensed nurse in recognizing his/her
accountability in effectively managing
patients’ pain through assessment,
intervention and advocacy.
Pain management is only one aspect of the
complex process of providing palliative care.
It is beyond the scope of this document to
address other issues involved in palliative
care.

BACKGROUND
Pain management encompasses various types
of pain experiences throughout an individual’s
life cycle from birth to the end of life. Pain experiences
may include acute and chronic pain, pain
from a chronic deteriorating condition, or pain as
one of many symptoms of the patient receiving
palliative care. Pain is not exclusively physiologi -
cal but also includes spiritual, emotional and psychosocial
dimensions. The goal of pain management
throughout the life cycle is the same - to
address the dimensions of pain and to provide
maximum pain relief with minimal side effects.
Review of the literature, anecdotal reports and
dialogue with colleagues reveals that the majority
of patients do not receive adequate pain management.
A wide variety of factors including inaccurate
information, myths, rumors, fear and cultural
issues contribute to inadequate pain management.
For example, a prevailing rumor in the nursing
profession is that a nurse can lose his/her nursing
license for causing a patient’s respiratory depression
by frequent administration or by giving high
doses of opioids, even though there is no documented
evidence to substantiate this fear. The
literature shows that adequate assessment in
conjunction with opioid titration based on patient
response can provide maximum pain relief
without adversely affecting respiratory status.
Therefore, it is unwarranted to under-utilize or
withhold opioids from a patient who is
experiencing pain based on fear of causing
respiratory depression.
Due to multiple advances in the field of pain
management (i.e. pain assessment, pharmacological
and non-pharmacological interventions),
licensed nurses may have incomplete or inaccurate
information about the following variables
which contribute to ineffective pain management:
1. What is pain and how do patients
demonstrate their pain?
2. How is pain assessed and managed?
3. Is there a difference between
psychological dependence, addiction
and physical dependence?
4. Does aggressive use of opioids cause
addiction?
5. How does the patient’s cultural background
effect pain expression and
management?
Myths and misinformation also contribute
to ineffective pain management. Some common
myths include: