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Call for better pain management assessment by nurses

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Nurses need to do more to assess the effectiveness of pain relief when working with older patients, according to those involved in a new campaign launched today by the British Pain Society.

More than half of older people in the UK are living with persistent pain according to the BPS, an organisation made up of nurses, patients, physiotherapists and other healthcare professionals.

“These problems become more frequent with advancing years, and are often associated with difficulty in conveying the intensity of the pain”

Dr Andrew Baranowski

Launching its “Pain:Less” campaign”, the organisation said it hoped to raise awareness of unnecessary and unmanaged pain, particularly among older people who may find it difficult to explain what they are experiencing.

“These problems become more frequent with advancing years, and are often associated with difficulty in conveying the intensity and quality of the pain,” said Dr Andrew Baranowski, president of the BPS.

For clinicians, one of the major hurdles in tackling unnecessary pain for all patients is a lack of evaluation of what works, according to Felicia Cox, who is chair of the Royal College of Nursing’s pain and palliative care forum and is advising the new BPS campaign.

“The problem we have is that no one assesses the effectiveness of the intervention,” said Ms Cox.

“With older people, that can be compounded by difficulty communicating, meaning that they are left in pain for longer,” she said.

“Persistent pain impacts upon quality of life and is associated with sleep disruption, appetite disturbance, cognitive impairment and limits on daily activities,” she added.

“The problem we have is that no one assesses the effectiveness of the intervention”

Felicia Cox

Ms Cox told Nursing Times she believed poor pain assessment by nurses was caused by gaps in education.

Nurses need to have assessment and management “embedded” in their learning, she said.

She is leading a three-year study to look at the issue and find out how to ensure pain assessment is taught within undergraduate and post graduate curricula.

In addition, communication difficulties among older people meant that nurses should think carefully about the language they use, according to Ms Cox: “So we’d probably ask ‘are you sore’ not are you in pain?”

It is also important for nurses to use a comprehensive checklist of questions when assessing the level of intensity, she said.

This should be followed up by a reassessment after the pain intervention to find out if it worked.

The BPS’s campaign is being led by pain medicine consultant Dr Paul Wilkinson and was launched to tie in with the United Nations’ older people’s day on 1 October.

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