Directions:
Pain tolerance and perception is different in every individual. You will care for patients that have chronic pain issues and develop a high tolerance for pain medications. The patient rates his pain as a 8-9/10 but does not look like they are in pain!! How can you accurately assess these type of patients and what do you do if they ask for more pain medication? High Tolerance Due To Chronic Pain
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When assessing patients with high pain tolerance due to chronic pain, it is important to consider that pain perception can vary greatly among individuals. Here are some strategies to accurately assess these patients:
Thorough medical history: Gather detailed information about the patient’s chronic pain condition, previous treatments, and their response to pain medications. Understanding their pain management journey can provide valuable insights into their pain tolerance.
Patient self-reporting: Encourage the patient to describe their pain using various pain assessment scales, such as the numerical rating scale (0-10) or visual analog scale. Although their outward appearance may not reflect the severity of their pain, their self-reporting can provide valuable subjective information.
Observational cues: Although the patient may not appear to be in pain, observe for any subtle signs of discomfort, such as facial grimacing, changes in body posture, guarding certain body parts, or changes in vital signs (e.g., increased heart rate or blood pressure). These cues can help corroborate their self-reporting.
Nonverbal communication: Pay attention to nonverbal cues, such as sighs, groans, or other expressions that may indicate underlying pain. Some patients may have learned to suppress their pain outwardly due to various reasons, including fear of judgment or stigma.
Multidisciplinary approach: Collaborate with a multidisciplinary team that includes pain specialists, psychologists, and physical therapists. They can provide additional assessments and insights into the patient’s pain experience, contributing to a more comprehensive understanding.
When a patient with a high pain tolerance requests additional pain medication, it is essential to approach their request with empathy and caution. Here are some considerations:
Re-evaluate pain levels: Assess the patient’s pain using the techniques mentioned earlier. Understand the context of their request by asking open-ended questions about their pain experience and its impact on their daily life.
Review the treatment plan: Evaluate the current pain management regimen, including the type, dosage, and frequency of pain medications. Ensure that the current treatment aligns with the patient’s needs and is optimized for their specific condition.
Consult the pain management team: Discuss the patient’s request with the pain management team, including the prescribing physician or pain specialist. Collaboratively determine if adjusting the medication regimen is appropriate and safe.
Consider non-pharmacological approaches: Explore complementary therapies, such as physical therapy, occupational therapy, acupuncture, or relaxation techniques. These interventions can complement medication and provide additional pain relief.
Monitor for medication misuse: Be vigilant for signs of medication misuse, such as frequent requests for early refills, escalating doses, or inappropriate use of pain medications. If there are concerns about misuse, consult with the pain management team to develop an appropriate plan.
It is crucial to strike a balance between providing adequate pain relief and ensuring patient safety, taking into account their individual needs, medical history, and the recommendations of the pain management team. Regular reassessment and open communication with the patient are key components of managing chronic pain effectively.
