CPD reflective account patients self-manage treatment collaboratively with healthcare professionals so they are engaged and in charge of their care.


Chronic pain in adults A CPD article informed Rosalind Ponomarenko-Jones of the types of pain, assessment tools and treatments available I was unaware of the full range of treatments available for individuals experiencing chronic pain before reading this CPD article. Many patients on the gynaecology ward where I work are admitted because of chronic pain. This persists for more than three months, with individuals aged 50-60 reported to experience the most. A large percentage of older people are thought to experience unreported chronic pain, possibly because of an acceptance of it as a natural course of ageing and difficulties with communication as a result of visual, hearing and cognitive impairments. Individuals may experience fatigue as a result of sleep disturbance, feelings of helplessness, depression, loss of employment, relationship breakdown and social isolation. Two types of pain were discussed. Nociceptive pain is caused by physical damage to the body tissue, which stimulates pain receptors and impulses are transmitted to the brain. It is localised, with a sharp aching or

throbbing sensation. Neuropathic pain is the result of injury or disease in the peripheral or central nervous system, and may be experienced as the sensation of burning or likened to electric shocks, or numbness and sometimes allodynia. Some patients may experience a mixture of both. Pain assessment involves diagnosis; physical assessment; identification of underlying causes and comorbidities; evaluation of psychosocial factors, activity levels, current and previous medications and personal goals; development of targeted treatment plans and referral to a pain clinic if appropriate. It is important that

This reflective account is based on NS765 Barrie J, Loughlin D (2014) Managing chronic pain in adults. Nursing Standard. 29, 7, 50-58.

Based on the pain assessment, paracetamol, non-steroidal anti-inflammatory drugs or opioid analgesics may be offered under supervision. Topical analgesic preparations can be applied directly to the affected area. Anti-convulsant and tricyclic antidepressants can be effective in patients with neuropathic pain. Multidisciplinary support via the pain clinic focusing on physical and psychosocial needs may help. Psychological therapies include pain management programmes and therapy aimed at changing negative behaviours and thoughts. Physiotherapy and exercise are proven to improve quality of life and transcutaneous electrical nerve stimulation may be used to manage pain. Reflexology, aromatherapy and acupuncture can enhance wellbeing by aiding relaxation and reducing stress. Nerve blocks, implantable devices and injections of local anaesthetic and corticosteroids are considered for those with complex pain. I intend to read further on pain assessments and ascertain which may be most appropriate in my clinical area. I intend to apply this knowledge to the care I provide to patients NS Rosalind Ponomarenko-Jones is a staff nurse at the Princess Royal Hospital, Telford

Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 53 for this week’s article and on page 62 you can find out how to present and submit your reflective account.

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Chronic pain in adults.

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