Dignity factors - Pain managment
Ensuring that people living with pain have the right help and medication to reduce suffering and improve their quality of life.
I think what worries me the most about pain is how it takes over and becomes the centre of your life. It shouldn't really be like that
Janet Allcock - Kumar and Allcock, 2008
Pain management in practice
- Raise staff awareness that people may not report pain, that it can have a significant impact on dignity and well-being and that it can be identified and treated.
- Enquire about pain during assessment
- Ensure that night staff receive equivalent training on pain identification and treatment to those working during the day
- Use assessment guidance (PDF) to support professionals to assess for pain in people with communication problems.
Care Quality Commission - what the regulator says
The CQC is the independent regulator for health and social care services. They have set out Essential Standards of Quality and Safety (CQC, 2010) for all those registered to provide health and social care services. There are 28 outcomes relating to the different aspects of care provision.
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What CQC outcomes say about Choice and controlOpen
These are the outcomes that relate to choice and control:
Outcome 4: Care and welfare of people who use services - relates to the care and welfare of people who use services. With regard to care at the end of life it requires that people are involved in the assessment and planning for their end of life care and are able to make choices and decisions about their preferred options, particularly those relating to pain management.
See all outcomes in the Care Quality Commission Essential Standards of Quality and Safety (PDF file)
Pain management and dignity - key points from policy and research
- Pain can wrongly be viewed as an unavoidable aspect of old age (Kumar and Allcock, 2008).
- Older people are more likely to experience pain, less likely to complain about it and less likely to comply with medication (Schofield and Reid, 2006).
- Pain in people with cognitive impairment, including learning disabilities and dementia is under diagnosed and under treated (Dutton.R. 2009, Closs et al, 2004, McGuire et al, 2010).
- In a study into the care and treatment of people with dementia in hospital 51 per cent of carers were dissatisfied with pain recognition and 71 per cent of nursing staff wanted more training on being able to recognise pain in people with dementia (Alzheimer’s Society, 2009)
- Pain can exacerbate the behavioural and psychological symptoms of dementia (Alzheimer’s Society, 2009) and could result in challenging behaviour (Cunningham 2006).
- Use of bank and agency staff can reduce pain recognition (Kerr et al, 2006) because regular staff would know the person and therefore be more likely to identify pain related behavior.
- Pain can cause people to wake at night; restlessness should trigger concerns about whether the person is suffering pain (Kerr et al, 2006)
- Pain can cause people to avoid activities and can increase social isolation as a result (Kumar and Allcock, 2008)
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Pain management and dignity - policy and research in more detailOpen
Badly managed or unacknowledged pain has emerged from consultation as one of the most powerful threats to older people’s dignity. In a Department of Health survey of almost 300 dignity champions, pain was rated fourth out of fifteen issues relating to dignity.
Pain management is defined as ‘any intervention designed to alleviate pain and or its impact, such that quality of life and ability to function are optimised’ (Essence of Care, pending publication)
A number of studies have looked at the issue of pain in older people and found that they are more likely to suffer pain due to physical conditions, eg arthritis, but that they are less likely to complain about it (Schofield and Reid, 2006). Pain can be wrongly viewed, even by older people themselves, as an inevitable part of old age (Kumar and Allcock, 2008), but if it is identified and managed it can hugely improve the quality of life of individuals.
It is important to acknowledge that people with dementia, learning difficulties or communication problems including language barriers may be unable to say when they are in pain. People who display challenging behavior may be experiencing pain but unable to communicate it in another way (Kerr et al, 2006). Use of bank and agency staff, as well as inadequate training for night staff (Kerr et al 2008), can reduce pain recognition simply because pain related behaviours either go unnoticed or are wrongly attributed to dementia.
Pain is often a particular issue for those nearing the end of life. At this time, the relationships between people and the care professionals that support them are very important, and good pain management is a vital component in ensuring dignity is promoted and protected. It is particularly important for people to remain in control so that they are able to prepare for death with their loved ones in a way that they choose. Careful consideration of pain relief that affects consciousness or cognitive ability is therefore essential.
