Show Allow patient to maintain a diary of pain ratings, timing, precipitating events, medications, treatments, and what works best to relieve pain. Systematic tracking of pain appears to be an important factor in improving pain management. Recognize and convey acceptance of the patient’s pain experience. Conveying acceptance of the patient’s pain promotes a more cooperative nurse-patient relationship. Aid the patient in making decisions about choosing a particular pain management strategy. The nurse can increase the patient’s willingness to adopt new interventions to promote pain relief through guidance and support. The patient may begin to feel confident regarding the effectiveness of these interventions. Explore the need for medications from the three classes of analgesics: opioids (narcotics), non-opioids (acetaminophen, Cox-2 inhibitors, and nonsteroidal anti-inflammatory drugs [NSAIDs]), and adjuvant medications. Analgesic combinations may enhance pain relief If the patient is receiving parenteral analgesia, use an equianalgesic chart to convert to an oral or another noninvasive route as smoothly as possible. The least invasive route of administration capable of providing adequate pain control is recommended. The oral route is the most preferred because it is the most convenient and cost effective. Avoid the intramuscular (IM) route because of unreliable absorption, pain, and inconvenience. Allow the patient to describe appetite, bowel elimination, and ability to rest and sleep. Administer medications and treatments to improve these functions. Always obtain a prescription for a peristaltic stimulant to prevent opioid-induced constipation. Because there is great individual variation in the development of opioid-induced side effects, they should be monitored and, if their development is inevitable (e.g., constipation), prophylactically treated. Opioids cause constipation by decreasing bowel peristalsis. Obtain prescriptions to increase or decrease analgesic doses when indicated. Base prescriptions on the patient’s report of pain severity and the comfort/function goal and response to previous dose in terms of relief, side effects, and ability to perform the daily activities and the prescribed therapeutic regimen. Opioid doses should be adjusted individually to achieve pain relief with an acceptable level of adverse effects. If opioid dose is increased, monitor sedation and respiratory status for a brief time. Patients receiving long-term opioid therapy generally develop tolerance to the respiratory depressant effects of these agents. Educate patient of pain management approach that has been ordered, including therapies, medication administration, side effects, and complications. One of the most important steps toward improved control of pain is a better patient understanding of the nature of pain, its treatment, and the role patient needs to play in pain control. Discuss patient’s fears of undertreated pain, addiction, and overdose. Because of the various misconceptions concerning pain and its treatment, education about the ability to control pain effectively and correction of myths about the use of opioids should be included as part of the treatment plan. Review patient’s pain diary, flow sheet, and medication records to determine overall degree of pain relief, side effects, and analgesic requirements for an appropriate period (e.g., one week). Systematic tracking of pain appears to be an important factor in improving pain management. Maintain the patient’s use of nonpharmacological methods to control pain, such as distraction, imagery, relaxation, massage, and heat and cold application. Cognitive-behavioral strategies can restore patient’s sense of self-control, personal efficacy, and active participation in their own care. Implement nonpharmacological interventions when pain is relatively well controlled with pharmacological interventions. Nonpharmacological interventions should be used to reinforce, not replace, pharmacological interventions. Plan care activities around periods of greatest comfort whenever possible. Pain diminishes activity. Examine relevant resources for management of pain on a long-term basis (e.g., hospice, pain care center). Most patients with cancer or chronic nonmalignant pain are treated for pain in outpatient and home care settings. Plans should be made to secure ongoing assessment of the pain and the effectiveness of treatments in these settings. If patient has growing cancer pain, assist patient and family with managing issues related to death and dying. Support groups and pastoral counseling may improve the patient’s and family’s coping skills and give needed support. If patient has chronic nonmalignant pain, help patient and family in lessening effects of pain on interpersonal relationships and daily activities such as work and recreation. Pain lessens patient’s options to exercise control, diminishes psychological well-being, and makes them feel helpless and vulnerable. Therefore clinicians should support active patient involvement in effective and practical methods to manage pain. Validate the patient’s feelings and emotions regarding current health status. Validation lets the patient know the nurse has heard and understands what was said, and it promotes the nurse-client relationship. Refer the patient and family to community support groups and self-help groups for people coping with chronic pain. This is to reduce the burden of suffering associated with chronic pain and provides additional resources like patient’s support network. Refer the patient to a physical therapist for assessment and evaluation. This is helpful to promote muscle strength and joint mobility, and therapies to promote relaxation of tense muscles, the physical therapist can help the patient with exercises suitable for his/her condition. These interventions can influence the effectiveness of pain management. Provide the patient and family with adequate information about chronic pain and options available for pain management. Lack of knowledge about the characteristics of chronic pain and pain management strategies can add to the burden of pain in the patient’s life. Discuss to patient and family the advantages of using nonpharmacological pain management strategies:
What other neurological condition increases the risk for trigeminal neuralgia?Multiple sclerosis is also sometimes cited as a cause of TN due to deterioration of the myelin sheath. In many cases, no underlying cause of TN can be identified (idiopathic). The trigeminal nerve is one of the 12 pairs of nerves that arise from the underside of the brain.
What is the primary symptoms of trigeminal neuralgia?The main symptom of trigeminal neuralgia is sudden attacks of severe, sharp, shooting facial pain that last from a few seconds to about 2 minutes. The pain is often described as excruciating, like an electric shock. The attacks can be so severe that you're unable to do anything while they're happening.
What are the underlying causes of trigeminal neuralgia?Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve. Some people may experience trigeminal neuralgia due to a brain lesion or other abnormalities. In other cases, surgical injuries, stroke or facial trauma may be responsible for trigeminal neuralgia.
Which cranial nerve is affected in patients with trigeminal neuralgia?Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head.
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The nurse would assess for trigeminal neuralgia in patients with which conditions
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