Updated: Sep 19
Patient satisfaction with pain management has always been a bit tricky. Doctors and nurses want to do a good job but treating pain to the point that it is non-existent is impossible, and attempts to do so are fraught with all sorts of difficulties and poor outcomes, including sedation, risk for addiction, falls, and death. This expectation in part has been responsible for the opioid dilemma. The difficulty lies in our ability to show we care for the patient while also understanding that pain management is not perfect and that experiencing some pain will be expected and normal.
Although this article (1) is nearly four years old, it emphasizes an important concept in pain management that is instrumental to improved experience whenever pain is present. In the HCAHPS survey sent to hospital patients throughout the US after hospital discharge, there has been a change in the question regarding patient satisfaction with pain management. Rather than focusing on the patient's interpretation of 'How often was your pain well-controlled?', the new question asks 'How often did hospital staff talk with you about how much pain you had?'.
Critics to this new approach often site that this sends a signal to providers that they should talk to their patients about their pain rather than actually treating their pain. Honestly, the action of talking about pain is an integral first step to the pain treatment in itself. But it doesn't end there. Of course, the expectation is that rather than just talking to patients about their pain, this improved dialogue would then allow the provider to better understand the pain experience and tools could be used to make changes towards improved pain management and subsequent functioning.
However, this is overly simplistic and we, as medical providers, need additional tools. We are not often taught how to 'talk to patients about their pain' in a meaningful way. Some of us do it quite well, others not at all. I would argue that patient's pain experience not being validated by a medical provider is the biggest set-up for poor patient satisfaction.
Stay tuned to this site for additional information on a practical tool to use at the bedside toward this goal. In the meantime, here are some of our recommendations to get the conversation started.
(Viewpoints below are those of PreEmpt Pain and have not been endorsed by the US Pain Foundation).
-review all pain scores over the past 24 hours; note if there is a pattern (worse at night, when up and ambulating, with a medical intervention?)
-ask the patient about their comfort goal (the level of pain above which the patient finds it difficult to rest for short periods, meet activity goals of physicians, meet with visitors, perform ADLs)
-ask if it is 'just pain' or if there are bothersome side effects contributing to their discomfort (nausea, vomiting, itching, caffeine-withdrawal headache, Foley catheter)
-ask if anything worries them about their pain (and then reassure them if this pain is expected)
-tell them you will do everything to balance their comfort and their safety (and then make a good plan)
-ask them if there is anything you should do different
-And stay tuned to this site for how you would respond to a patient if they ask you to
escalate treatment in a manner you were not expected to
Now your turn. How do you engage your patients to share their pain experience so you can provide best care?