Pain is a common event in many scenarios involving healthcare, from birth to death, in the hospital or outside of it. The overall purpose of this work was to critically review articles on types of pain and options employed in managing pain. Some electronic sources like google scholar, Ovid MEDLINE, PsychINFO, Embase were used to source for information. The articles were reviewed according to the various themes of the topic. From the different sources pain is categorized as acute or chronic with physical, psychological and social characteristics. Effective management of pain utilizes both pharmacologic and non-pharmacologic therapy. Pharmacological therapy employs non-opioids medications. Prolonged or unnecessary use of opioids causes some harmful side effects to the patient. Non-pharmacologic therapy plays a significant role and should be included in the multidisciplinary treatment plan. Nurses are members of the healthcare team who spend most of their time with patients as such they must work in collaboration with other healthcare professionals to facilitate patient’s recovery from pain. Healthcare professionals should also make use of internationally recognized guidelines during practice.
Pain is a very collective phenomenon observed in medical care environment [
| Type of pain | Definition | Pathophysiology | What to handle |
|---|---|---|---|
| Acute pain | It is pain sudden in onset, may last less than 7days but often extends up to 30 days or 3 months | It is nociceptive pain that occurs during and after injury to the viscera, skin tissue or joints. The body respond by following the pain pathway; transduction, conduction, transmission, perception and modulation. | For better management it is important to assess the cause, pain intensity duration and what makes it worst. Medications can be used to reduce pain intensity while treating the underlying cause. |
| Chronic pain | It is pain that has lasted beyond the normal tissue healing time (about three months). | Increase in pain intensity may lead to an exaggerated prolonged reaction of the C-fibre nociceptors, causing the release of series of substances into the synaptic gap. This may trigger a cascade of events leading to a vicious cycle. | Treatment of this kind of pain may involve a mix physical medical, and psychological components. |
experience to noxious stimuli that can become pathologic, is normally sudden in onset, time limited, and motivates behaviors to avoid actual or potential tissue injuries.” [
From the inception of each database, the study made use of electronic searches on MEDLINE®, Ovid® and PsycINFO in April 2021. To search the relevant articles in the above search engines we used keyword like “acute pain”, “chronic pain”, “pain management”, “approaches in pain management”, “pharmacologic pain management” and “nonpharmacologic pain management”. This paper made use of cohort studies, randomized control trials, and cross-sectional studies in its review.
Generally acute pain is effectively managed by resting the affected part of the body [
Generally, pain is best managed following a multidisciplinary approach [
| Medication | Action | Used | Not Used |
|---|---|---|---|
| Codeine | It is a central nervous system (CNS) depressant. It changes the way the body or brain responds to pain. | Painkiller, cough suppressant and treats mild to severe pain. | Postoperative pain in children, paralytic Ileus, hypercapnia, acute or severe bronchial asthma and respiratory depression. |
| Hydrocodone | Specific CNS opioid receptors for endogenous compounds with opioid-like activity and play a role in the analgesic effects of this drug | Use in the management of severe pain that require the use of opioids. | Hypersensitivity to hydrocodone, acute or severe bronchial asthma, respiratory depression and suspected gastrointestinal obstruction |
| Hydromorphone | It is an agonist at the mu opioid peptide receptor/it has a weaker affinity at the kappa and delta opioid peptide receptors. | Same as above | Same as above |
| Oxycodone | A semisynthetic opioid with agonistic properties on the different opioid receptors. It has the strongest affinity for mu-type receptors. | Used for all types of pain especially in cases where other medications showed failure | Same as above |
| Methadone | It is a synthetic opioid, it induces other opioid receptors. Methadone activates the μ-receptors in the same pathway as the above mentioned opioids. | Manages pain that is non-responsive to non-narcotic drugs. Treatment of neonatal abstinence syndrome | CNS-related pathologies such as trauma, delirium, etc. Not to be used in conjunction with medications or substances with similar depressant effects |
| Morphine | It binds to the mu-opioid receptor in the CNS and the PNS to reduce nociceptive transmission. | Moderate to severe pain that may be acute or chronic especially in the management of palliative care, in active cancer treatment, and vaso-occlusive pain during sickle cell crisis. | It should be avoided in severe respiratory depression, asthma exacerbation cases and in cases of previous hypersensitivity reaction and immediately discontinued in the presence of an active reaction. |
| Acetaminophen | It acts as an inhibitor for the cyclooxygenase (COX) pathways. | It is an antipyretic and a non-opioid analgesic agent. | Hypersensitivity to acetaminophen and severe hepatic impairment. |
| Non-steroidal anti-inflammatory drugs (NSAIDs) | Inhibition cyclooxygenase thus leading to lack of eicosanoids such as prostaglandins which has an anti-nociception activity. | Used to treat pain, fever, and other inflammatory processes. | Hypersensitivity to NSAIDs, patients who have undergone coronary artery bypass graft and third trimester pregnancy |
| Antidepressants | They increase neurotransmitters serotonin or norepinephrine or both in the synapse. | Depression, pain, insomnia and migraine | Hypersensitivity to antidepressants, cardiovascular disease |
| Tricyclic antidepressants | Work by inhibiting the reuptake of serotonin and norepinephrine. | Same as above | Patients with orthostatic hypotension, bundle-branch disease |
| Musculoskeletal agents | There are two types; antispasmodics and antispasticity. The latter works directly on the skeletal muscle and on the spinal cord. Antispasmodics alters conduction in the CNS hence decrease muscle spasms. | They are used as muscle relaxants and musculoskeletal spasmodic pain. | Severe hepatic and renal dysfunction and patients who have hypersensitivity to these agents. |
| Topical analgesics | Its mode of actions is the same as described above, but are applied transdermally. | Management of moderate to severe acute and chronic pain | Patients who have sympathetic systems blocks |
including the use of opioids and non-opioids medications [
Following a comprehensive assessment, restorative therapy can be highly effective in pain management especially if it is part of a multidisciplinary treatment plan [
Interventional pain medicine uses minimal invasive procedures and minimizes the use of oral medication. Intervention therapy is offered as part of a comprehensive treatment program [
In recent decades, experts have found a strong connection between psychological health and pain [
| Therapy | Rationale | Action | Expected outcomes |
|---|---|---|---|
| Therapeutic exercises | Bodily movements prescribed to help restore impairment, maintain wellbeing and improve functioning of the musculoskeletal system. | Passive movements and active exercises | Improved ambulation, reduce risk, optimize overall health and improve fitness and wellbeing |
| Massage therapy | Inhibits the transmission of noxious stimuli wherein large nerve fibers are stimulated to alter pain perception. | Swedish, shiatsu and deep tissue message. | Lowers blood pressure, decrease oxygen consumption and muscle tension. |
| Cold therapy | Cold substances are applied to decrease temperature on the contact area and adjacent tissues. | Uses bags of crushed ice, ice massage and cold compress units etc. | Pain relief. |
| Heat therapy | It activates TPRVI receptors as which modulate the antinociceptive descending pathway, Resulting to increase blood flow, metabolism, and connective tissue elasticity. | Uses heat pads, hot towels, soft heated packs etc for massage and compression. | Pain relief. |
| Heat therapy | It activates TPRVI receptors as which modulate the antinociceptive descending pathway, Resulting to increase blood flow, metabolism, and connective tissue elasticity. | Uses heat pads, hot towels, soft heated packs etc for massage and compression. | Pain relief. |
| Bracing | It uses sticks and other material to uses sticks and other materials to immobilize part of a body. These objects limits motion, corrects deformation like scoliosis or improve functions in certain parts of the body. | Use of lumbar brace, knee braces | Reduces swelling, stiffness and pain. |
| Intervention Procedure | Rationale | Expected Outcome |
|---|---|---|
| Epidural Steroid Injection | They function as mechanical and biochemical mediator in pain relief by inhibiting the release of inflammatory mediators. | Reduced inflammation, thereby reducing pain. |
| Facet Joint Nerve Block and denervation injection | It is a common fluoroscopy-guided procedure for facet-related spinal pain of the neck or low back. | Long term effect in relieving pain |
| Cryoneuroablation | Interventional technique that uses a cryoprobe. It freezes sensory nerves at the directly on the source of pain. | Long term effect in relieving pain. |
| Radiofrequency ablation | Blocks the transmission of pain signals by ablating certain nerves that contribute to chronic pain syndrome. | Decrease pain intensity. |
| Peripheral Nerve Injection | Contains a mixture of local anesthetic agents and anti-inflammatory steroid medication. Effectively blocks the transmission of pain signals around peripheral nerves | Decrease pain intensity |
| Approach | Rationale | Expected Outcome |
|---|---|---|
| Behavioral Therapy | Uses the principles of operant conditioning in identifying and reducing maladaptive pain behaviors while increasing adaptive or “well” behaviors. | It reduces pain behavior and increases function. |
| Cognitive Behavioral Therapy | It uses psychoeducation to relate pain with other psychological factors like training in a variety of pain coping strategies, pleasant activity scheduling and activity pacing. | It improves over all functioning and reduces maladaptive behavior. |
| Mindfulness-based Stress Reduction | Mind-body treatment delivered to a group it uses meditation to teach individuals how to self-regulate their pain. | It reduces pain intensity; fatigue improves physical functioning and wellbeing. |
Proper pain management and the way it is assessed remains an important aspect in the provision of quality care. During their stay in the hospital, patents experience pain resulting from different medical procedures, surgical interventions or as a result of the disease condition [
Pain is an important sensitive nursing indicator, consequently nurses play a central role on how pain is assessed and managed. Unfortunately, there is under-treatment of pain because of social stigma associated with pain, fear of becoming addicted to the use of some pain medications and knowledge deficit demonstrated by some clinicians in the management of pain. There is lack of complete evidence whether increasing knowledge and improving attitudes about pain can influence or improve pain relief.
Some studies reported healthcare professionals intentionally trained to manage pain known as Pain Resource Nurse (PRN) have actually improved quality of pain care [
Assessing and managing pain are essential components of nursing practice. Physical therapy, psychotherapy, multidisciplinary rehabilitation in primary, specialized care settings and conservative medical treatment are very effective options for short term treatment of pain [
In general literature, pain is principally understood as biological phenomenon. As a result, most studies focus more on clinical or medical approach to pain management. Just like the clinical approach, this study lays emphasis on the extent to which pharmacological and non-pharmacologic approaches are effective cultural competence in managing pain.
Pain is ubiquitous in pre-clinical and clinical settings and easily verbalized by adults. It is the nurse’s responsibility to provide the best management approaches during pain care for different patients. Healthcare providers should consider integrating international guidelines and employ the use of nonpharmacologic interventions as well as nonopioid-based multimodal analgesic regimens when managing patients are with pain. Factors such as astute pain assessment, involving families in decision making, understanding effective treatment and patient advocacy must be considered in order to prevent acute from becoming chronic.
From the above presentation, the following recommendations can be made:
· Considering the ubiquitous nature of pain in healthcare facilities, all healthcare professionals involved in patients should be offered specialized courses on how to manage pain.
· Healthcare professionals should make use of internationally recognized guidelines in practice.
Healthcare professionals (doctors, nurses and physiotherapist) play an essential role while caring for patients with acute pain. They help prevent its transition to chronic pain. Nurses have the duty to advocate for patients. They much collaborate with other members of the healthcare team to design and administer the most effective treatment and care that will restore physical, emotional, and social health, facilitate recovery and lead to the best possible outcomes for patients with pain. They must involve and respect both patients and their families as partners in decisions regarding care.
The authors declare no conflicts of interest regarding the publication of this paper.
Balgah, V.P. and Atanga, M.B.S. (2022) Acute and Chronic Pain: Best Management Approaches in Resource Limited Setting, Cameroon. Pain Studies and Treatment, 10, 1-8. https://doi.org/10.4236/pst.2022.101001