Patients and their families may have difficulty in understanding and remembering the details of the plan for managing pain. Therefore, patients should be given a written pain management plan (Figure 5, see page 74). Pertinent instructions related to the management of pain include the specific drugs to be taken; the type and purpose of pain medication (e.g., opioid, tricyclic antidepressant, anxiolytic); the frequency of drug administration, with an emphasis in most cases on taking the medication around the clock rather than as needed; potential side effects of each pain medication (particularly constipation for opioids) and a plan for their prevention or treatment; potential drug interactions; specific precautions to follow when taking a pain medication, such as physical activity limitations and dietary restrictions; and whom to notify about pain problems or concerns about the medication.
The plan should be reviewed with the patient, and the patient and/or caregiver should be given an opportunity to discuss fears or concerns about the use of opioid analgesics; to clarify issues related to tolerance, dependence, and addiction; to voice concerns about side effects; and to discuss when it is appropriate to communicate with a clinician regarding the need for a change in the plan.
Discharge planners should advise patients and clinicians to communicate the plan to other clinicians when the patient is being transferred from one health care setting to another, such as being discharged from an acute care facility to a hospice, in order to maintain continuity in pain management. Attachment B contains examples of forms that patients can use at home to document their pain.
Barriers to Effective Pain Management
ASSESSMENT OF PAIN IN THE PATIENT WITH CANCER
Patient education program content
Sources of information for patients and their families
How to find local support groups
MONITORING THE QUALITY OF PAIN MANAGEMENT