* Barriers to Effective Pain Management-


*Both patients and providers establish barriers-

*Provider Barriers--

Health care professionals often fail to routinely assess and document pain.


Due to inadequate training, health care professionals often lack knowledge and skills to assess and manage pain effectively.


There is a lack of practical, effective treatment protocols.


Health care professionals lack sufficient knowledge to employ safe equianalgesic principles.


Health care professionals may have exaggerated concerns related to the side effects of opiods, especially about tolerance and addiction.


Health care professionals may undertreat pain because of belief in common misconceptions regarding pain:


Myth: A patients pain perception can accurately be correlated with vital sign changes and evidence of injury.


Myth: Patients in pain readily express their pain to health care providers.


Myth: Patients of certain cultural, ethnic, or socioeconomic backgrounds consistently underreport or over-report their pain.
Myth: Opioids are addictive and a treatment of last resort because of unmanageable side effects.


Myth: Patients experiencing chronic pain over-report pain because they are addicted to opioids.


Myth: Older patients, and cognitively impaired patients do not perceive pain as intensely as other patients.


Myth: If a patient is able to sleep, they must not be in very much pain.


Myth: The goal of chronic pain management is to keep the dose of medication as low as possible.Myth: Patients with a history of substance abuse who require IV opioids should never be allowed to control their own dose of medication (i.e. patient controlled analgesia).


Myth: There is no physiological basis for the moderating effects of emotions on pain perception.

Patient Barriers

Patients often share similar concerns and all too often seem willing to "tough it out" rather than complain about their pain. A patient may be reluctant to report pain because of a belief in these myths:


Myth: Severe or chronic pain cannot be effectively controlled.


Myth: Opioids are always addictive and a treatment of last resort ( "I must really be dying.").


Myth: Pain is always evidence of disease progression. Myth: It is more admirable or socially acceptable to ignore pain.


Myth: Pain is an unavoidable result of aging or disease.

Myth: Pain is a deserved punishment.

*Basic Concepts Of Pain Management-



The patient is the authority on his own pain.


It is very important to know and recognize the patients physiological, psychological, and emotional responses to pain when developing a pain management plan. Without addressing these important issues, it is often difficult to develop an adequate pain treatment plan.


Changes in vital signs do not occur with all patients who are experiencing severe pain. Do not rely on vital signs to determine the severity of a patients pain.


Patients with pain, even severe pain, can be distracted from thinking about their pain, and may even be able to sleep. Dont trust that a patient isnt having pain because he "looks comfortable." Always ask, and believe the patients assessment of his own pain.



The patient has the right to expect a rapid and effective response to a complaint of pain.

Treat the pain, reassess frequently, and continue to treat until the patient is comfortable or side effects prevent further treatment. If this occurs, consult a pain expert- dont leave a patient in pain without a treatment plan.

A history and physical examination of the pain is very helpful. Details of the pains location, duration, radiation, and character often provide valuable clues about how to treat the pain most effectively.


Medications are best given orally for long-term management of pain. For short-term management, like postoperative pain, the IV route is preferred (especially with severe pain).


Most pain medications have side effects. Effective pain relief is often accompanied by at least some of these side effects. Be prepared to treat the side effects of opioids if they occur (e.g., nausea or itching).


A balanced approach to pain management combines nonpharmacologic and pharmacologic therapy, and frequently utilizes multiple analgesics which work by different mechanisms.


Chronic pain patients are usually on a specific regimen of pharmacologic and nonpharmacologic therapy. This regimen must be continued during their hospitalization. Superimposed acute pain (e.g. acute postoperative pain) should be treated with additional opioids.


-Courtesy of the University of Michigan Health System- Adult Pain Management.