nursing.elitecme.com Page 109 Complete Your CE Test Online - Click Here Disclosures Resolution of Conflict of Interest In accordance with the ANCC Standards for Commercial Support for continuing education, Elite implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/Commercial Support and Non-Endorsement It is the policy of Elite not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners. Disclaimer The information provided in this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition. ©2018: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Elite Professional Education, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge of the areas covered. It is not meant to provide medical, legal, or professional advice. Elite Professional Education, LLC recommends that you consult a medical, legal, or professional services expert licensed in your state. Elite Professional Education, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation nor circumstances and assumes no liability from reliance on these materials. Quotes are collected from customer feedback surveys. The models are intended to be representative and not actual customers. Introduction Pain affects millions of people worldwide. It is among the top causes for primary care visits and emergency room visits (St. Sauver et al., 2013; Samcam & Papa, 2016). Pain is defined as an “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage” (International Association for the Study of Pain [IASP], n.d.) Pain can be acute (lasting less than three to six months) or chronic (persisting more than three months). It is a subjective and multidimensional experience with psychological influence and impacts (Institute of Medicine [IOM], 2011). Each individual’s perception of pain is unique and is influenced by biological factors (comorbidities, stress, genetic influence on pain tolerance), psychological factors (anxiety, fear, depression), and social factors (cultural/familial attitudes toward pain) (IOM). Effective pain assessment and management begins with the education of health care workers. Every nurse will encounter patients suffering pain from a plethora of causes; therefore, nurses must understand the physiology, assessment, and management of pain. According to the Institute of Medicine’s Committee on Advancing Pain Research (2011), “Effective pain management is a moral imperative, a professional responsibility and the duty of people in the healing professions” (p. 3). Unfortunately, effective pain management is complicated by the risk of opioid addiction and the massive rise of prescriptive misuse of pain medications in the United States. Nurses have a responsibility to advocate for the millions of people suffering daily from pain to ensure the greatest level of pain relief is achieved safely and effectively without harm to the patient. Prevalence The prevalence of pain can be difficult to accurately assess not only because of its subjective nature but also because of factors that contribute to the under-reporting of pain. Factors that influence a person’s response to pain, or willingness to report pain, include age, gender, race, and ethnicity (Nahin, 2015). In general, women, older individuals, and non-Hispanics are more likely to report pain; Asians are less likely to report pain (Nahin, 2015). Current estimates of those experiencing pain in the United States conclude that approximately 126.1 million adults (55.7%) have had some pain in a previous three-month period, with 25.3 million (11.2%) having daily or chronic pain and 23.4 million (10.3%) reporting severe pain (Nahin, 2015). The high incidence of pain requires that health care workers be informed of the latest and best approaches to pain assessment, treatment, and management to achieve the best outcome. Financial impact The financial impact of pain is burdensome, with billions of dollars lost directly (treatment or caregiving) and indirectly (through lost wages or productivity). It is estimated that the total costs associated with those experiencing pain ranges from $560 billion to $635 billion annually. Pain is more costly than heart disease ($309 billion) and cancer ($243 billion) (Gaskin & Richard, 2012). Medicare is responsible for the payment of one-fourth of the medical expenses for pain in the United States, which in 2008 totaled $65.3 billion (IOM, 2011). The misuse of opioid pain prescriptions alone in the United States carries an economic burden of $78.5 billion a year, which includes costs of health care, lost productivity, addiction treatment, and criminal justice involvement (Florence, Zhou, Luo, & Xu, 2016). Physiologic and pathologic pain Pain can be considered physiologic or pathologic. Physiologic pain describes the type of pain that occurs when tissue is injured; its function is to prevent further injury and promote survival. The injured person develops a memory in response to the pain and will avoid being injured in the same fashion (example: a small child getting burned by the stove will remember not to touch a hot stove in the future). Physiologic pain is often associated with acute, short-lived pain. Pathologic pain can also start with an injury to tissue but eventually changes occur in the peripheral and central nervous system along somatosensory pathways from periphery to cortex (Copstead & Banasik, 2013). These changes do not serve a known purpose and are thought to be the cause of chronic (long-lasting) pain conditions, such as neuropathic pain and fibromyalgia (Copstead & Banasik).