Helping pts cope with painful procedures

Hi all,

I work in an urgent care clinic and many times, patients come in requiring short procedures (minor burn management, wound care). I am wondering, from your personal experiences (maybe even as a patient), what are some strategies to help your patients cope with short term, acute pain? I suppose the strategies vary by population too.

Give them directions? ("take deep breaths")
Try to talk to them about something irrelevant? (I am bad at doing this because I can't focus on a conversation while performing a procedure very well.....)

When I am getting my blood drawn (painful, but sort of nerve wrecking still) or having wound care done, I prefer not say anything so I can go to my happy place.

What do you prefer?
I've had a LOT of painful procedures (4 bone marrow biopsies in the last 1 1/2 years alone). What helps me is to be told what is going to happen, and how i can help it go smoother (some people don't want to know anything- so this is very individualized). I found that the two I'd seen before on other people were much worse than the ones I've had !! Also, if there's likely to be discomfort, tell the patient. It's easier to put up with something for a few seconds/minutes if you know what to expect (again- have to gauge how the patient is reacting to the idea of the procedure). If you can use EMLA for injections, that can help. (I personally don't like lidocaine with IVs- it's just one more stick- and I'm a horrible stick- had IVs in my breast twice, foot- don't even remember how many). With kids, if they're old enough, maybe an analgesic lollypop (if dose appropriate); distraction, papoose- and if the parent is making things worse, see if you can get them out of there- if not, dose 'em both !! (just kidding )

had your ob rotation yet? that panting thing works really well; i used to teach it to patients all the time. gives them something else to concentrate on, and blows their ph down a bit and makes the nerves a little less efficient at transmitting painful impulses, too. i've even trained my dentist to teach it to his patients to use while he's putting in the local :d .

haha, I remember during my OB rotation, the nurse was working hard to coach the woman through her breathing while the baby was crowning. I felt a little helpless and just kept saying "almost there, I see the head!" I kept repeating this multiple times before the baby came all the way out. I reflected back on this, thinking how irritating that must have been for her and I should have just been silent.the deep breathing is great

I always like to know whats going to happen and how long it's going to last. I can get thru anything as long as I have an idea of when it will be over and have an idea of how bad it's going to get. Unexpected pain is the worse and don't sugar coat it. If it's going to hurt, tell me it's going to hurt.I have dealt with my kids the same way. I have watched both sit perfectly still thru blood draws, immunizations and IV starts since they were very little (they always held my hand with their free hand and were always told to squeeze when it hurt and I would squeeze back gently with an "almost over"). Funny stories - Took daughter in for pre-op labs at age 4. Explained entire procedure to her and told her it would hurt but must sit still, will only hurt for a minute. She bravely put her arm out and sat perfectly still - needle in and she's watching the entire event. Sudden look of shear panic "MOOOOMMMM....how are they gonna close that hole in my arm". (Oops, forgot to explain that part to her - haha).Same kid at 14 to the eye Dr for the first time. Never explained anything because I didn't expect any pain. She walked into office and nearly freaked out because of all the "scary" equipment.

Quote from linguineHi all,I work in an urgent care clinic and many times, patients come in requiring short procedures (minor burn management, wound care). I am wondering, from your personal experiences (maybe even as a patient), what are some strategies to help your patients cope with short term, acute pain? I suppose the strategies vary by population too. Give them directions? ("take deep breaths") Try to talk to them about something irrelevant? (I am bad at doing this because I can't focus on a conversation while performing a procedure very well.....)When I am getting my blood drawn (painful, but sort of nerve wrecking still) or having wound care done, I prefer not say anything so I can go to my happy place. What do you prefer?

Quote from xtxrni've had a lot of painful procedures ([color="sandybrown"]4 bone marrow biopsies in the last 1 1/2 years alone). what helps me is to be told what is going to happen, and how i can help it go smoother (some people don't want to know anything- so this is very individualized). i found that the two i'd seen before on other people were much worse than the ones i've had !! also, if there's likely to be discomfort, tell the patient. it's easier to put up with something for a few seconds/minutes if you know what to expect (again- have to gauge how the patient is reacting to the idea of the procedure). if you can use emla for injections, that can help. (i personally don't like lidocaine with ivs- it's just one more stick- and i'm a horrible stick- had ivs in my breast twice, foot- don't even remember how many). with kids, if they're old enough, maybe an analgesic lollypop (if dose appropriate); distraction, papoose- and if the parent is making things worse, see if you can get them out of there- if not, dose 'em both !! (just kidding :d)

Quote from TrekfanOMG OUCH I would have told them no way in hell are you doing that to me with out drugging me I have had to to just put my foot down more then once .

http://www.ideafit.com/fitness-libra...ain-managementhttp://journals.lww.com/smajournalon...on_Pain.5.aspxSome studies say deep breathing helps for acute pain...some say it doesn't.It is used widely chronic pain,and has evidence to prove it works there. I use it with pt's whose BP is too low to give pain meds to sometimes, or with pt's who are on the tranplant list who have chronic angina that can't receive any more IV nitroglycerin/pain meds and are still having pain, but are quite ready for ICU tx. It does increase pt satisfaction, and along with guided imagery does put the pt back into some control over their pain vs the pain controlling the pt. Also, in a pt who has a PCI site or graft that has blown, and you are trying to keep them from vagaling, deep breathing really helps keep them from bearing down when you are holding lots of pressure on that groin site.

Quote from elthiahttp://www.ideafit.com/fitness-libra...ain-managementhttp://journals.lww.com/smajournalon...on_Pain.5.aspxSome studies say deep breathing helps for acute pain...some say it doesn't.It is used widely chronic pain,and has evidence to prove it works there. I use it with pt's whose BP is too low to give pain meds to sometimes, or with pt's who are on the tranplant list who have chronic angina that can't receive any more IV nitroglycerin/pain meds and are still having pain, but are quite ready for ICU tx. It does increase pt satisfaction, and along with guided imagery does put the pt back into some control over their pain vs the pain controlling the pt. Also, in a pt who has a PCI site or graft that has blown, and you are trying to keep them from vagaling, deep breathing really helps keep them from bearing down when you are holding lots of pressure on that groin site.

Panting doesn't help me...deep breathing does...I've had herniated disks in my neck, I've had bowel obstructions, and I'm a migraineur. I live with pain. I've explored nonpharmacological pain techniques, and I know what works for me. Guided imagery works, if applied correctly with deep breathing it is a form of self hypnosis but it is best with chronic pain. Yes, when I am in status migraine and it has been going on for days and I am vomiting uncontrollably, I can't do my guided imagery, but when it is only 5/10...yes it works.I've held patients hands and had them breathe through the pain while they were bleeding out from a blown graft and the blood pressure was in the toilet, and the MD's fist was in the groin, and we were pressure bagging blood on the way to the OR, and couldn't give any pain meds...and the pt thanked me later....I've done the same for a pt who threw an arterial thrombus and and was screaming from the pain, and the MD wouldn't let me give any sedation...because he was afraid it would interfere with the anesthesia as we were on the way to the ORSometimes when pain meds are contraindicated, that's all a nurse has to work with...

Quote from elthiaPanting doesn't help me...deep breathing does...I've had herniated disks in my neck, I've had bowel obstructions, and I'm a migraineur. I live with pain. I've explored nonpharmacological pain techniques, and I know what works for me. Guided imagery works, if applied correctly with deep breathing it is a form of self hypnosis but it is best with chronic pain. Yes, when I am in status migraine and it has been going on for days and I am vomiting uncontrollably, I can't do my guided imagery, but when it is only 5/10...yes it works.I've held patients hands and had them breathe through the pain while they were bleeding out from a blown graft and the blood pressure was in the toilet, and the MD's fist was in the groin, and we were pressure bagging blood on the way to the OR, and couldn't give any pain meds...and the pt thanked me later....I've done the same for a pt who threw an arterial thrombus and and was screaming from the pain, and the MD wouldn't let me give any sedation...because he was afraid it would interfere with the anesthesia as we were on the way to the ORSometimes when pain meds are contraindicated, that's all a nurse has to work with...

I had the most lovely man who had to get a bedside sternal biopsy. Just saying it makes me shiver. I didn't know if I was going to be able to handle it.I used distraction. I held his hand, I spoke to him about how lovely his family is, spoke about his wife, and anything else. he seemed to handle it well.