Pain – Nursing Interventions for Acute Spinal Cord Injury

by Rhonda Lawes, PhD, RN

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    00:01 Now let's look at pain for a patient with a spinal cord injury.

    00:05 There's really two types of pain and this is why how you assess your patient really, really matters.

    00:11 We treat these different types of pain differently.

    00:14 Now they can have nociceptive pain or neuropathic pain.

    00:18 I don't want either kind.

    00:20 But as a nurse, I need to be sharp with my assessments so I could ask them simple questions that will quickly get them to describe their pain.

    00:29 Because you know what, when patients hurt, they don't want to do an interview with Barbara Walters, right? They just want you to fix it.

    00:36 So as much as you can work on developing a therapeutic relationship with that patient, then you wanna ask them questions in a quick and efficient manner.

    00:45 Now, nociceptive pain is like musculoskeletal pain or visceral pain.

    00:49 So patients will talk about the musculoskeletal pain as it’s dull or it's aching and if they moved, it gets worse.

    00:57 Now visceral pain is no fun either.

    00:59 It's like a dull, tender or cramping pain in their thorax, their abdomen or their pelvis.

    01:04 So that's nociceptive pain. Underline the words that sound kind of similar.

    01:10 Look, dull in both. You got dull in both. Good.

    01:14 So that will kinda give you a feel for that's nociceptive because neuropathic pain has a very different characteristic.

    01:21 Now it's caused because of damage to the spinal cord or the nerve roots.

    01:25 Remember, the spinal cord has those nerve roots coming off both sides, and so we either damaged one or both.

    01:32 Usually it's at or below the injury.

    01:36 So there's another's specific thing for neuropathic pain.

    01:39 So, patients will describe this pain as hot, burning, tingling, pins and needles, cold or shooting pain, very different than nociceptive pain.

    01:50 Nociceptive pain is dull, aching.

    01:54 Neuropathic pain is hot, burning, cold, shooting, tingling, pins and needles.

    02:02 This is what a lot of our diabetic patients also feel.

    02:05 But we're talking about the type of pain that spinal cord injury patients will feel.

    02:09 A lot of times they are hypersensitive.

    02:13 I'm talking hypersensitive to stimuli especially to touch.

    02:17 So you may just barely touch them and it causes extreme pain in the patient.

    02:22 Now they're not just being dramatic, it's because those nerves have been damaged.

    02:27 So when you're thinking about pain, this is gonna be a complex part of dealing with a spinal cord injury.

    02:33 So you're gonna need to work with the patient, work with the healthcare provider and really come up with a plan that's going to help your patient deal with this types of pain.

    02:43 So what interventions when it comes to pain? Well, we talked about a complete and a thorough pain assessment.

    02:49 You need to stay very calm, make excellent eye contact with your patient, let them know that you believe their pain and that you're gonna help find a solution. Okay? So you don't wanna appear rushed or hurried.

    03:02 But you want them to know that you recognize that this is important.

    03:06 You're gonna collaborate with that healthcare provider to figure out the best plan of care for the pain management.

    03:11 And you're gonna keep reassessing that plan and the level of pain.

    03:16 Because you wanna make sure that you use a scale that can help you measure that which - it's really annoying the patients when you ask them when they're hurting.

    03:23 They want you just to help them make it stop and you're saying, "Well, on a scale of 1 to 10," I know we've all done that.

    03:29 But don't play it off, just say, "Hey, listen. I understand.

    03:32 I wanna give you the best plan for managing this pain.

    03:35 So if you can help me by giving me a number, then I'm gonna know how the treatments working for you so I can find you the best treatment." So you assess before what their level of pain is.

    03:45 You give them the treatment and then you assess afterwards based on the route of that medication to see if that made a difference.

    03:52 And make sure you document that in a clear, concise and objective manner in the chart.

    03:58 And as always, pain is what the patient tells you it is.

    04:04 So don't write subjective things in the chart. Clear, concise, objective information.

    About the Lecture

    The lecture Pain – Nursing Interventions for Acute Spinal Cord Injury by Rhonda Lawes, PhD, RN is from the course Spinal Cord Injuries and Syndromes (Nursing) .

    Included Quiz Questions

    1. Nociceptive pain
    2. Neuropathic pain
    3. Phantom pain
    4. Inflammatory pain
    1. Neuropathic pain
    2. Nociceptive pain
    3. Phantom pain
    4. Inflammatory pain

    Author of lecture Pain – Nursing Interventions for Acute Spinal Cord Injury

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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