Pain – Nursing Interventions for Acute Spinal Cord Injury

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.