References
Assessment and management of chronic pain in adults: implications for paramedics
Abstract
Chronic pain represents a complex health problem that affects a significant number of individuals living in the community. Paramedics will encounter patients with a complaint of pain that may be associated with injury, malignancy, and degenerative diseases such as osteoarthritis. In some cases, the patient may have a diagnosis of ‘neuropathic pain’ where there is no obvious basis for the pain. Some individuals with chronic pain may experience exacerbation of pain. This may occur in association with malignancy and disease progression, and when the pain becomes unmanageable, this becomes a health emergency. These individuals may rely on paramedics to manage this distressing symptom. However, in order to care for patients with chronic pain, paramedics need to understand the physiology of pain, use validated tools to assess pain, and appreciate the range of therapeutic approaches used to manage this debilitating symptom. As such, this article aims to provide information to support the paramedic's assessment and management of patients with chronic pain. Paramedics have practice guidelines for the management of acute pain, and these may be adapted to care for patients with acute exacerbation of chronic pain.
Paramedics play an important role in alleviating pain experienced by individuals in the community, with the relief of pain and distress described as a primary goal of paramedics and emergency medical services (EMS) (Callaham, 1997). In Australia, the Council of Ambulance Authorities (CAA) has identified quality of pain relief as a surrogate measure of compassion and caring, and has recommended that EMS develop and adopt clinical performance indicators that include reduction in pain (CAA, 2001).
Pain may be considered an innocuous diagnostic marker of injury or disease that will resolve once the underlying pathology is treated or the injury heals. However, there is increasing evidence that prolonged pain produces physiological changes that are associated with significant morbidity. It is known that acute pain may progress to chronic pain (Macintyre et al. 2010), and that chronic pain has psychosocial and economic consequences due to impaired mobility, loss of productivity and depression (McNeill et al. 2004; AIHW, 2010). It is estimated that pain is the third most costly health problem in Australia with an annual cost to the community estimated to be AUD$ 34 billion (MBF Foundation, 2007). This has led to a recommendation by the National Pain Strategy— representing health professionals, consumers and funding agencies—to recognize the management of pain as a national health priority (National Pain Summit, 2010).
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