Chronic Pain Nursing Diagnosis and Nursing Care Plan

Chronic Pain Nursing Care Plans Diagnosis and Interventions

Chronic Pain NCLEX Review and Nursing Care Plans

Chronic pain is defined as the persistence of pain for longer than 12 weeks despite pain management or treatment.

The pain can be continuous or intermittent. It can stay on one part of the body or it can move to another.

Chronic pain can affect all ages and it can feel different in various areas of the body.

A common numerical scale from 0 to 10 is used in many healthcare settings, wherein:

  • 0 means no pain
  • 1 to 3 means mild pain
  • 4 to 7 means moderate pain
  • 8 to 10 means severe pain

As per the American Academy of Pain Medicine, chronic pain affects about 1.5 billion people worldwide.

It is usually precipitated by an injury. However, the pain persists even after the underlying injury has been treated.

Signs and Symptoms of Chronic Pain

Aside from pain, other symptoms may be noted to people with chronic pain. The following are the signs and symptoms associated with chronic pain:

  • Atrophy of affected muscle group
  • Autonomic responses including diaphoresis, changes in blood pressure, respiration, and pulse
  • Changes in behavior and sleep pattern
  • Guarding sign on the affected site
  • Fatigue
  • Fear and/or anxiety
  • Irritability or restlessness
  • Preoccupation with pain
  • Weight changes
  • Reduced social interaction
  • Depression

Causes of Chronic Pain

The common causes of chronic pain are the following:

  • Longstanding physical disability
  • Longstanding psychological problems
  • Chronic disease processes such as diabetes, fibromyalgia, interstitial cystitis, inflammatory bowel disease, and temporomandibular joint dysfunction
  • Side effects from cancer therapy agents

Chronic Pain Nursing Diagnosis

Chronic Pain Nursing Care Plan 1

Arthritis

Nursing Diagnosis: Chronic pain related to the inflammatory process in joints secondary to arthritis as evidenced by pain score of 4 to 10 out of 10, verbalization of unrelieved and/or long-standing pain, and reduced mobility

Desired Outcome: The patient will verbalize a lower pain score of 0 to 3 (no pain to mild pain) and be able to tolerate mobility.

Nursing Interventions for Chronic PainRationales
Assess for pain using the following guide:
P – provoke: what makes the pain worse? What makes it better?
Q – quality: what does the pain feel like?
R – radiation: where is the pain located?
S – severity: rate the pain on a scale of 1-10.
T – timing: when does the pain start and how long does it last?  
Pain assessment determines pain management needs and is effective in evaluating the success of interventions.
Assess the patient’s previous pain experiences and response to pain medication.The patient may have a drug therapy that works best in his/her experience of chronic pain. Knowing what works and what is ineffective may help the staff save time from getting a prescription. It also saves the patient valuable time to be free from his pain.  
Assess the patient’s ability to mobilize.Arthritic pain may restrict mobility. Assessing what the patient can and cannot do can help direct patient care and minimize the pain.
Assist the patient in position changes.The pain may improve with regular exercises and repositioning. The patient may need support when doing so if the pain is severe.
Administer painkillers prior to activities, ideally 30 minutes before initiating the task.It is good practice to anticipate activities and the use of painkillers to successfully carry out needed interventions by reducing the probability of the patient having an increased pain level.
Use mobility aids as needed.The use of aids when mobilizing will reduce the stress on joints.
Provide adequate rest in between activities as needed.Certain activities may be too stressful for the patient and the patient’s joints. Giving the patient time to relax can help relieve fatigue which is helpful to not aggravate the pain.
Refer the patient for physiotherapy and occupational therapy.PT and OTs can help the patient cope and manage pain. They have special skills to assess and recommend position changes, use of aids, or any other assistive devices to keep the pressure on bones and joints low when trying to mobilize.

Chronic Pain Nursing Care Plan 2

Irritable Bowel Syndrome

Nursing Diagnosis: Chronic pain related to constant gastro-intestinal discomfort secondary to irritable bowel syndrome as evidenced by diarrhea, pain score of 4 to 10 out of 10, guarding sign of the abdominal region, and restlessness

Desired Outcome: The patient will verbalize a lower pain score of 0 to 3 (no pain to mild pain).

Nursing Interventions for Chronic PainRationales
Assess the patient’s pain using the PQRST tool.Pain assessment is a helpful tool in directing patient care and in the evaluation of the success of interventions.
Encourage patient to assume a position of comfort and assist if needed.Flexing of the knees reduces abdominal tension and can lessen discomfort.
Provide non-pharmacologic comfort measures such as back rub and use of diversional activities.Some activities promote relaxation and refocus attention which can lessen the patient’s discomfort.
Encourage the patient to adhere to prescribed dietary advice.A diet regimen is commonly prescribed for patients with IBS. This diet is designed to reduce episodes of diarrhea, provide bowel rest and reduce pain.
Administer IBS medications regularly as prescribed.There are medications that can help improve gastrointestinal disturbances.

Chronic Pain Nursing Care Plan 3

Fibromyalgia

Nursing Diagnosis: Chronic Pain related to painful sensations secondary to fibromyalgia as evidenced by a pain score of 4 to 10 out of 10, generalized weakness, anxiety, irritability and distress

Desired Outcome: The patient will develop an understanding of both pharmacological and non-pharmacological measures to cope with pain.

Nursing Interventions for Chronic PainRationales
Assess and record the patient’s pain using the PQRST tool.  A record of the patient’s pain assessment can help direct patient care and help in the evaluation of the success of pain management and other treatments.
Encourage adequate rest periods and uninterrupted night-time sleep.Systemic rest is helpful in the management of fibromyalgia.
Educate patient on non-pharmacological pain management techniques such as the following:
Reading
Chatting with someone else
Listening to music
Watching a television show
Meditating
Yoga  
Non-pharmacological pain management involves pain treatment without the use of medications. They can be used as standalone therapies, or they can be done in combination with drug therapies.
Advise the patient on where to ask or where to get more information regarding pain management including both pharmacological and non-pharmacological pain treatments.Pain management is a broad discipline. Information overload can occur if advice is given to the patient at once. Allowing them to have the option to get the information when needed gives the patients more control of their care.
Explain the diagnosis to the patient. Encourage the patient to speak up and ask questions.A deeper understanding of the disease process can help patients comprehend the symptoms they are experiencing.
Administer pain medications regularly.Regular administration of analgesics can help manage the pain to tolerable levels. Regular assessment of pain will help evaluate the effectiveness of drug therapy.
Refer the patient to a pain specialist.A pain specialist is a doctor that specializes in assessing the chronic pain of the patient, prescribing a suitable pain relief drug regimen and adjusting doses or changing drugs accordingly, and recommending non-pharmacological methods to ease the chronic pain and help improve the patient’s quality of life.

Chronic Pain Nursing Care Plan 4

Chronic Heart Failure

Nursing Diagnosis: Chronic Pain related to decreased myocardial blood flow secondary to chronic heart failure as evidenced by pain score of 4 to 10 out of 10, verbalization of unrelieved pain on the chest or anywhere in the body, guarding sign on the painful body part, and restlessness

Desired Outcome: The patient will demonstrate reduction of pain as evidenced by a pain score of 0 to 3 out of 10 (no pain to mild pain), stable vital signs, and absence of restlessness.

Nursing Interventions for Chronic PainRationale
Assess and record the patient’s pain using the PQRST tool.A record of the patient’s pain assessment can help direct patient care and help in the evaluation of the success of pain management and other treatments.
Administer prescribed medications that alleviate the symptoms of pain, especially chest pain or angina.Salicylates may be given to reduce the ability of the blood to clot, so that the blood flows easier through the narrowed arteries. Nitrates may be given to relax the blood vessels. Other medications that help treat angina include anti-cholesterol drugs (e.g. statins), beta blockers, calcium channel blockers, and Ranolazine.
Monitor the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of angina. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value of at least 94%.
Place the patient in complete bed rest during angina attacks. Educate patient on stress management, deep breathing exercises, and relaxation techniques.Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. The effects of stress are likely to increase myocardial workload.

Chronic Pain Nursing Care Plan 5

Multiple Sclerosis

Nursing Diagnosis: Chronic Pain related to neuromuscular involvement secondary to multiple sclerosis as evidenced by numbness and weakness on one side of the body or both, pain score of 4 to 10 out of 10, verbalization of unrelieved and/or long-standing pain, reduced mobility, inability to do activities of daily living (ADLs) as normal, and verbalization of overwhelming tiredness

Desired Outcome: The patient will verbalize a lower pain score of 0 to 3 (no pain to mild pain) and be able to tolerate mobility.

Nursing Interventions for Chronic PainRationales
Assess the patient’s degree of pain and fatigability by asking to rate his/her pain and fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels, degree of pain and fatigability, and mental status related to fatigue and activity intolerance.
Encourage activity through self-care and exercise as tolerated Alternate periods of physical activity with rest and sleep.    Encourage enough rest and sleep, and provide comfort measures.To help the patient balance his/her physical activity and rest periods.   To reserve energy levels and provide optimal comfort and relaxation.
Administer pain medications regularly.Regular administration of analgesics can help manage the pain to tolerable levels. Regular assessment of pain will help evaluate the effectiveness of drug therapy.
Teach deep breathing exercises and relaxation techniques.   Provide adequate ventilation in the room.To allow the patient to relax while at rest. To allow enough oxygenation in the room.
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in balancing daily physical activity and rest periods, as well as in maximizing the use of mobility aids.
Refer the patient to a pain specialist.A pain specialist is a doctor that specializes in assessing the chronic pain of the patient, prescribing a suitable pain relief drug regimen and adjusting doses or changing drugs accordingly, and recommending non-pharmacological methods to ease the chronic pain and help improve the patient’s quality of life.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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