Nurses Teaching Nurses: Pain Management

At, we strive to bring nurses and nursing students relevant and meaningful information as it relates to nursing education. This week, in an effort to demonstrate how important it is for nurses to educate one another, we are featuring an article by Jerome Stone RN, MA, author of Minding the Bedside: Nursing from the Heart of the Awakened Mind. Jerome has decades of experience as a Registered Nurse in many different practice settings, including a pain clinic where he managed over 3500 patients experiencing chronic and acute pain.

As well-educated nurses, we have many tools at our disposal to aid with pain management, including accurate patient assessment and diagnosis. We also have a wealth of compassionate nursing interventions we can employ, alongside, or in lieu of, pharmaceutical efforts. While you deepen your nursing knowledge of pain management, keep following five very important key points in mind.

Five Tips For Effective Pain Management in Nursing

1. Remember that pain is a subjective experience; pain lies in the perception of the beholder.
An individual who is in pain is having an experience based on numerous factors including their cultural beliefs, their previous experiences with pain, and even their genetic predispositions. Remember that there's absolutely no way that you can know exactly what your patient is experiencing when they're in pain. Understanding this helps you to remain compassionate about what your patient is experiencing, regardless of how bad, or how minimal, you believe their pain actually is.

2. Know your own feelings and attitudes about pain.
If you have a personal fear of pain, it's going to be a lot more difficult for you to remain present when your patients are experiencing it. Learn how to deal with pain on a personal level, become friends with it, or at least become an understanding collaborator to its relief.

3. Know the basics of pain management.
This doesn't require a lot of time or learning. Know your opiates, your anti-anxiety medications, and your sleep medications. In addition, it's good to know your anti-inflammatory agents as well. There are numerous easy-to-use equianalgesic charts, including ones that you can keep in your pocket, that provide the proper dosages of opiates in equal amounts across a number of different agents.

4. Learn how to interpret the language of pain and how it's expressed in the body of your patient.
I've had people sit placidly and tell me that their pain is a "10" on a 1-10 scale; I've also had patients writhing in bed, telling me that their pain was getting to be a "7." Pain speaks in many ways, in the facial expressions, the words that a patient expresses, or in the subtlety of heart-rate variability and blood pressure. Become familiar with embodied pain.

5. Learn how to use your mind to deal with pain, and then teach others to do it.
What? Why? How? Recent research into meditation and mind-body techniques has shown us that learning a meditative or contemplative method can actually reduce one's perception of pain and reduce the need for pain medication. If you know how to use your mind to reduce pain, your ability to help others who are in pain will be more evidenced in how you help them to work with their mind-in-pain.

Here he offers a five-minute lesson for nurses on how to manage pain. It's not an end-all to pain management, but offers key points to consider, from an expert nurse. If you have your own tips for managing pain that you'd like to share with other nurses and students, feel free to leave them in the comments section below.

A Five Minute Lesson In Pain Management

In the United States today, more prescription painkillers are being used and abused than at any other time in our nation's history. In 2010 alone, more than 12 million people reported using painkillers non-medically, paralleling a 300% increase in sales of opiod pain relievers over the last decade (CDC, 2011). It is no stretch to say that the abuse of certain pain medications has become epidemic.

Pain management is a topic of lively, and sometimes discordant, debate. Pain is also an issue that we, as nurses, face daily. Pain is complex, can create a powerful emotional response, is difficult to describe and even harder to relieve.

Pain has an element of blank;

It cannot recollect

When it began, or if there was

A time when it was not.

It has no future but itself,

Its infinite realms contain

Its past, enlightened to perceive

New periods of pain.

-Emily Dickinson-

For most of us, pain is something that we'd rather avoid, in our own personal lives and in the lives of those who we care for, including our patients. Like the narrator in Dickinson's poem, pain can seem like a limitless sensation- far beyond our control- a creature of its own making. That leads us to ask, "how do we as nurses help others who are in pain?"

As nurses, we are taught that pain is the "fifth vital sign," and that pain assessment is essential for our patients. We are also taught that pain is a subjective phenomenon. Pain is what the patient says it is, and our nursing interventions should be tailored around the patient's ideas and perceptions about what pain is.

We are also taught the importance of empathy in caring for our patients. Empathy requires that we examine our own own perceptions surrounding pain and how they affect the nursing care we provide for our patients.

So, let me ask you: What are your feelings about pain management? How do you deal with those who are in pain? Have you formulated ideas or biases about pain? Do you fear it, or is it an uneasy friend?

Many of us do fear pain, which can lead to uncertainty about how to deal with it. Because it comes so close to our own humanity and frailty, we may find ourselves, as nurses, unable to surmount our own limitations when attempting to relieve the suffering of a patient in pain. Yet, there are some very basic tools that we can use to help those who are in pain and to practice conscientious nursing at the same time.

In my own nursing practice, I have noticed that many patients, especially the elderly, are often afraid to take opiates to manage their pain. Why? Because they don't want to become addicted to the medication. However, automatic addiction does not happen every time a patient is given a narcotic or an opioid. This is a misconception based on the belief that, with the use of opiates as analgesics, it's only a matter of time before the jaws of addiction grab hold. The fact is, that as our patients' pain decreases, so does the need to use opioid analgesic medication. It is our role as nurses to educate our patients to this fact, and to help manage the gradual discontinuation of pain medication as it becomes less needed.

Because of our misunderstanding about pain and our patients' perceptions of pain, many nurses have come to view those who need large doses of pain medication as being manipulative or falsely representing their pain; they are viewed as "drug seeking." While there are indeed those patients who, out of dependency, seek care in to obtain pain medications, this is not the case with every patient who presents in pain. In fact, because of this view, nurses under-medicate thousands of people who are truly suffering and whose pain can be alleviated by conscientious pain management, including both pharmaceutical and non-pharmacological methods of pain relief.

Putting it into Nursing Practice

Your five-minute lesson goes like this: When you walk into your patient's room, bring the previous five points to bear on your assessment, how you design your nursing interventions, and how you measure the outcomes.

First, know that pain is subjective and with it, also know your own subjectivity about pain; keep in mind that it can be difficult to be objective. Look at your patient and take note of what her body language is saying, as well as what the words she is using are telling you. Once you've assessed your patient's pain, know what medications you have at your disposal and how to use them most effectively. Finally, relax your mind and attend to your patient from a place of awareness and compassion. Teach your patients about different methods of pain relief, like guided imagery, meditation, deep breathing and relaxation techniques. Utilize humor, distraction and redirection to help those you are caring for make it through the acute experiences of pain they may feel.

Above all, be compassionate. Put aside any tendency to judge what they're experiencing and attend to them as you would someone who you loved and cared about. Imagine what kinds of interventions might help you in a similar situation and use those empathetic ideas, coupled with your nursing knowledge, to help effectively manage your patients' pain.

Nursing knowledge is something to be shared, so that we may all benefit our patients to the best of our ability. If you have pain management tips to share, please post in the comments! And if you feel this lesson can benefit other nurses, please spread the word by sharing this article. At, we intend to transform the future of nursing, and we plan to do it one educated nurse at a time.