Tuesday, April 9, 2013

Gaining a Better Understanding of Pain Management

Today we had the opportunity to attend the Maryland's Dietetics in Health Care Communities annual spring workshop.  Presentation topics included how to better manage glucose levels in sub-acute facilities, the basics of parentral nutrition, electronic medical/health records, renal failure nutrition therapy and practical pain management for dietitians.  While all the presentations were informative, I found the pain management discussion especially thought-provoking and interesting.  How many times have we as dietitians heard patients complain that their low po intake was directly related to their high pain level? It had never occured to me that dietitians could help improve both appetite and intake through better pain management.  During the talk, I learned that with the right tools, dietitians can play an active role in a patient's pain management regimen to improve mealtime outcomes.  Below are a few tips on how to assess a patient's pain level and the basic information needed to initiate a conversation within the health care team regarding pain management. 
1) Have a dialogue with your patient if pain is impacting their intake
   - Use the universal pain scale (seen below), but ask follow up questions.  For example, if a patient gives you a 10/10 for pain, follow up by asking, is this the worst pain imaginable, could you imagine the pain getting worse?
2) Know the basics
  - All opioids are created equal at equal doses i.e. no medication is stronger than another
 - All opioids are metabolized in the liver and cleared in the kidneys
 - Short acting oral opioids and IV opioids have different onset times but around the same average duration (3-4 hours)
3) Work with the inter-disciplinary team to modify pain dosage or timing to improve patients mealtime intake.


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