Listening, learning, leading: The nurse’s role in chronic pain

Pain management represents one of the most significant challenges in modern health care, affecting millions of Australians and placing a substantial burden on healthcare systems, communities, and individuals. This paper examines the complex nature of pain management in Australia, exploring its impact on public health, the evolution of treatment approaches, and the crucial role of nurses in providing comprehensive care. Through analysis of current evidence and practice guidelines, we investigate how healthcare professionals, particularly nurses, contribute to effective pain management through multidisciplinary collaboration, patient education, and implementation of evidence-based interventions. Special attention is given to the support services available to patients and the critical role these services play in achieving optimal outcomes in pain management.

Background of pain

Pain is a significant health problem in Australia, yet it continues to be largely unrecognised. According to the Australian Institute of Health and Welfare (AIHW), one in five people in Australia live with persistent chronic pain, surpassing rates of coronary heart disease and cancer (AIHW, 2020). Despite its prevalence, health care for pain management remains underfunded. Chronic pain can lead to severe disability, driving increased healthcare use and with an annual economic impact of around $144.10 billion in 2020, with projections indicating it could rise to $215.6 billion if no action is taken (Pain Australia, 2022). As outlined in Australia’s National Pain Strategy (Department of Health and Aged Care, 2021, p. 7), ‘Chronic pain is estimated to be Australia’s third most costly health condition’. The physical, psychosocial and economic burden on individuals experiencing pain and on the broader community has far-reaching consequences.

Pain is a complex perceptual experience that affects reasoning and emotions. The pain sensation conveys the location, the type and the intensity of the pain at that moment. At its simplest level, pain is a normal response to tissue damage—however, the experience of pain results from complex, multi-layered information–processing networks. Pain is a personal experience, and it is not possible to elucidate one definition that encompasses everyone’s experience of pain.

Acute pain is the body’s immediate response to injury or illness, signalling potential harm and triggering protective mechanisms. It typically arises suddenly and diminishes as the underlying cause is treated. Serving an essential evolutionary role, acute pain helps detect and respond to physical threats, guiding the body toward healing and recovery (Urien & Wang, 2019).
Chronic pain, on the other hand, persists over an extended period, typically lasting longer than three months (Treede et al., 2019). It may continue even after the initial injury has healed and can be influenced by physical, psychological, and environmental factors. Chronic pain can be a symptom of an underlying condition or a disease, and it is often associated with mental disorders and can severely impact the quality of life (Kela et al., 2021; Soelch, 2020).

Historically, pain was viewed as an unavoidable part of life or a form of divine punishment (Paley et al., 2023). Early pain relief efforts included natural substances like willow bark, opium, and mandrake (Apelbaum, 2021). Pain research and management have evolved significantly since the 17th century, with historical developments in pain treatment, including the use of opioids, which date back to ancient times, and the invention of the hollow needle, which revolutionised analgesic delivery and led to interventional pain medicine (Paladini et al., 2023). The International Association for the Study of Pain has played a crucial role in advancing pain concepts, where today, pain is managed using a biopsychosocial model that considers physical, psychological, and social factors (Gatchel & McGeary, 2020). In contemporary practice, pain management has evolved into a comprehensive, person-centred approach that addresses the complex nature of pain. Healthcare professionals now emphasise individualised treatment plans that integrate medical, psychological, and social support. This holistic view improves pain relief and enhances a person’s overall well-being and quality of life. As you progress through this theme, consider how these historical developments inform modern strategies and clinical interventions in pain management.

Nurses’ role in pain management

Pain resulting from different causes (e.g. acute, chronic or end-of-life pain) requires different discharge planning strategies. However, some key components have overarching goals. Open communication and ongoing education must be continued during every encounter with the patient and family members. For example, when administering breakthrough pain relief, it is also an opportunity to explain the similarities at home and how to manage these situations confidently. This encourages inclusiveness and transparency with their treatment plan to engage, motivate and inform patients and family members of the various recommendations by each healthcare professional.

Progression from acute to chronic pain may occur in some people, and while the underlying mechanisms remain unclear, several risk factors have been identified. These include surgical trauma, with specific procedures, such as extensive breast reconstructive surgery, being more likely to result in chronic pain. Psychological factors, such as depression and anxiety, as well as female gender and the presence of pre-existing chronic pain, have also been associated with this progression (Macintyre & Schug, 2021). Preventing the development of chronic pain is most effectively managed by addressing acute pain promptly and thoroughly. Ongoing pain assessment and management, maintaining functional movement levels, and encouraging social and mental activity are key strategies in care planning.

Chronic pain management is complex and requires effective communication between the patient and the numerous specialist health professionals who work together as part of a specialist interdisciplinary team. Nurses play a crucial role in pain management in acute care and community settings, particularly for people with chronic pain (Al-Harbi et al., 2022). People with chronic pain often have firmly established chronic pain behaviours and coping mechanisms before they are introduced to programmes designed to help them better manage their chronic condition. Multidisciplinary pain management clinics and support are often offered once all other options have been exhausted or as a last resort. As a result, many are sceptical and unmotivated to start ‘another course’ or engage in being taught different techniques. Encouraging and reinforcing regular participation, by telephone or email, helps prevent people from reverting to previous unsuccessful behaviours.

People with ongoing pain need help and support from healthcare professionals. Factors influencing pain intensity and outcomes are multifaceted and require a broader team approach. This allows various health professionals to collaborate and use a biopsychosocial approach to pain management. Each multidisciplinary team member brings expertise and performs a unique role to support the patient. Collaborative care and discharge planning is a critical process that integrates the expertise of multidisciplinary teams to ensure that it addresses immediate pain management needs and continuity of care for patients managing acute, chronic, or end-of-life pain. By coordinating roles across disciplines such as nursing, physiotherapy, psychology, and pharmacy, discharge planning not only addresses the immediate needs of pain management but also empowers patients and carers with the knowledge and tools required for effective self-management at home.

Nurses work across various clinical settings, including inpatient, outpatient and community settings, providing a range of supportive, educational and advocacy activities. They initiate pain assessments and treatments, endorse activities to promote healing, use evidenced-based information, explain and educate the patient about the diagnoses, treatment and analgesia regimes, and maintain detailed records of the activities undertaken, which can be an invaluable insight into the patient’s progress. Nurses provide key roles, such as case managers and researchers, to help improve treatment outcomes (Merritt et al., 2015).
Medication adherence contributes to managing conditions, and pain management is no exception (Timmerman et al., 2019). Patients are encouraged to take responsibility for their treatment wherever possible, but the level of motivation or significance influences their adherence to the activity. Nurses are well positioned to recognise the interferences that may impact a person’s ability to adhere to prescribed treatment and assess and identify whether compliance issues are evident as the relationship develops. The nurse can also initiate steps to reduce the likelihood of adverse effects arising from non-adherence to treatment plans. Initiating behaviour modification strategies should be encouraged to minimise the risk of poor outcomes – active motivational techniques can be tailored to the individual to provide encouragement and support.

Effective pain management requires a comprehensive understanding that extends beyond medical interventions. Nurses must consider each patient’s unique biopsychosocial needs when developing and implementing pain management strategies, considering their physical condition, psychological state, and social circumstances. Through clear communication and patient education, nurses play a vital role in ensuring patients understand their medication regimens, can effectively manage their symptoms, and know when to seek additional support.

A fundamental aspect of nursing care involves empowering patients to actively participate in their treatment journey. When nurses engage patients in their care decisions and treatment planning, it often leads to improved self-efficacy and better health outcomes. Additionally, nurses must remain vigilant in identifying and addressing potential barriers to care, whether they be cultural, linguistic, economic, or geographical. This ensures all patients have equitable access to the multidisciplinary support and resources necessary for effective pain management.

Support services

Pain Australia stands as the nation’s leading pain advocacy organisation, serving as a crucial voice in establishing pain management as a national health priority. The organisation works tirelessly to implement the National Pain Strategy while promoting equitable access to pain management services throughout Australia. Through their extensive efforts in policy development, research support, and resource creation, Pain Australia helps shape the landscape of pain management across the country. Their commitment extends to coordinating nationwide initiatives that bridge gaps in care delivery and promote evidence-based practices among healthcare providers.

Chronic Pain Australia focuses specifically on community support and education, taking a grassroots approach to pain management support. The organisation emphasises empowerment through self-management strategies, creating supportive communities for what they term “pain warriors.” Their work encompasses extensive educational resource development, community building through peer support networks, and regular awareness campaigns. These efforts help individuals living with chronic pain better understand and manage their conditions while fostering a supportive environment for sharing experiences and coping strategies.

Mental health services, such as Beyond Blue, Lifeline and Black Dog Institute, provide emotional support and mental health assistance to individuals experiencing chronic pain, which can significantly impact a patient’s overall wellbeing and ability to cope with their pain, allowing them to better manage their condition by addressing the psychological aspects associated with chronic pain.

Conclusion

The management of pain in Australia represents a complex healthcare challenge that requires a coordinated, multidisciplinary approach. As champions of patient advocacy, nurses are uniquely positioned to bridge the gap between research and clinical practice, ensuring that advancements in health care translate into tangible benefits for individuals under their care. Nurses play an important role in pain management across various healthcare settings, from acute care to community support. The success of pain management strategies depends heavily on integrating evidence-based practices, effective communication, and utilising available support services. Continuing focus on professional development, patient education, and strengthening support networks will improve positive outcomes for individuals with pain. The collaborative efforts of healthcare professionals, support organisations, and policymakers remain essential in addressing the significant personal and societal impact of pain in Australia. Future developments in pain management should prioritise accessibility, patient-centred care, and the ongoing evolution of treatment approaches to meet the diverse needs of those affected by acute and chronic pain conditions.

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