I was speaking to a friend recently, discussing her dad’s recent orthopedic surgery. Her father had long-standing pain in his hips due to osteoarthritis and he decided to get both replaced simultaneously. I was surprised when I heard this, remembering my patients in the hospital that underwent joint replacements, and the challenges they faced with issues such as ambulation and physical therapy, along with pain management. Fortunately his surgery went well and during the post-op course,  his nurses were amazed as to how well he was ambulating and doing his prescribed exercises. The pain was managed with a patient-controlled analgesia (PCA) pump initially, but he was soon able to manage without it.

However his roommate, who only had one hip replaced, was not faring so well after his surgery. His pain was seemingly not well controlled according to my friend, because he was constantly moaning and complaining. My friend and her sister were surprised that his pain appeared to be so bad and their father seemed to make his post-op course look easy. But in discussing how pain affects people differently, we started talking about how a patients state of mind and tolerance for pain differs, along with other illnesses they may have – thus the perception of how well a person “handles” pain.  Ultimately we started discussing how clinicians assess and help patients that cannot speak for themselves or make their needs known clearly, and what is done to relieve their pain.

Not everyone describes pain in the same fashion, and it’s good to have different tools at your disposal. To assist clinicians assess pain levels, CHAMP has various tools to help measure pain in patients. A unique challenge however, is assessing pain in those patients that cannot convey clearly how they are feeling, such as those with dementia. The Pain Assessment in Advanced Dementia Scale (PAINAD) is useful in those instances.

There are a variety of evidence-based practices to help patients manage their pain, including pharmacological and non-pharmacological methods. Effective management of the fifth vital sign can and will help improve the quality of life for all our patients.