Guidelines for a Palliative Approach in Residential Aged Care

Table 8: Common myths about pain management
Myths
4. There is no reason for a resident to hurt
when no physical cause for pain can be
determined.
5. Clinicians should rely on their own
personal opinions and beliefs as to
whether the resident is truthful to
determine the resident’s true pain status.
Counter-Facts
As pain is a new science, not all aspects are understood.
Therefore it is better to accept that a resident is in pain,
given their authority on the matter.
Personal beliefs are neither consistent nor adequate to
determine pain management. It is essential to establish the
resident’s self-report of pain as the standard.
6. Pain never killed anyone. Chronic pain has many serious adverse effects such as
suppressing the immune system, which can lead to further
deterioration for the resident and may indeed hasten their
death.
7. Pain relief should only be given for pain
that is currently present.
6.2.3 Types of pain
It is better to give analgesics in anticipation of movement,
as this gives the resident control over the incident pain.
Adapted from McCaffery & Pasero (1999) [134]
It is not always easy to distinguish between various types of pain; this difficulty tends to
result in omissions or overlaps in providing adequate pain relief. The literature related to pain
frequently refers to three types: acute pain (relatively brief that subsides as healing occurs),
cancer pain, and chronic non-malignant pain. [130] However, this typology has limited value in
helping direct the aged care team in assessing and managing pain. Instead, the method adopted
by the Therapeutic Guidelines: Palliative Care, [109] based on the inferred pathophysiology of the
pain and classified into two broad groups, has been found to be most helpful and will be used.
(However, because much of the literature specifically refers to chronic pain, this term will also
be used in this section). The two broad groups are:
• nociceptive pain (stimuli from somatic and visceral pain); and
• neuropathic pain (results from an injury to the nervous system).
The following table provides examples of nociceptive and neuropathic pain types and
recommendations for referral.
74 Guidelines for a Palliative Approach in Residential Aged Care