Issues in effective pain control. 2: From assessment to management

In the first of these two articles, Davies and McVicar (2000) reviewed issues regarding pain assessment and examined the best means of providing the underpinning education. In the second article, pain management issues are considered while focusing on the factors that influence the translation of planned care into action. The literature identifies that inadequate pain control continues to be a problem and, assessment issues apart, suggests that a lack of knowledge of analgesic pharmacology, and resultant misconceptions among both health professionals and patients, are major factors. This article provides an overview of the rationale for the use of analgesics by considering their biological actions, how the drugs fit into the analgesic 'ladder' (World Health Organization (WHO), 1994), and how they relate to the principles of managing chronic pain. The most common misconceptions concern the use of morphine and arise as a consequence of a lack of understanding of this drug. Further issues relating to the multidimensional aspects of pain and the need for psychosocial care and sound re-evaluations of the continuing effectiveness of pain control are identified. Finally, some of the professional issues that affect the transference of assessment and knowledge are examined. Nurses have a pivotal role in pain assessment and it is suggested that education must play a role in the development of genuine interprofessional working which will allow nurses to have more influence in formulating the care strategy and subsequent action.