Prioritizing the assessment of postoperative movement-induced pain

It hurts to maneuver.

It is 10:00, 15 hours after surgery, your patient has eaten breakfast and is resting comfortably in bed. You ask the patient, “On a scale of zero to 10, how much pain do you feel right now?” The patient replies: “zero, as long as I don’t move.” The nurse documents a pain rating of 0/10 and continues rounds.

Most nurses are satisfied when patients report no pain. What is the nurse missing? A contextual factor called motion.

A number of years ago, a research participant told me, “There’s no point in getting up to hurt someone.” A quite simple but powerful statement began my quest to vary the way in which we understand and evaluate the dynamics between pain and movement.

The reality is that this:

• Movement increases acute postoperative pain and most patients are afraid to maneuver, even in the event that they know the way essential it’s to maneuver.
• Most patients need some style of pain medication or non-pharmacological intervention to have the opportunity to perform mobility-related activities.
• Movement and mobility promote regeneration and rehabilitation.
• A serious barrier to participation in activity-based interventions is movement-induced pain.

Movement-induced pain is a vital pain characteristic that describes pain and discomfort during energetic or passive movement of the affected area. However, despite nurses’ awareness of the importance of setting goals for functional pain, most of our pain assessments are performed while the patient is resting at random times or at set intervals. Or before or after activities. Rarely, pain is assessed during activity or movement at the purpose of care.

A movement-induced pain assessment (also generally known as a movement-based pain assessment) assesses pain during movement, functional activities, or other physical tasks. On a more biological level, movement-induced pain reveals how the nervous and motor systems interact and highlights any dysfunctional pain responses. Understanding pain patterns at rest and through movement offers a singular opportunity to plan care in an intentional way and develop a pain management plan that can control pain at its peak.

Changing the care paradigm.

Even with pain medication, most postoperative patients can expect some level of pain with movement, especially at first. Pain goals specific to specific activities resembling walking, transferring from bed to chair, or bathing/dressing, established by the patient and physician, have long been recognized as essential. Yet we regularly assess pain before or independently of activity after which set a pain function goal that’s inconsistent with the assessment method. What makes the presented model different is the precise and intended goal of the nurse, which is to evaluate pain while performing activities. Yes, it is a change of mind! However, recent strategies are needed to cope with the pain.

Because pain often occurs or worsens with movement and has a major impact on every day functional ability, a movement pain assessment can concurrently measure two critical recovery activities: pain and performance. Movement Pain Assessment provides a ‘real-time’, individualized and more precise report of pain experienced during movement, together with monitoring functions resembling gait, range of motion and physical adaptation. We still focus an excessive amount of on assessing pain intensity without making an allowance for the patient’s functional microenvironment.

Strategies for coping with movement-induced pain.

Movement plays a necessary role in recovery from surgery, and good pain management can reduce the pain a patient may expect or experience during physical activity.

Don’t let the pain of movement overwhelm your patient. As nurses we should always:

• Ask about pain during movement or significant activities.
• Treat pain preventatively and proactively using a wide range of treatments and methods.
• Educate patients in regards to the positive and negative effects of movement on pain and pain on movement.
• Work with an interdisciplinary team to develop a comprehensive pain management plan that features rest pain, spontaneous pain, and movement-induced pain.

The basic goal is straightforward: easy methods to help postoperative patients move? To quote the recommendation from a James Brown song lyric: “Get up off that thing/And shake it until you feel better!”

(For more detailed information on the evaluation and treatment of motion-induced pain, see the 2 CE articles, “Assessment of pain attributable to movement“And”Overcoming movement-induced pain to facilitate post-operative recovery“)

Staja “Star” Booker, PhD, RN, is a pain researcher and lecturer on the University of Florida College of Nursing, where she studies how older adults experience chronic joint pain.