Creating a Pain PlanWhat It Is and How It Helps
By Laurie Fronek, Staff Writer
Patients and caregivers alike want good pain relief. Your loved one’s pain management plan, or pain plan for short, is the roadmap to achieving that relief. A pain plan is a written document that describes all the pain-relief methods your loved one can use—the what’s, when’s, why’s, and how’s of administering medicines and nondrug remedies.
“It’s about having some way to be sure that people know what medications they have been told to use and how to use them,” explains Gail Loughlin, RN, CHPN, clinical liaison at Providence Hospice of Seattle. The same goes for pain-relief methods like heat, ice, and relaxation. The plan should also include information about what to do if the method of choice doesn’t work and when it’s time to call the doctor.
A Written Resource for Everyone
Ideally, the pain plan brings all this information together in one place, where it’s easy to check what to do. A written plan is especially helpful in the following situations.
- Other people share caregiving responsibilities with you. The plan helps ensure that each person has the same instructions. Loughlin gives this example: “If several daughters trade off caring for their mother, the plan is a central place that says what’s done, when, and for what reason.”
- The person’s relief starts to subside and the pain returns. According to Jessie Bell, RN: The first thing to do, is to refer to the pain plan and determine which remedies apply to the type of pain the person is having. If you can’t find an answer there—for example, if someone’s having a pain she hasn’t had before—Bell recommends calling the primary doctor.
- Your loved one’s pain does not seem well-managed. This is a good reason to sit down with her medical providers and read through the pain plan together to discuss which methods are helping, which are not, and what else can be done.
Creating and Using a Pain Plan
To develop a pain plan, your loved one (or you on her behalf, if she cannot do this herself) needs to talk with her doctor and other medical providers. Her medical team needs the details of her pain to prescribe or recommend medicines and other remedies most likely to help. (To find out what information providers need, visit these pages:
assessing pain,
describing pain,
questions to ask about pain, and
nonverbal signs of pain.)
You can use any format you like for writing down the plan. Just make sure it’s clear to your loved one (if she is able to take part in her care decisions), to you, and to any other caregivers. Keep it organized, and update it whenever her treatment changes.
You can print and use our pain plan template, or create your own template. The following is a brief guide to our template.
- Page 1 is an overview, or master list, of options.
- Page 2 is for details of each medicine.
- Page 3 is for details of each nondrug remedy.
Put blank copies of the template in a three-ring binder, and place the binder where it will be most handy, such as next to your loved one’s bed. (Use dividers to make sections in the binder for her
pain journal, her
medication list, the names and numbers of her care providers, and any other information you want nearby.)
What to Record about Medicines
Use the pain plan to record this information about each pain medicine.
- Name of the medicine. Get the generic name and the brand name.
- What to use the medicine for. This should say more than simply “for pain.” Find out from the doctor whether to use this medicine for mild, moderate, or severe pain. Also, find out whether it’s for a certain type of pain, such as for tingling or burning pain.
- The form and route of administration. For example, is it a pill or a liquid taken orally? Is it an injection? Is it a suppository?
- How much medicine to take. Note how much to use each time you give the medicine; whether it’s OK to take more (and if so, how much) if the original dose doesn’t help enough; and whether there’s a limit to how much to give per day.
- When to take it. If the medicine should be taken on a certain schedule, such as every six hours, write that. If the medicine should be used only in certain circumstances, such as when breakthrough pain occurs, write that.
- Special instructions for how to take it. For example, write whether the medicine should be taken with food or whether the patient should not drive after taking the medicine.
- Possible side effects of the medicine. Include what to do about each side effect, and when to call the doctor to report side effects.
- Who prescribed or recommended it. List the name of the medical provider and who this person is, such as oncologist or pain specialist.
It’s helpful to keep this same information about every medicine your loved one takes—not just her pain medicines. You can use our
medication list template to collect and organize medication details. (
Page 1 is for a master list of all medicines your loved one takes.
Page 2 is for details of each medicine.)
“In general, it’s good to have a central list to help caregivers as well as the medical providers,” says Loughlin.
What to Record about Nondrug Remedies
The pain plan should also include the following information about each nondrug pain remedy.
- Name of the remedy.
- What to use the remedy for—which severity and type of pain, or where the pain is located.
- When and how to use the remedy. The details will depend on the type of remedy. For instance, a medical provider who recommends using heat can tell you what form to use (such as a hot water bottle), how to safely apply it (such as wrapped in a towel to prevent burns), how long to apply it (such as 15 minutes), and how often (such as twice every hour, as needed).
- Possible side effects—including what to do about them and when to report them to the doctor.
- Who prescribed or recommended it—the name of the medical provider and who this person is, such as primary doctor or hospice nurse.
Revise the Plan as Needed
Once your loved one has a pain management plan, check with her regularly to find out whether the plan is working for her. Here are some useful questions to ask.
- Do you have trouble understanding the plan?
- Do you have trouble following the plan?
- Do you have trouble getting or taking any of your pain medicines?
- Do you have trouble using any of the nondrug remedies recommended?
- Are you experiencing any side effects?
- Are you satisfied with the pain relief you get?
Make sure the medical providers know these answers, especially if your loved one is having any trouble with the plan or is not getting enough relief. Medical providers should work with patients and caregivers to revise the plan so it’s truly helpful.