When Melanie was admitted to the Women's Inpatient Unit at CAMH, she says she was surprised that she was being asked if she was experiencing any physical pain.
“I would not expect it from a place that focuses on mental health and addictions," says Melanie.Dr. Przemyslaw Pietucha, Physician Lead Hospitalist Service at CAMH, says clients like Melanie are at a higher risk of experiencing a wide range of chronic physical conditions, however assessing pain in the mental health and addiction population is complex.
“Pain is a complex phenomenon, especially in our populations,” Dr. Pietucha explains. ''It is not tangible, often ill-defined, mind-numbing and can overwhelm and consume those that struggle with it on a consistent daily basis.”
“Unidentified and unrelieved pain can significantly impact the physiological and psychological well-being of clients and their ability to recover from acute illness, including psychiatric impairment,” says Cheryl Rolin-Gilman, Advanced Practice Nurse, Ambulatory Care and Structured Treatment Program, CAMH.
Best Practice Guidelines
To better care for clients experiencing pain, CAMH is implementing a best practice guideline from the Registered Nurses’ Association of Ontario (RNAO) on assessing and managing pain, one of eight guidelines that CAMH must implement to become a Best Practice Spotlight Organization (BPSO).
“We formed a pain assessment and management committee and surveyed clients and clinicians about ways we can do this better,” Cheryl says. “The implementation of this guideline will result in a pain assessment with every patient assessment.”
CAMH now has a new policy outlining expectations about the assessment and management of pain for patients at admission and throughout their hospital stay. New pain assessment tools are resulting in better assessments of the parameters of pain and an online training session is providing clinicians with information on the intersection between pain, mental health and addictions as well as pharmacological and non-pharmacological pain management strategies.
Clinicians who have taken part in the training sessions say they are changing the way they care for clients experiencing pain. "My practice has improved and become more client-centered since these guidelines have been implemented,” says CAMH RN Sarah Grife.
Melanie says she is grateful that her needs regarding pain management are now being routinely addressed. “It is nice to have some attention paid to me concerning pain. My nurse was on the ball. She would check up on me with respect to my pain routinely. The pain scales were really nice. They gave nurses an idea more specifically of how severe my pain was and what they could do to help me.”
“Studies have shown that by solely identifying and asking about pain we decrease pain scores,“ says Dr. Pietucha. "If nothing else, the simple acknowledgment of this human shared condition, in tracking its progression, is enough to make a big difference in a patient’s life and give them hope.”