Unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage, with a duration of greater than 3 months

• Difficulty establishing social interaction
• Ineffective fatigue self-management
• Ineffective overweight self-management
• Ineffective sexuality pattern
• Injury agent
• Malnutrition
• Prolonged computer use
• Psychological distress
• Repeated handling of heavy loads
• Whole-body vibration

• Bone fractures
• Central nervous system sensitization
• Chronic musculoskeletal diseases
• Crush syndrome
• Imbalance of neurotransmitters, neuromodulators and receptors
• Immune system diseases
• Impaired metabolism
• Inborn genetic diseases
• Ischemia
• Neoplasms
• Nervous system diseases
• Post-trauma related condition
• Prolonged increase in cortisol level
• Wounds and injuries

• Descriptive characteristics of pain, including location, quality, intensity on a scale of 1 to 10, temporal factors, duration, precipitating factors (food, alcohol, activity, and stress), and comfort factors
• Physiologic variables, such as general health state, length of pain, organ system involvement, pain tolerance, disability (work, family, or social), and pain interventions (such as injection, traction, ice, physical therapy, and transcutaneous electrical nerve stimulation)
• Psychological variables, such as age, self-esteem, self-worth, role (worker, husband, breadwinner), coping behavior (appropriate or inappropriate), secondary gains (disability insurance, workmen's compensation, litigation), suffering (emotional component), manipulative behavior, dependence on others or on system, and previous hospital experience
• Sociocultural variables, including educational level, motivation, culture or ethnicity, sex, values and beliefs, pain behaviors, financial distress, and religion
• Environmental variables, such as setting and time
• Pharmacologic variables, including type of drugs, amount used in 1 day, use of illicit drugs, and use of alcohol

• Altered ability to continue activities
• Altered sleep-wake cycle
• Evidence of pain using standardized pain behavior checklist for those unable to communicate verbally
• Facial expression of pain
• Fatigue
• Hypervigilance to pain
• Inadequate appetite
• Pain characteristics assessed using standardized, validated assessment instrument
• Pain intensity assessed using standardized, validated assessment instrument
• Proxy report of activity changes
• Proxy report of pain behavior
• Verbal report of pain

• Patient will rate pain on a scale of 1 to 10 on a standardized scale.
• Patient will identify characteristics of pain and pain behaviors.
• Patient will develop pain management program that includes activity and rest schedule, exercise program, and medication regimen that isn't pain contingent.
• Patient will state relationship of increasing pain to stress, activity, and fatigue.

Suggested NOC Outcomes

• Assess patient's physical symptoms of pain, physical complaints, and daily activities. Administer pain medication, as prescribed. Monitor and record the effectiveness and adverse effects of medication. (Keep in mind that pain behavior and pain talk may be inconsistent.) Correlating patient's pain behavior with activities, time of day, and visits may be useful in modifying tasks.
• Provide instruction about amount of pain medication needed to control symptoms and allow patient to remain active. Teaching patient about medications may help to increase the accuracy of dosage necessary to provide pain relief.
• Develop a behavior-oriented care plan; for instance, set up a plan to follow the activity schedule. Behavioral-cognitive measures can help patient modify learned pain behaviors.
• Teach patient how to use relaxation techniques, guided imagery, massage, or music therapy to relieve pain. These methods work as an adjunct to medications, increase self-help, and foster independence.
• Teach patient and family members such techniques as massage, application of ice, and exercise to relieve pain and foster independence.
• Work closely with staff and patient's family to achieve pain management goals and maximize patient's cooperation.
• Use behavior modification; for example, spend time with patient only if the discussion includes no pain talk. Use contingency rewards for decreasing pain talk and pain behavior. Reducing pain talk helps patient refocus on other, more important matters.
• Encourage self-care activities. Develop a schedule. This helps patient gain a sense of control and reduces dependence on caregivers and society.
• Establish a specific time to talk with patient about pain and its psychological and emotional effects to establish a trusting, supportive relationship that encompasses patient's physiologic, emotional, social, sexual, and financial concerns.

Suggested NIC Interventions

• Patient maintains activity diary and pain-level chart that rates severity of pain on a scale of 1 to 10.
• Patient maintains pain management program that includes activity and rest schedule, exercise program, and medication regimen.
• Patient states that stress, activity, and fatigue may increase pain.

• Patient's description of physical pain, pain relief, and feelings about pain
• Pain talk and pain behavior and affect
• Relationship of reports of pain to activities
• Treatments and pain talk
• Time out of bed
• Comfort measures initiated by nurse, patient, or family members
• Response to interventions
• Response to pharmacologic agents
• Interaction with staff
• Evaluations for expected outcomes

• Ahuja, D., Bharati, S. J., Mishra, S., & Bhatnagar, S. (2017). Chronic cancer pain: Diagnostic dilemma and management challenges. Indian Journal of Palliative Care, 23(4), 480-483. doi:10.4103/IJPC.IJPC_74_17
• Geurts, J. W., Willems, P. C., Lockwood, C., Kleef, M., Kleijnen, J., & Dirksen, C. (2017). Patient expectations for management of chronic non-cancer pain: A systematic review. Health Expectations, 20(6), 1201-1217. doi.org/10.1111/hex.12527
• Gilmartin-Thomas, J. F., Bell, J. S., Liew, D., Arnold, C. A., Buchbinder, R., Chapman, C., … McNeil, J. (2019). Chronic pain medication management of older populations: Key points from a national conference and innovative opportunities for pharmacy practice. Research in Social & Administrative Pharmacy, 15(2), 207-213. doi:10.1016/j.sapharm.2018.03.060
• Oosterhaven, J., Wittink, H., Mollema, J., Kruitwagen, C., & Deville, W. (2019). Predictors of dropout in interdisciplinary chronic pain management programmes: A systematic review. Journal of Rehabilitation Medicine (Stiftelsen Rehabiliteringsinformation), 51(1), 2-10. doi:10.2340/16501977-2502