Total Pain (by Kathrynn Thompson)

There has been a lot about pain management and opioids in the news recently. It reminds me that when we talk about pain we primarily refer to physical pain. But there are many kinds of pain including psycho-social, spiritual and social. These different kinds of pain can stand alone or in combination with other types. When they exist concurrently they can exacerbate each other.  Nursing, with our holistic focus, is ideally suited to assess and intervene in these different types of pain.  As we try to decrease the use of opioids perhaps we should have an increased awareness of non-physical pain.  Cicely Saunders, the mother of the modern hospice movement, created a model of total pain and encourages assessment and intervention in all areas of pain.



Assessment of all types of pain is within our scope of practice and many interventions can be initiated autonomously by nurses. NANDA nursing diagnoses such as Spiritual Distress, Hopelessness, Fear of suffering, Powerlessness, Grieving, Impaired Coping and Anxiety can guide our care.  As  healthcare providers focus on changing management of physical pain, I hope nursing can be the leader in managing total pain.