Last updated on December 28th, 2023
Introduction
In this article, you will find NANDA nursing diagnoses and nursing care plans for Chronic Pain. You will also learn how to develop chronic pain nursing care plans that include intervention and rationales.
Click here to check the NANDA pain domain and sample acute pain nursing diagnoses and care plans.
NANDA Definition of Chronic pain nursing diagnosis
NANDA nursing diagnosis for chronic pain is defined as a pain which lasts longer than 3 months. Chronic pain may an ongoing or intermittent, lasting longer than the normal healing process.
Low back pain, headaches, and arthritic pain are the most common causes of chronic pain. Chronic pain can result in substantial psychological and mental anguish, as well as a decline in a person’s ability to function completely.
List of Acute Pain Nursing Diagnosis
Chronic Pain Related to Musculoskeletal Disorders
- Amputation: Chronic pain related to surgery; phantom limb sensation; as evidenced by verbal reports of pain, facial grimace, changes in vital signs, moaning, irritability, restlessness.
- Arthritis: Chronic pain related to progression of joint deterioration; inflammatory process; as evidenced by verbal reports of pain, facial grimace, changes in vital signs, moaning, irritability, restlessness.
- Carpel Tunnel Syndrome: Chronic pain related to unrelieved pressure on median nerve as evidenced by verbal reports of pain, facial grimace, changes in vital signs, moaning, irritability, restlessness, limited ROM.
- Endometriosis: Chronic pain related to distention of endometrial tissue as evidenced by verbal reports of pain, facial grimace, changes in vital signs, moaning, irritability, restlessness.
- Fibromyalgia: Chronic pain related to fatigue; inability to sleep; inability to focus; as evidenced by verbal reports of pain, facial grimace, changes in vital signs, moaning, irritability, restlessness, limited ROM.
- Fracture: Chronic pain related to nerve damage; aggravation of arthritis; persistent post-surgical pain; as evidenced by verbal reports of pain, facial grimace, changes in vital signs, moaning, irritability, restlessness, limited ROM of affected limb and/or joint.
- Gout: Chronic pain related to inflammation of affected joint as evidenced by verbal reports of pain, facial grimace, changes in vital signs, moaning, irritability, restlessness, limited ROM affected joint.
- Low back pain: Chronic pain related to degenerative processes; musculotendinous strain; injury; inflammation; congenital deformities; as evidenced by verbal reports of pain, facial grimace, changes in vital signs, moaning, irritability, restlessness.
- Multiple Sclerosis: Chronic pain related to motor and sensory nerve tract damage as evidenced by verbal reports of pain, facial grimace, changes in vital signs, moaning, irritability, restlessness, dizziness, slurred speech, report of blurry vision.
- Osteoarthritis: (See chronic pain nursing care plan example #2)
- Peripheral Neuropathy: Chronic pain related to damage to nerves in the peripheral nervous system as a result of medication side effects, vitamin deficiency, or diabetes
- Plantar Fasciitis: Chronic pain related to inflammation as evidenced by verbal reports of pain especially in the morning, facial grimace, changes in vital signs, moaning, irritability, restlessness.
- Restless Leg Syndrome: Chronic pain related to leg discomfort as evidenced by verbal reports of pain and/or discomfort, facial grimace, irritability, restlessness, uncontrollable leg movements.
- Rheumatoid Arthritis (RA): (See chronic pain nursing care plan example #4)
Chronic pain related nursing care plans for medical conditions
- Ascites: Chronic pain related to peritoneal fluid accumulation; altered body function; as evidenced by verbal reports of pain, increased abdominal girth, shortness of breath, indigestion, vomiting, facial grimace, changes in vital signs, moaning, irritability, restlessness,
- Burns: Chronic pain related to burn injury; treatments; nerve damage.
- Cancer: (See chronic pain nursing care plan example #1)
- HIV: (See chronic pain nursing care plan example #3)
- IBS: Chronic pain related to spasms; increased motility of bowel.
- Peripheral Vascular Disease (PVD): Chronic pain related to intermittent claudication due to ischemia
- Somatization Disorder: Chronic pain related to unexpressed anger; multiple physical disorders; depression.
- Varicose Vein: Chronic pain related to impaired circulation as evidenced by verbal reports of pain, facial grimace, twisted and bulging of veins, changes in vital signs, skin discoloration, moaning, irritability, restlessness,
Chronic Pain Related Nursing Care Plan Examples
#1 Chronic Pain Related to Cancer (general ncp)
Nursing Diagnosis for Cancer
Chronic pain related to tumor infiltration into nerves; post-chemotherapy pain syndromes (such as peripheral neuropathy or plexopathy); or post-radiation syndromes (such as plexopathy, radiation-induced enteritis or proctitis, or osteoradionecrosis) as evidenced by verbal reports of pain, inability to sleep at night, restlessness, confusion, changes in vital signs, fatigue.
Goal/ Expected Outcomes
- Demonstrates alleviation of pain by patient participating in a prescribed pain regimen and reports that pain to a level of three or less based on validated pain assessment tool (0 representing no pain and 10 is the most severe).
- Demonstrates relief of pain as evidenced by uninterrupted sleep at night and appears rested with pain management regimen.
- Demonstrates the ability to regularly participate in activities of daily living (ADLs).
- Vital signs remain within acceptable range.
Chronic pain related nursing interventions with rationales for Cancer
| Nursing Interventions | Rationales |
| Assess the patient’s understanding of the evaluation and pain treatment techniques after the patient has had a full medical evaluation for the causes of pain and the most effective pain management strategies. | This evaluation assists in making the patient’s degree of comprehension and reaffirms findings, enhancing awareness and adherence to pain management measures. It also enables patients to play as much of a role as possible in managing his/her pain. |
| Consider the patient’s cultural viewpoints regarding pain. Never dismiss a patient’s complaint of pain, keeping in mind that the patient’s definition of pain may differ from the assessing nurse’s. | Individuals’ readiness to ask for pain medicine and how they describe their pain and its severity may be influenced by cultural views. Pain is dynamic, and effective management necessitates regular assessments at regular intervals of time. |
| In addition to the typical pain assessment, evaluate the patient’s level of “discomfort” or unusual feelings and sensations. | Patients typically describe neuropathic pain as sensations of burning, tingling, numbness, prickling, shooting discomfort. It is because nociceptive pain is perceived differently by the body than neuropathic pain. The sense of pain and the body’s response to it is referred to as nociceptive pain. It starts when mechanical or thermal stimuli activate the peripheral ends of sensory neurons known as nociceptors, causing the tissue to be threatened or harmed. Neuropathic pain, on the other hand, is produced by damage to central or peripheral nervous system tissue or by changes in pain processing centers in the CNS. |
| Assess the pain for its: 1 – Character (eg, burning, tingling, shooting). 2 – Onset, duration, alleviating, and aggravating factors. 3 – Measure the severity of pain using a validated pain assessment tool. 4 – Inquire about the use of successful pain-relieving techniques in the past. 5 – Evaluate the attitudes and knowledge of the patient and caregiver regarding the pain treatment regimen. | 1 – Characterizing pain and precisely documenting its location will lead to more effective pharmacologic management and will assist nurses in developing a personalized strategy that includes nonpharmacologic measures as well. 2 – This knowledge could help with pain prevention or relief. 3 – Severe discomfort can indicate complications such as internal hemorrhage or visceral fluid leakage. The use of a pain scale provides an objective measurement that allows the health care team to evaluate the success of pain management measures. On a 0-10 scale, the patient’s pain should be scored as 4 or less. 4 – Techniques that have been successful in the past may be effective in alleviating current pain as well. 5 – If patients and their families are concerned about the patient’s eventual opioid dependence, it is critical to remove any misconceptions about opioid-induced addiction. Fear of addiction may result in ineffective pain management, especially when chronic pain management is required. |
| Administer nonopioid and opioid analgesics as prescribed. | Pharmacological pain control strategies are the principal means of managing chronic cancer pain. |
| Teach the patient about non-pharmacological pain-alleviating measures such as diversion, visualization, yoga. | Nonpharmacologic pain management methods can complement pharmacologic pain control strategies. These measures may help to reduce the dose and frequency of analgesics. |
Click here to check NANDA acute pain nursing diagnoses and care plans.
#2 Chronic Pain Related to Osteoarthritis
Nursing Diagnosis for Osteoarthritis
Chronic pain related to arthritic joint changes; inflammation of the joint; associated therapies; joint stiffness and immobility; gastric irritation secondary to chronic non-steroidal anti-inflammatory drugs (NSAIDs) use; as evidenced by verbal reports of pain, limited range of motion (ROM), nausea, bloating, changes in vital signs, refusal to move, facial grimace.
Goal/ Expected Outcomes
- Verbal reports of reduction in pain to a level of three or less based on validated pain assessment tool (0 representing no pain and 10 is the most severe).
- Vital signs remain within normal range.
- Demonstrate ability to move and perform activities of daily living (ADLs) without causing undue pain.
Chronic pain related nursing interventions with rationales for Osteoarthritis
| Nursing Interventions | Rationales |
| Assess patient’s pain using a validated pain assessment tool such as visual analog scale (VAS), Wong-Baker FACES pain rating scale. | The patient can provide a personal perceived pain baseline report, which allows nurses to more accurately analyze subsequent pain spikes and declines. |
| Assess and document vital signs. | It provides baseline data regarding physiologic changes related to pain. |
| Administer NSAIDs and opioid analgesics and adjuncts as prescribed. | In the treatment of osteoarthritis, pain control is a key goal. Acetaminophen is recommended as the first-line treatment for osteoarthritis pain by the American College of Rheumatology. If acetaminophen is ineffective, NSAIDs and opioids should be added to pain management regimen. |
| Watch for NSAID side effects such as GI bleeding or renal failure. | Typical NSAIDs, such as ibuprofen or naproxen sodium, may increase the risk of gastric ulcers or renal impairment by inhibiting cyclooxygenase-1 (Cox-1) and thereby lowering prostaglandin levels in the stomach and kidneys. They also inhibit renal prostaglandin synthesis, which reduces renal circulation. |
| Educate patients about the dangers of taking large dosages of NSAIDs, such as the risk of MI and stroke. | Patients should be aware of the dangers of long-term NSAID use. High NSAID doses have been linked to an increased risk of heart disease. The risk of MI from NSAID use rises in direct proportion to the individual’s underlying risk. Individuals having a history of cardiac disease, hypertension, or hypercholesterolemia are thus at the greatest risk. |
| Encourage the patient in coordinating the time of peak analgesic or NSAID effectiveness with periods of exercise or other use of arthritic joints. | Patients can achieve the best pain control before exercise or ambulation by carefully scheduling analgesics. Participating in a workout regimen helps to preserve joint function. |
| Administer topical analgesics as directed. | For osteoarthritis patients, topical treatment may aid in the management of local pains. Capsaicin cream, in particular, has been demonstrated to considerably relieve knee pain when combined with other recommended arthritic drugs. |
| Teach nonpharmacological techniques of pain management (eg, guided imagery, relaxation, massage, distraction, biofeedback, heat or cold therapy, yoga, music, and art therapy. Additionally, traditional nursing techniques such as back rubs and repositioning may be included in the pain management plan. | Nonpharmacologic pain treatment methods can be used in conjunction with pharmacologic pain management strategies. These strategies may be crucial to minimize analgesic use. Thermal treatment has been shown to aid in the reduction of pain and stiffness. On occasion, ice can be used to treat acute inflammation, whilst heat therapy can be used to alleviate stiffness. |
| Explain the purpose and application of biological agents to the patient. | Patients with osteoarthritis may want to experiment with biological agents such as glucosamine sulfate and chondroitin sulfate which claims to have beneficial effects on cartilage regeneration. The scientific literature does not decisively confirm the efficacy of biologic agents. However, anecdotal evidence suggests that some patients have beneficial outcomes. Therefore, the nurse must be prepared to explain their use. |
| Instruct the patient not to immobilize his or her joints for more than a week. | Prolonged joint rest might cause additional stiffness and discomfort. |
| Refer the patient to occupational therapy if appropriate. Based on an assessment of the patient’s pain-related self-care limitations, recommend the use of assistive devices and dressing/grooming assistance if appropriate. | The use of suitable assistive devices reduces pain during self-care activities. Sock dispensers, lightweight long-handled reachers, elevated toilet seats, and other tools may assist reduce joint stress. Clothing can also be modified to make dressing easier (e.g., zipper pulls, Velcro closures). |
#3 Chronic Pain Related to HIV
Nursing Diagnosis for HIV
Chronic pain related to physical and chemical factors associated with prolonged immobility; neoplasms; chemotherapy side effects; infections; and peripheral neuropathy; as evidenced by verbal reports of pain, inability to sleep at night, restlessness, confusion, changes in vital signs, fatigue, refusal to move, facial grimace.
Goal/ Expected Outcomes
- Demonstrates alleviation of pain by patient participating in a prescribed pain regimen and reports that pain to a level of three or less based on validated pain assessment tool (0 representing no pain and 10 is the most severe).
- Demonstrates relief of pain as evidenced by uninterrupted sleep at night and appears rested with pain management regimen.
- Demonstrates the ability to regularly participate in activities of daily living (ADLs).
- Vital signs remain within acceptable range.
Chronic pain related nursing interventions with rationales for HIV
| Nursing Interventions | Rationales |
| Evaluate patient’s pain using a validated pain assessment tool such as visual analog scale (VAS), Wong-Baker FACES Pain Rating Scale. | The patient can provide a personal perceived pain baseline report, which allows nurses to more accurately analyze subsequent pain spikes and declines. |
| Monitor and document vital signs. | It provides baseline data regarding physiologic changes related to pain. |
| Administer nonopioid and opioid analgesics as prescribed. Instruct the patient to take analgesics before it becomes severe. | Pain that is permitted to worsen is more difficult to manage. Prolonged activation of pain receptors increases sensitivity to painful stimuli and increases the amount of dose needed to treat pain. |
| Apply heat or cold compress to affected areas (for example, apply heat to sore joints and cold packs to minimize edema caused by infections or repeated venipunctures). | Heat and cold applications are excellent nonpharmacologic pain relievers that also enhance the effects of analgesics. |
| Promote distracting exercises such as focused slow breathing, soothing music, reading. | Distraction is a technique for developing pain tolerance while decreasing pain severity. |
| Teach nonpharmacological pain-relieving techniques such as deep breathing exercises, biofeedback, and yoga. Also, provide back rubs and massages. | These nonpharmacological measures alleviate pain by reducing skeletal muscle tension. Back rub and massages promote relaxation and comfort. |
| Discuss with the physician whether a capped venous catheter for long-term blood withdrawal is advisable. | This intervention will assist in reducing pain in patients who need repeated venipunctures. |
#4 Chronic Pain Related Rheumatoid Arthritis (RA)
Nursing Diagnosis for Rheumatoid Arthritis
Chronic pain related to arthritic joint changes; accumulation of fluid or inflammatory process (eg, joint swelling and redness); fatigue; alteration in sleep; as evidenced by verbal reports of pain, limited range of motion (ROM), nausea, bloating, changes in vital signs, refusal to move, facial grimace, irritability.
Goal/ Expected Outcomes
- Verbal reports of reduction in pain to a level of three or less based on validated pain assessment tool (0 representing no pain and 10 is the most severe).
- Vital signs remain within the normal range.
- Improved ROM of the affected joints.
Chronic pain related nursing interventions with rationales for Rheumatoid Arthritis
| Nursing Interventions | Rationales |
| Assess patient’s pain using a validated pain assessment tool. Also, observe the non-verbal cues. | The patient’s report of pain should be the main factor in the pain evaluation to determine the need for and effectiveness of a pain management regimen. |
| Advise the patient to assume a comfortable position in bed or when sitting in a chair. When indicated, promote bedrest, but resume movement as soon as possible. | To reduce pain and joint injury in severe disease or acute exacerbation, total bed rest may be required until objective and subjective improvements are seen. It should be noted that immobility is known to aggravate arthritis pain and stiffness. |
| Teach and assess the use of pillows, sandbags, trochanter rolls, splints, and orthotics. | Stabilizing the joint reduces joint movement and pain. Note that orthotic devices are important in rehabilitation management because they help to reduce pain and inflammation, restore mobility, minimize deformity, and rectify biomechanical malalignment. |
| Motivate and facilitate regular position changes. | Helps to limit joint stiffness and fatigue. |
| Advise taking a warm bath or shower when they wake up and/or before going to bed. Also, to use warm and moist compresses to the affected joints various times per day. Alert the patient to check the temperature of the water each time. | Heat improves muscle relaxation and mobility, as well as pain relief and morning stiffness. Heat sensitivity may be reduced due to constant use of heat compress, caution the about thermal injury. |
| Provide back rubs and massages. | They promote relaxation and comfort. |
| Promote the use of stress-reduction techniques (eg, progressive relaxation, biofeedback, visualization, guided imagery, self-hypnosis, regulated breathing, and therapeutic touch). | Relaxation is promoted, a sense of control is obtained, and coping skills may be enhanced. |
| Encourage the patient in coordinating the time of peak analgesic or NSAID effectiveness with periods of exercise or other use of arthritic joints. | Patients can achieve the best pain management before exercise or ambulation by carefully scheduling analgesics. Participating in a workout regimen helps to preserve joint function. |
| Administer medication as directed (eg, NSAIDs, COX-2 inhibitors, disease-modifying antirheumatic drugs [DMARDS], immunomodulatory and cytotoxic agents, corticosteroids) | Pharmacological pain control measures are the principal means of managing chronic rheumatoid arthritis pain and preserving joint function. |
| Facilitate physical therapies (eg, paraffin gloves, whirlpool baths) | Provides continuous heat to reduce pain and improve range of motion in arthritic joints. |
| Teach patients how to use and measure the effectiveness of a transcutaneous electrical nerve stimulator (TENS) unit, if one is used. | Sustained low electrical stimulation prevents the transmission of pain sensations. |
| Prepare the patient for surgical procedures (eg, tendon realignment and repair, TKR, and joint fusion), if indicated. | Corrective surgeries may be recommended to alleviate pain and/or optimize joint function and mobility. |
Click here to check NANDA acute pain nursing diagnoses and care plans.
Conclusion
To recap, we discussed sample NANDA nursing diagnoses for chronic pain for a variety of chronic diseases in this post. In addition, we’ve created four chronic pain nursing care plan samples. These four chronic pain nursing care plans are for cancer, osteoarthrosis, HIV, and rheumatoid arthritis.
Reference
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Doenges, M., Murr, A., & Moorhouse, M. (2019). NURSING CARE PLANS: Guidelines for Individualizing Client Care Across the Life Span (10th ed.). F. A. Davis Company.
Gulanick, M. and Myers, J. (2014). NURSING CARE PLANS: Diagnoses, Interventions, and Outcomes (8th ed.). Elsevier/Mosby.
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