new video designed to help patients better communicate their pain after surgery may someday be a fixture in preoperative classes, doctors' waiting rooms, and clinics.

The 15-minute video, inspired by the research of Deborah McDonald on decreasing postoperative pain, was produced by the University's Center for Instructional Media and Technology.

McDonald, an associate professor of nursing, observed that despite advances in pain management, many patients continued to have high levels of pain.

She began conducting research to examine how patients, particularly older adults, manage their pain, and how doctors and nurses can best help them.

A study completed in 1999 showed that elderly people who watched a slide show teaching postoperative pain management and pain communication skills before their joint replacement surgery had significantly less pain than those who did not receive this preoperative teaching. The study was done in collaboration with clinical nurse specialists from St. Francis Hospital and Medical Center.

A $106,000 grant from the National Institute of Nursing Research allowed McDonald to undertake a further study - still underway at St. Francis and Hartford Hospitals - with elderly patients awaiting joint replacement surgery.

McDonald hopes the video will be a way of conveying some of the pain management information gathered during these studies to a wider audience.

The first part of the video, "Managing Your Pain After Surgery," concerns general techniques for dealing with pain and pain medication. The development of patient-controlled analgesics has been a breakthrough, according to McDonald, and allows those recovering to administer their own pain medication through an intravenous pump. The dosage is pre-set and the pump is programmed so that patients cannot over-medicate themselves. McDonald emphasizes in the video that it is rare to become addicted to pain medication taken for postoperative pain.

Many patients still rely on pain medication administered at set times or as needed by nurses. Whatever the medication, McDonald says, "it should be taken before the pain increases. Don't wait until the pain is severe before asking for more medication."

She also suggests other procedures that may enhance a patient's sense of well being and reduce pain, including relaxation techniques, deep breathing, massage, and distraction - watching television or listening to music. All of these are demonstrated on the video.

The second part of the video, "Communicating Your Pain After Surgery," illustrates what McDonald believes is a major problem in pain management: mis-communication between caregivers and patients.

"I realized that many patients did not know how to talk about pain, or talked about their pain in the wrong way," she says. Patients may be too stoic, believing they should not complain or take up too much of the caregiver's time. Others may communicate ineffectively, omitting important pain information such as the location or intensity of the pain.

As for caregivers, they may be rushed and unable to listen closely or perceive non-verbal signals of pain. "I think caregivers also make a mistake by frequently opening our conversation with patients by asking 'how are you feeling?'" she says, adding that this might encourage patients to respond in a socially acceptable way, and not complain of their pain.

A better approach might be to ask patients, "tell me how much pain you're having."

During the video and when talking with patients, McDonald emphasizes the subjective nature of pain: "you are the expert on the subject of your own pain," she says.

She suggests that patients use a pain scale from 0-10 to help them determine their level of discomfort, with 0 representing no pain and 10, the highest level of pain intensity.

McDonald urges patients to make sure that discussion of pain comes first when speaking to a doctor or nurse, if it is a priority. Often patients feel they should engage in polite social talk before discussing problems, but caregivers have only limited time to spend with each patient and that time needs to be used well, she says.

She also urges patients to be clear when talking about their pain, identifying the precise location of the pain; how it feels(e.g. burning, pounding); and how it responds to pain medication.

"Observe the body language of the caregiver," she adds, "if they look puzzled, ask them if they understand what you are saying and repeat it if necessary. If you don't understand something they are saying, ask them to repeat it."

The main point, says McDonald, is to help people keep their pain low and under control, so they can get better faster, and back to a more active, healthy life.

The video was filmed at St. Francis Hospital using actual doctors and nurses and volunteers who played the roles of patients, and directed by Lisa Letendre, a media producer at UCIMT. It was narrated by Mark J. Roy, a media specialist in University Communications.

Diane Cox