Pain Assessment and Management – A Case Study Approach in UK Nursing Practice

Assignment Question:

Using a case study approach, critically reflect on your experience of assessing and managing a patient’s pain. Discuss the application of pain theories, assessment tools, and both pharmacological and non-pharmacological interventions. Evaluate the effectiveness of your approach and consider any barriers encountered in delivering optimal pain management.

Why Pain Management Matters in Nursing

Pain is our constant companion from the moment we are born. In a sense, it is our only true friend, who, come what may, vows never to abandon us! Be it physical or emotional, pain produces (and repeats) the same result – it overwhelms us to the point where we can no longer think straight, move on, or heal.

The same is true for patients. Managing pain, therefore, should never be about ticking off some literally and metaphorically colourless checklist created by a bunch of lonely academicians with no life. Pain management must always be about connecting with the patient, recognizing their suffering early on, and putting targeted interventions in place that actually reduce their pain, instead of being only functional on paper (Driscoll et al., 2021).

6 months ago, I tended to an elderly male patient in a dialysis unit at one of the NHS Units I was working in. He was experiencing chronic lower back pain during sessions, and it made the already unbearable treatment feel even more insufferable.

Like how faith begins where science stops, practice comes into play when theory falls short on answers. This case reminded me just how central pain management is to what we do every day as nurses, and the following sections will explain why.

Quick Look at Pain Theories That Inform Practice

Before we being, let us get some dull, theoretical talk out of the way.

Pain is complex – two people can go through identical conditions, and yet feel totally different levels of discomfort (Coghill et al., 2003).

The Gate Control Theory says that pain signals can be either blocked or allowed through “gates” in the spinal cord, explaining how interventions like distraction or heat can sometimes work (‘sometimes’, being the operative word) (Heitler, 2023).

The Biopsychosocial Model, on the other hand, describes pain as a combination of physical, emotional, social factors; as well as personal beliefs (Smart, 2023). To simplify even further, this meant that isolation and fear could potentially amplify my patient’s physical symptoms.

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Case Background: Meet My Patient

Noah, a 74-year-old male with stage 4 chronic kidney disease, had been receiving dialysis at our NHS unit for the past six months. Over these six months, he began to complain about persistent lower back pain: especially during the last hour of his sessions. Noah was visibly uncomfortable, often shifting in his seat and making faces. When enquired, he rated his pain 8/10, describing it as a “deep ache”.

Noah lived alone, had little to no mobility, and often appeared lost in thought. He rarely started conversations and said he felt like a burden. His pain was, evidently, taking an undeniable toll on his emotional wellbeing. With an evident lack of dignity, independence, and human connection, Noah was clearly far from doing well.

How the Pain Was Assessed – Tools in Action

Going by the book, I began with the Numeric Rating Scale (NRS) to understand and assess Noah’s pain clearly and monitor it effectively over time (Kumari et al., 2022). His previous rating of 8/10 during dialysis triggered a formal care plan. The NRS was helpful for quick snapshots, but sometimes he struggled to describe exactly what he was feeling.

Suspecting that Noah found numeric scales abstract, I introduced the Wong-Baker FACES Pain Scale; which, though designed for children, can work well for adults under special circumstances (Lawson et al., 2022). On days Noah was too tired to talk much, he found it to be rather helpful.

I also remembered some of my colleagues using the PAINAD scale in our unit for patients with dementia. In PAINAD, facial expression, body language, and breathing can reveal a lot more than words at times (Bellas & Piirainen, 2024). While Noah wasn’t cognitively impaired, and it was tempting to skip these tools under staffing pressures, I figured they would save time in the long run by providing measurable data to justify interventions.

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What the Plan Was – Pharmacological Interventions

Given Noha’s age and renal condition, I administered conservative dosage of acetaminophen as per the NICE guidelines for older adults with chronic non-malignant pain (Zambelli et al., 2022). It was safer, was easy for him to tolerate, and did not interact with his dialysis medications either.

I briefly considered opioids, but ultimately chose to avoid them given his kidney function, risk of sedation, and respiratory depression. That being said, I kept codeine on standby for breakthrough pain, with GP input and careful documentation.

My team reassessed Noah’s pain after every dialysis session using the NRS scale, and within a week of regular paracetamol, Noah reported a 5/10 pain rating, and his mood had visibly improved.

Going Beyond Pills – Non-Pharmacological Interventions

While some would give the credit to acetaminophen (paracetamol) alone in this case, for me, medication was not the whole story at all. First of all, we had also introduced gentle repositioning during dialysis sessions. Even tiny shifts in posture sometimes reduced pressure on Noha’s lower back and made him feel more comfortable. We timed this with the dialysis cycle to avoid disrupting the process.

We also opted for heat therapy: a warm pack was often placed carefully on his lower back. Gate Control Theory seemed rather effective here, considering Noha’s reduced pain signals at the spinal level.

However, we also added distraction techniques in the mix. Sometimes, I offered Noah headphones and music; some days, I just chatted about cricket or his family. Following these techniques, Noah became more alert, social, and visibly calmer.

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Did It Work? Evaluating Effectiveness

The results were clear. Over two dialysis sessions, Noah’s pain went from 8/10 to 4/10. It may not seem dramatic, but it made a world of difference to Noah. He became more relaxed, chatted more, and no longer winced every time he shifted.

What stood out most was the emotional relief. Less pain meant less fear, less frustration. His mood improved, and he started engaging more with staff and his care routine. I was quite ecstatic about Noah’s improvements, and had a rather hard time not drawing comparisons between grumpy old Noah and Dr. House in my head!

Barriers I Faced as a Nurse

Of course, it was not all smooth sailing.

Staff shortages were a real issue. With only a few nurses covering a busy dialysis ward, I often had to choose between non-drug pain relief and completing other tasks. That meant interventions like repositioning or heat therapy could not always be applied consistently.

Since Noah was withdrawn and nearly incommunicado in the beginning, understanding his pain relied more on observation than verbal feedback.

And then there was the institutional pressure – charting, targets, throughput, and whatnot. NHS systems reward ‘efficiency’ over empathy, which makes reflective, patient-centred care in the UK healthcare system utopian at best.

What I Learned – Reflective Practice

This case taught me that pain is never just physical; it is dynamic, influenced by mood, environment, and even the nurse standing beside the patient.

A few weeks of observing Noah made me a polyglot in non-verbal cues: my instincts took over, and his clenched fists, tense shoulders, and even his silence spoke to me in depth.

Combining theories (like the Gate Control Model), validated tools (like NRS), and empathy allowed me to create a care plan that worked. It also deepened my understanding of clinical judgement. I took the NMC Code of “prioritising people” (Adams, 2024) by heart, and it seemed not to disappoint me.

What Can Be Done Better?

For the Noah’s of the world, we require more than goodwill – we need structural change:

• Nurses need more time to reflect and document thoroughly.
• Interdisciplinary collaboration must be tuned down to the last piston – there must be a shared care plans between nurses, doctors, physiotherapists.
• Communication training focused on patients with complex needs like Noah could make all the difference in pain management settings.

Conclusion

Legends say that when Joan of Arc walked through the war tents from Reims to Rouen, soldiers felt better at the mere sight of her (Schwarz, 2022).

Every ache has a backstory, and every intervention carries emotional weight. Like Joan of Arc standing amidst the flames, nurses—and the field of nursing itself—must often carry conviction and compassion into clinical systems that burn with bureaucracy and urgency. Reflective, holistic pain care in nursing, thus, is our quiet rebellion against cold, calculated ‘efficiency.’

FAQs

1. What are the best pain assessment tools for elderly patients in the UK?
   The Numeric Rating Scale (NRS) and Wong-Baker Faces Scale are commonly used. For patients with dementia, the PAINAD tool is preferred.
2. How can nurses choose between medication and alternative pain relief methods?
   Start with a full assessment. If pain is mild to moderate, combine paracetamol with non-drug strategies like heat or distraction. Avoid opioids unless essential.
3. What makes pain management so complex in nursing?
   Pain is subjective. Each patient responds differently. Time pressures, communication gaps, and resource shortages complicate it further.
4. How do NHS staffing levels impact patient pain relief?
   Low staffing often means fewer opportunities for non-pharmacological care. Nurses may be rushed, leaving less time for repositioning, listening, or follow-up assessments.
5. What’s the most important lesson for nurses managing chronic pain?
   Balance science with empathy. Use pain theories and tools, but never forget to listen, observe, and adapt to the whole person behind the symptom.
   

References

Adams, J. (2024). Decision-making in evidence-based practice: The law, ethics and values. In M. Owens, J. Adams, V. Welsh, H. Smith, & P. Rogers, Understanding evidence-based practice for nursing associates (p. 83). Learning Matters. http://digital.casalini.it/9781529617849

Bellas, M., & Piirainen, J. (2024). The challenges of pain assessment in dementia patients: A literature review from a nursing perspective [Bachelor’s thesis, Arcada University of Applied Sciences]. Theseus. https://www.theseus.fi/bitstream/handle/10024/859608/Bellas_Piirainen.pdf?sequence=2&isAllowed=y

Coghill, R. C., McHaffie, J. G., & Yen, Y.-F. (2003). Neural correlates of interindividual differences in the subjective experience of pain. Proceedings of the National Academy of Sciences, 100(14), 8538–8542. https://doi.org/10.1073/pnas.1430684100

Driscoll, M. A., Edwards, R. R., Becker, W. C., Kaptchuk, T. J., & Kerns, R. D. (2021). Psychological interventions for the treatment of chronic pain in adults. Psychological Science in the Public Interest, 22(2), 52–95. https://doi.org/10.1177/15291006211008157

Heitler, B. (2023). Primary afferent depolarization and the gate control theory of pain: A tutorial simulation. Journal of Undergraduate Neuroscience Education, 22(1), A58–A65. https://doi.org/10.59390/PWFC1224

Kumari, S., Jaya, C., Reddy, P., & Reddy, G. (2022). Pain intensity scales and studies comparing numerical rating scale and visual analogue scale. World Journal of Pharmaceutical Research, 11(7), 561–577. https://wjpr.s3.ap-south-1.amazonaws.com/article_issue/dc859b30c7a8e919497d139a27d4b87f.pdf

Lawson, S. L., Hogg, M. M., Moore, C. G., Anderson, W. E., Osipoff, P. S., Runyon, M. S., & Reynolds, S. L. (2021). Pediatric pain assessment in the emergency department: Patient and caregiver agreement using the Wong-Baker FACES and the Faces Pain Scale–Revised. Pediatric Emergency Care, 37(12), e950–e954. https://doi.org/10.1097/PEC.0000000000001837

Schwarz, V. (2022). Ride the wind, choose the fire: The story of Joan of Arc. Next Chapter.

Smart, K. M. (2023). The biopsychosocial model of pain in physiotherapy: Past, present and future. Physical Therapy Reviews, 28(2), 61–70. https://doi.org/10.1080/10833196.2023.2177792

Zambelli, Z., Halstead, E. J., Iles, R., Fidalgo, A. R., & Dimitriou, D. (2022). The 2021 NICE guidelines for assessment and management of chronic pain: A cross-sectional study mapping against a sample of 1,000 in the community. British Journal of Pain, 16(4), 439–449. https://doi.org/10.1177/2049463722108383