Pain can be defined as unpleasant feeling either physical, sensory or emotional associated with potential or actual tissue damage. It is considered the first symptom that makes patients visit the health institution (Mclean S. et al. 2004). Though it involves multi-professional team to treat pain, nurses play a very significant role as they are the one who spends most of the time with the patients. They are involved from the first stage to establish the cause of the pain, frequent assessment of pain, provide treatment and do follow-ups. For these reasons, nurses should be well equipped with adequate and correct knowledge of pain management.  Although there are a lot of advances in medical fields, under-treatment of pain remains unresolved.This is so because most nurses are found to have inadequate knowledge and wrong attitude in pain management (Jones KR et al., 2004). 

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       Pain management is a compelling and universal requirement. A study was done at Tribhuvan University Hospital (TUTH) which is one of the largest hospitals in Nepal, revealed that most nurses have the wrong attitude toward pain management. Similar outcomes were obtained in another study conducted in Turkey (Yava A et al., 2013). This evidence of the lack of knowledge in pain management was emphasized by another similar study done among Jordanian nurses. The outcomes demonstrated that more health care providers including nurses are trained to concentrate more on the disease rather than pain and sufferings. 

      Studies have revealed that most nurses determine the intensity of the pain through the behavior of the patient rather than the statements given by the patients. This was demonstrated by a study done by Bernardi M et al, 2007and Omran et al., 2017. The report of the patients should be more reliable in determining the intensity of the pain as opposed to the behavior (Mccaffery M, 1990). The first and the foremost step in pain management is to establish whether there is the pain. This study showed that nurses could not recognize the patient in pain. Nurses rely on vital signs and ignore patient’s statements. As a result, they tend to inject the patient with sterile water to establish the pain. Studies have also revealed that most nurses do not understand the magnitude of the pain in cancer patients due to lack of knowledge of the pharmacological features of cancer-treating drugs such as opioids (Lui LYY, SO wkw and Fong DYT,2008). 

      Studies have shown that there is no relationship between knowledge and attitude with other factors such as age, education, working area and duration of work. ( Glajchen M.and Bookbinder M. 2001) .  This was an inconsistency with what was established by Yava  et al. who demonstrated that nurses with a higher level of education have a considerably better understanding of pain.  

Dimensions of Effective pain management

      Lack of integrated proper pain management can lead to unnecessary physical, psychological, emotional adverse implications. The World Health Organization together with many professional organizations has established that pain management is a very crucial aspect of patient care. 

    The American Pain Society has raised the most current procedures for improving pain management. These procedures include fast recognition and treatment of pain, working together with the patient in the pain management plan, improvement of treatment patterns, re-establishment and adjustment of the pain management plan as required and evaluation of processes and results of pain management. 

Benefits of efficient pain management

    Efficient pain management enhances flexibility, productivity and minimizes side effects of small intestines, urinary retention, and functioning of the heart. Pain management also reduces insomnia that can lead to postoperative fatigue. Patients together with their families can respond to stress when their physiological pains are well managed. The other benefits of pain management include increased productivity, reduced expenditure and earlier overall recovery, improved quality of life and health care systems (14)


    Nurses are the most critical part of the multidisciplinary approach in pain management. Therefore their knowledge and attitude make a big difference hence the need to equip them with regular in-service education on pain management according to the World Health Organization and American Pain Society. 


Bernardi M, Catania G and Lambert A et al. Knowledge and attitudes about cancer pain management. A national survey of Italian oncology nurses. European Journal of Oncology Nursing; 11(3), 272-279.

Jones KR, Fink R, and Pepper G et al. (2004). Improving nursing home staff knowledge and attitude about pain. The Gerontologist, 44, 469-478

McCaffery M , Beebe A. Pain (1990) Clinical Manual for Nursing Practice. Journal of Pain and Symptoms  Management 5 (5) : 338-339

Mclean S, Domeier R, and Devore H. Et al. (2004).  The epidemiology of pain in pre-hospital           settings. Prehospital Emergency Care, 4, 402-405 

Omran S. Qadire MA. And Ali NA et al. (2014) Knowledge and attitudes about pain management: A comparison of oncology and Non- oncology Jordanian nurses. Nursing and Health; 2(4), 73-80Yava A, Cicek H, and Tuson N et al. Knowledge and beliefs about pain management in Turkey.  International Journal of Caring Sciences, 6 (3), 494-505

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