It hurts to move.

Staja Booker, PhD, RN

It’s 10:00, 15 hours postoperative, and your patient has eaten breakfast and is resting comfortably in bed. You ask the patient, “On a scale of zero to 10, how much pain are you having right now?” The patient replies “zero, as long as I don’t move.” The nurse documents the pain score as 0/10 and continues their rounds.

Most nurses are happy when patients report no pain. What is the nurse missing? The contextual factor called movement.

Several years ago, a research participant told me, “Ain’t no sense in getting up to hurt.” A very simple yet powerful statement began my quest to shift how we understand and assess the dynamics between pain and movement.

The realities are:

  • Movement increases acute pain postoperatively, and most patients are afraid to move even when the importance of ambulation is known.
  • Most patients need some type of pain medication or non-pharmacological intervention to engage in mobility-related activities.
  • Movement and mobility enhance recovery and rehabilitation.
  • Movement-evoked pain is as a major barrier to participating in activity-based interventions.

Movement-evoked pain is an important pain characteristic that describes pain and discomfort during active or passive motion of the affected area. Yet, despite awareness among nurses of the importance of setting function-related pain goals, most of our pain assessments are performed when the patient is resting at random times or at set intervals, or before or after activities. Rarely is pain assessed during activity or with movement at the point of care.

A movement-evoked pain assessment (also known as movement-based pain assessment) evaluates pain during movement, functional activities, or other physical tasks. At a more biological level, movement-evoked pain reveals how the nervous and motor systems are functioning together and highlights any dysfunction in pain responses. Understanding the patterns of pain at rest and during movement offers a unique opportunity to plan care with intentionality and develop a pain management plan that will control pain at its peak.

Moving the care paradigm.

Even with pain medications, the majority of postsurgical patients can expect to feel a certain level of pain with movement, especially at first. Pain goals specific to undertaking certain functions such as walking, transferring from bed to chair, or bathing/dressing that are set by the patient and clinician have long been understood as important. Despite this, we often assess pain before an activity or irrespective of the activity, then set a pain–function goal that is not congruent with the method of assessment. What differs in the model presented here is a specific and intentional goal by the nurse to assess pain during the activity. Yes, this is a shift in thinking! But new strategies are needed to tackle pain.

Since pain often occurs or increases with movement and has a significant impact on daily functional ability, a movement-evoked pain assessment can measure two critical recovery activities at once: pain and function. Movement-evoked pain assessment offers ‘real-time,’ individualized, and more precise report of pain that occurs with movement along with observation of function, such as gait, range of motion, and physical adaptations. We still remain overly focused on assessing pain intensity without consideration of the patient’s functional microenvironment.

Strategies for managing movement-evoked pain.

Movement is instrumental in recovery after surgery and good pain management can reduce pain that a patient may anticipate or experience during physical activities.

Don’t let movement-related pain overwhelm your patient. As nurses, we should:

  • Ask about pain during movement or significant activities.
  • Treat pain preemptively and proactively using multiple treatments and strategies.
  • Educate patients on the positive and negative impact of movement on pain and pain on movement.
  • Work with an interdisciplinary team to formulate a comprehensive pain management plan that addresses pain at rest, spontaneous pain, and movement-evoked pain.

The underlying goal is simple: how do we help postoperative patients get moving? To quote the advice in a James Brown song lyric, “Get up offa that thing/And shake ’till you feel better!”

(For more in-depth information on assessing and managing movement-evoked pain, see the two CE articles, “Assessing Movement-Evoked Pain” and “Overcoming Movement-Evoked Pain to Facilitate Postoperative Recovery.”)

Staja “Star” Booker, PhD, RN, is a pain researcher and faculty at the University of Florida College of Nursing where she studies how older adults experience chronic joint pain.