Essential Pain Management

Question 1

Overall EPM Aims (RAT)

Answer 1

Recognition
Assessment
Treatment

Question 2

RECOGNITION

What is Pain?

Answer 2

International Association for the Study of Pain (IASP)
Pain is ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
The cause is not always visible.
‘Pain is what the patient says hurts.’

Question 3

ASSESS
Assessment of Severity
(Why should we assess the severity of pain)

Answer 3

Guides choice of treatment
Measures response to treatment

‘Pain is the 5th vital sign.’
Measure and record severity

Question 4

Methods to assess pain severity

Answer 4

Verbal Rating Scale
Mild, moderate, severe
0 (no pain) to 10 (worst pain imaginable)
Visual
Visual Analogue Scale (VAS)
Faces Pain Scale (FPS)
Other more specialised methods

Question 5

ASSESS
Classification of Pain
“What type of pain is it?”

Answer 5

Not all pain is the same!
Three main questions:

“How long has the patient had pain?
What is the cause?
What is the pain mechanism?”

Question 6

Classification of Pain (duration)

Acute versus Chronic

Answer 6

Acute
Pain of recent onset and probable limited duration
Chronic
Pain lasting for more than 3 months
Pain lasting after normal healing
Sometimes no identifiable cause

Question 7

Classification of Pain (cause)

Cancer versus Non-Cancer

Answer 7

Cancer pain
Progressive
May be mixture of acute and chronic
Non-cancer pain
Many different causes
Acute or chronic

Question 8

Classification of Pain (mechanism)

Answer 8

Nociceptive Pain:
Obvious tissue injury or illness
Sometimes called physiological or inflammatory pain
Protective function
Description
Sharp and/or dull
Well localised
Neuropathic Pain:
Caused by a lesion or disease of the sensory nervous system
Peripheral
Central (spinal cord or brain)
Tissue injury may not be obvious
Does not have a protective function (adopting a protective pain behavior doesn’t help it to heal)
Description
Burning, shooting, pins and needles, or numbness
Not well localised