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PHRM 100 – IMM > IMM 12: Pain Assessment > Flashcards

IMM 12: Pain Assessment Flashcards

1
Q

What is acute pain?

A

pain from an isolated event with a beginning and an end – ie. from injury

  • has a positive purpose
  • often accompanied by signs of ANS activity – ie. sweating, pallor, tachycardia, hypertension
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2
Q

What is chronic pain?

A

pain persisting > 3-6 months presenting in a circular or cyclic pattern – ie. nerve pain

  • serves no physiological function
  • usually devoid of physical signs and symptoms
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3
Q

What are the 3 overall goals of pain assessment?

A

capture the patient’s individual pain experience in a standardized way

  • determine the effect and impact the pain experience has on the patient and their ability to function
  • identify individual patient’s goals

develop a treatment plan to manage pain

  • compare effect of therapy to patient’s goals of therapy
  • reassess regularly

promote communication between the interdisciplinary team members

  • ensures continuity of care, patient safety, and improved patient outcomes
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4
Q

List the hierarchy of pain assessment from most reliable to least reliable.

A
  • patient’s self-report
  • pathologic conditions or procedures that usually cause pain
  • observe behaviours (ie. facial expressions, hand clenching, writhing, sleep disturbances, crying, poor feeding)
  • ratings from caregivers (ie. report from parent, family member, others close to patient)
  • physiologic measures (ie. ↑ HR, ↑ BP, ↑ RR, ↑ muscle tone, sweating, flushing, pallor)
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5
Q

What is the general history part of pain assessment?

A
  • chief complaint
  • history of present illness
  • past medical history
  • family history
  • social history
  • medication history
  • allergies
  • review of systems
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6
Q

What is the clinical exam part of pain assessment?

A

physical exam

  • vital signs: HR, BP, RR
  • observations of patient’s behaviours, movements, etc.
  • generalized MSK or NEURO examination
  • focused examination for local/regional pain

functional assessment

  • evaluate impact of pain on activities of daily living (ADL)
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7
Q

Conduct a pain history using the “OPQRSTUV” acronym.

A
  • Onset: when did it begin, how long does it last, how often does it occur
  • Provoking/Palliating: what brings the pain on, what makes it better, what makes it worse
  • Quality: what does it feel like, can you describe it – ie. dull, aching, burning, sharp, stabbing, shooting, pulsating
  • Region/Radiation: where is it, does it spread anywhere, does it follow a pattern
  • Severity: what is the intensity of the pain now/at best/at worst/on average, do other symptom(s) accompany the pain
  • Treatment: what medications and treatments are currently used, how effectie are they, any side effects, what was used in the past
  • Understanding the Patient: how is the pain affecting them, how has it affected their quality of life and activities of daily living
  • Values of the Patient: what are the goals in managing the pain, what is an acceptable pain level
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8
Q

What are single dimension pain assessment tools?

A

measures pain intensity

  • simple to administer and easy to understand by patients
  • reproducible
  • sensitive to small changes in pain
  • useful in acute pain when etiology is clear, but may oversimplify pain
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9
Q

What are multi-dimension pain assessment tools?

A

measures intensity, nature, location of pain

  • assesses impact on activity or mood
  • provides information on need for social support, interference with ADLs, treatment for depression
  • useful in complex or persistent acute or chronic pain
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10
Q

What are the 4 single dimension pain assessment tools?

A
  • numeric rating scale (NRS)
  • visual analog scale (VAS)
  • Wong-Baker faces pain scale
  • faces pain scale – revised (FPS-R)
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11
Q

What are the advantages and disadvantages of the numeric rating scale (NRS)?

A

number on scale from 1-10

advantages:

  • reliable with good validity
  • detects treatment effects acutely
  • easy to administer – may be administered verbally

disadvantages:

  • decreased validity with extremes of age
  • difficult to use with cognitive, visual, and auditory impairment
  • not sensitive to long-term changes in pain
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12
Q

What are the advantages and disadvantages of the visual analog scale (VAS)?

A

none, mild, moderate, severe

advantages:

  • reliable with good validity
  • useful with patients who have difficulty translating pain experience into a numeric value
  • easy to administer

disadvantages:

  • limited number of response categories
  • patients must be familiar with the terms
  • may not find a descriptor that accurately describes perceived pain intensity
  • decreased validity in illiterate patients
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13
Q

What are the advantages and disadvantages of the Wong-Baker faces pain scale?

A

cartoon faces

advantages:

  • reliable with good validity in pediatric and adult patients
  • useful for patients with poor literacy or language barrier

disadvantages:

  • requires abstract thinking
  • not specific for pain
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14
Q

What are the advantages and disadvantages of the faces pain scale – revised (FPS-R)?

A

realistic faces

advantages:

  • reliable with good validity in pediatric and adult patients
  • useful for patients with poor literacy or language barrier
  • makes it possible to score pain using the widely used 0-to-10 metric
  • absence of smiles and tears

disadvantages:

  • requires abstract thinking
  • not specific for pain
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15
Q

What are the 4 multi-dimensional pain assessment tools?

A
  • pain diary
  • brief pain inventory
  • McGill pain questionnaire
  • initial pain assessment tool
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16
Q

What is a pain diary?

A

oral or written account of patient’s day-to-day experiences

  • patients record pain intensity as it relates to behaviours such as ADLs, sleep, sexual activity, when pain medications are taken, meals, recreational activities
17
Q

What are the advantages and disadvantages of a pain diary?

A

advantages:

  • useful in monitoring daily variations in disease states and patient’s response to therapy

disadvantages:

  • time-consuming
  • daily adherence often difficult
18
Q

What is a brief pain inventory?

A

captures 2 broad domains:

  • sensory intensity of pain
  • degree to which pain interferes with ADLs
19
Q

What are the advantages and disadvantages of a brief pain inventory?

A

advantages:

  • reliable with good validity
  • may be administered written or verbally
  • sensitive to change over time
  • addresses mood, quality of life, and daily functioning

disadvantages:

  • does not assess quality of pain
20
Q

What is the McGill pain questionnaire?

A

self-report questionnaire that evaluates quality of pain and intensity of pain

  • quality: uses 78 words that describe the sensory, affective, and evaluative aspects of pain, and scored to give “pain rating index” (PRI)
  • quantity: uses a 5-point scale to rate “present pain intensity” (PPI)
21
Q

What are the advantages and disadvantages of the McGill pain questionnaire?

A

advantages:

  • reliable and valid in both cancer and non-cancer pain
  • valid in elderly patients
  • measures sensory and affective components of pain
  • short-form (SF-MPQ) is available

disadvantages:

  • long-form is more time consuming
  • requires patients to understand terms used in the questionnaire
22
Q

What is an initial pain assessment tool?

A
  • used to guide clinicians through an initial assessment of patient’s pain
  • describes location, intensity, quality, causes, effects, and contributing factors of pain
23
Q

What are the advantages and disadvantages of an initial pain assessment tool?

A

advantages:

  • easy to administer
  • addresses sensory and some affective components
  • uses open-ended questions

disadvantages:
- similar to a “OPQRST” assessment

24
Q

What are the 4 non-verbal assessment tools?

A
  • adult non-verbal pain scale (NVPS)
  • PAINAD scale
  • FLACC behavioural pain assessment scale
  • CRIES scale
25
Q

What is the adult non-verbal pain scale (NVPS)?

A

used in critical care patients (ie. trauma, surgery, burn, open heart surgery, intubated patients)

26
Q

What are the advantages and disadvantages of the adult non-verbal pain scale (NVPS)?

A

advantages:

  • good reliability and validity
  • allows for standardized pain assessment in non-verbal patients
  • parameters include ventilator synchrony (for intubated patients)

disadvantages:

  • poor inter-rater reliability in burn patient populations
27
Q

What is the PAINAD scale?

A
  • used in advanced dementia patients who may be in pain – in hospital and long-term care
  • assess patient during different periods of activity (at rest, ambulating, turning over, transferring)
28
Q

What are the advantages and disadvantages of the PAINAD scale?

A

advantages:

  • reliable in verbal and non-verbal dementia patients
  • valid in patients ranging from mild to severe cognitive impairment
  • may be useful in elderly patients reluctant to report pain

disadvantages:

  • clinicians may compare 0 to 10 score on PAINAD scale with 0 to 10 score on numeric rating scale – no evidence that the PAINAD score correlates with self-reported graduations of pain
29
Q

What is the FLACC behavioural pain assessment scale?

A
  • assesses 5 behavioural variables associated with pain
  • used for non-verbal or pre-verbal pediatric patients
30
Q

What are the advantages and disadvantages of the FLACC behavioural pain assessment scale?

A

advantages:

  • good reliability and validity in children 2 months to 7 years of age
  • may be used in patients who are awake (observe for 1-5 mins) or asleep (observe for ≥ 5 mins)
  • easy to use

disadvantages:

  • cannot be used in intubated or paralyzed patients (who cannot illicit behavioural symptoms)
  • not all variables are caused solely by pain
31
Q

What is the CRIES scale?

A

often used for post-operative pain assessment in neonates

32
Q

What are the advantages and disadvantages of the CRIES scale?

A

advantages:

  • assesses 5 physiological and behavioural variables shown to be associated with neonatal pain
  • good reliability and validity
  • easy to use

disadvantages:

  • cannot be used in intubated or paralyzed patients (who cannot cry or grimace)
  • not all CRIES variables are caused solely by pain

PHRM 100 – IMM (22 decks)

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