Lecture 3

Question 1

Pain is considered which vital?

Answer 1

The 5th

Question 2

Assumption 1: Patient will be able to…

Answer 2

tell exactly how the pain feels
o Assessment
 Where does it hurt? Does pain move? Point to place of pain. Identify all areas pain is felt.

Question 3

Assumption 2: People may have…

What’s the assessment and theory?

Answer 3

more than one kind of pain
o Assessment
 Do you have more than one spot where it hurts?
 When does the pain happen? How long does it last? Does the pain come and go?
o Theory
 Some caused by identified disease, some caused by medical treatments, some unrelated pain.

Question 4

Assumption 3: Pain may stop people from…

What’s the assessment, theory, utility?

Answer 4

moving, walking, climbing stairs, bathing, working, playing, or getting around
o Assessment
 Does pain keep you from doing all you want to do?
o Theory
 Sometimes pain interferes with thinking, concentration, being close to other people
o Utility
 Describing how pain limits life will help the doctor or nurse set goals for dealing with your pain

Question 5

Assumption 4: When pain interferes with….what can it do?

What’s the assessment, treatment, and theory?

Answer 5

when pain interferes with sleep, mood, or appetite, it can affect parts of life
o Assessment
 Does pain interrupt your sleep? Does it change your mood? Affect your appetite?
o Treatment
 A first goal for treatment may be to improve sleep
o Theory
 Pain can also cause one to feel grumpy or sad, especially when it lasts a long time
 Pain can change the way people eat and cause some to gain or lose weight.
 Pain that won’t go away changes the way patients feel about themselves and others

Question 6

Assumption 5: Many people fear…

What’s the assessment and theory?

Answer 6

what the pain may be indicating
o	Assessment
	What do you think causes the pain?
o	Theory
	Cancer or another life-threatening disease or that a previous disease is spreading or has returned

Question 7

Assumption 6: People try lots of…

What’s the assessment and theory?

Answer 7

things to relieve pain
o Assessment
 What makes the pain better? What makes it worse?
o Theory
 Some things work well; other may not work at all
 Sometimes pain occurs when moving a certain way
 Sometimes staying in one position eases the pain
 Sometimes movement helps—like walking with back pain

Question 8

Assumption 7: Different kinds of pain…

What’s the assessment, utility, and theory?

Answer 8

respond to different treatment
o Assessment
 What have you tried to relieve the pain?
o Utility
 What has been tried and worked or failed is very helpful info
o Theory
 Relaxation, meditation, heat, cold, or mild exercise may all relieve some kinds of pain
 Certain medicines, including over-the-counter or supplements may or may not have relieved the pain

Question 9

Assumption 8: Patients need to know about or bring…

What’s the assessment?

Answer 9

in their meds for accurate records
o Assessment
 What medicines are you taking for pain right now?
 The name, amount of medicine, time the medicine was take, amount of relief, and any side effects

Question 10

Assumption 9: Meds that have not worked before…

What’s the assessment?

Answer 10

work if taken in a different way
o Assessment
 How are you currently taking medications to relieve pain?
 Describe how long the medicine takes to work, how long does pain relief last? Does all the pain go away after you take the medicine? Does the pain return before the next dose is due?

Question 11

Assumption 10: Managing medication side effects…

What’s the assessment and theory?

Answer 11

helps with adherence
o Assessment
 Do you have any side effects from medicines you are taking? Do you have any allergies?
o Theory
 Medication for severe pain cause constipation and other challenging side effects.
• Dealing with constipation is an important part of the pain control. People given opiates should expect to be asked about bowel movements at each visit
• Two days is too long to go without a bowel movement when taking most medications for severe pain

Question 12

Assumption 11: Asking now about issues that can affect compliance/adherence…
What’s the assessment and theory?

Answer 12

is smart!
o Assessment
 Do you have any worries about taking medicines for pain relief?
o Theory
 Many people worry about taking medicines, especially narcotics or opiates, for pain relief (addiction/side effects)
 Many people do not take because of this fear

Question 13

New guidelines: Patients are asked their goal for pain relief: strengths-based approach: Examples are…

Answer 13

• How much relief would allow you to get around better?
• What is your goal for pain relief
• The goal may be based on the ratings scale (e.g., 2 on a scale of 0 to 10).
• Goal may focus on activities the patient wants to accomplish (e.g., walking without pain, being able to work).

Question 14

If referral from primary care clinic, follow these guidelines

Answer 14

•	FLOW:
o	Psychological history, social history, family history, home environment (F*UCKING SCID)
•	TIPS:
o	Try hard not to come to conclusions
o	Reflective listening
o	Reassure
o	Restate your role
o	Seek consensus
o	Normalize psychological symptoms