Pain

Question 1

Definition of Pain

Answer 1

• 2020 IASP Definition: Pain is an unpleasant sensory and emotional experience linked to actual or potential tissue damage.
  o Canada: 1 in 5 Canadians experience chronic pain, with a 40% prevalence in older adults.
  o Pain management is influenced by the opioid crisis and systemic issues like racism and colonialism.

Question 2

Types of Pain

Answer 2

1. Nociceptive Pain: Direct response to tissue damage.
2. Neuropathic Pain: Linked to nerve damage or dysfunction.
3. Nociplastic Pain: Altered nociception without clear tissue damage.
4. Mixed Pain: Involves multiple pain sources.
5. Referred Pain: Felt in a location different from the source.
6. Acute vs. Chronic Pain: Based on duration.

Question 3

Pain Assessment

Answer 3

• Tools and Scales:
  o Examples: Horizontal/vertical pain scales, faces pain scale.
  o Pediatric: FLACC scale.
  o Nonverbal: PAINAD, CPOT for behavioral indicators.
• Behavioral Indicators: Facial expressions, body movements, muscle tension, vocalizations, breathing.
• Vital Signs: Cannot reliably indicate pain.
• Factors Influencing Assessment:
  o Interpersonal: Age, sex, gender.
  o Contextual: Medications, mechanical ventilation.
  o Decoding: Observer bias, family perceptions, professional training.

Question 4

Stepwise Approach to Pain Assessment

Answer 4

1. Self-Report: Attempt verbal or simple yes/no responses.
2. Behavioral Indicators: Use validated tools for nonverbal patients.
3. Family Input: Identify usual pain behaviors.
4. Intervention: Provide pain relief and reassess effectiveness.
5. Documentation: Record all assessments and interventions.

Question 5

Cultural Considerations

Answer 5

• Reflect on biases in pain assessment tools.
• Consider the impact of cultural beliefs, trauma, systemic racism, and colonialism.
• Marginalized communities often experience undertreated pain due to value judgments.
• Indigenous children may not express pain outwardly due to cultural traditions and historical trauma.
• Advocacy for understanding cultural influences on pain expression is essential.

Question 6

Pain in Older Adults

Answer 6

• Pain Perception:
  o Older adults do not have diminished pain sensitivity.
  o Chronic pain is common but not a normal part of aging.
• Common Pain Conditions: Arthritis, osteoporosis, peripheral vascular disease, angina.
• Acute Pain:
  o Short-term, self-limiting.
  o Examples: Surgery, trauma, kidney stones.
  o Serves a protective purpose (warns of tissue damage).
• Persistent (Chronic) Pain:
  o Lasts ≥6 months, often beyond normal healing.
  o Categories:
   Malignant: Related to cancer; fluctuates with disease progression.
   Nonmalignant: Associated with conditions like arthritis, back pain, fibromyalgia.
  o Pathophysiology:
   Peripheral sensitization: Lowered pain threshold.
   Central sensitization: Increased CNS neuron excitability.

Question 7

Pain Assessment Tools

Answer 7

• Numeric Rating Scale (0–10): Common for adults.
• Faces Pain Scale—Revised (FPS-R):
  o 6 facial expressions (0 = no pain; 10 = severe pain).
• Descriptor Scale (for older adults):
  o Uses words like no pain, mild, moderate, severe.

Question 8

General Points

Answer 8

• Behavioral pain assessment tools help detect presence of pain but cannot measure severity.
• Patients who cannot verbalize pain are at high risk for undertreatment.

Question 9

Acute Pain Behaviors

Answer 9

• Reasons for inability to verbalize pain: cognitive or physical limitations (e.g., intubation).
• Nonverbal but cognitively intact individuals may:
  o Use a Numeric Rating Scale.
  o Write a description of pain.
  o Point to the pain location.

Question 10

Persistent (Chronic) Pain Behaviors

Answer 10

• Over time, patients adapt to pain, reducing observable pain behaviors.
• Behaviors like grimacing, guarding, and diaphoresis may not persist.
• Chronic pain patients are at risk for underdetection.
• Ask patients how they behave when in pain for accurate assessment.

Question 11

Unconscious Individuals

Answer 11

• Unconscious patients can still feel pain, which may manifest as:
  o Grimacing, wincing, moaning.
  o Rigidity, arching, restlessness.
  o Shaking or pushing movements.
• Critical-Care Pain Observation Tool (CPOT):
  o Assesses facial expressions, body movements, muscle tension, vocalizations, and ventilation compliance.
  o Scores range from 0 to 8 (higher scores indicate more pain).