pain 3 Flashcards
Assessment of pain – Adults & elderly
• It is important to give the person the opportunity to answer questions in
relation to their pain. Prompt them but let them describe it in their
own words.
• The pain is what the person says it is as it is their lived experience.
• A good pain assessment can give clues as to the nature of underlying
pathology and can assist in making treatment choices.
Assessment of pain – Special groups
• Those who are from Aboriginal, TSI, Pacific or Asian backgrounds
are more likely to underreport pain when compared to those of
European background
• Cultural norms
• Stoicism
• Mistrust of health care professionals
• Family values (maintenance of privacy or religious beliefs)
• Learn to ask questions in a way that will help you identify the
presence of pain
“are you able to do as much exercise as you usually are?”
“have your sleeping/eating habits changed recently?”
• Observe for changes in facial expressions, body posture and vital
signs
Assessment of pain - non-verbal or intubated patient
For people who cannot selfreport their pain (such as an intubated patient or a patient who has had a stroke) it is best to consistently use a behaviour pain scale such as the FACES pain rating scale so they can point to how they are feeling. This scale may also be used for developmentally delayed patients and there are versions in other languages.
Assessment of pain – patients
with dementia
• This group is particularly at risk of living with chronic pain,
poorly managed, as they frequently are unable to verbalise
they are in pain.
• Studies have shown this group is less likely to have their
pain assessed and treated than people who have no
cognitive impairment.
• The Abbey Pain Scale is a validated assessment tool for use
in people with dementia who are unable to communicate
they are in pain. It relies on the nurses observation of nonverbal signs of pain including body language and
physiological signs of pain such as tachycardia, diaphoresis
etc
Chronic Pain assessment
• Assessment of chronic pain has many similarities to acute pain
assessments
• Begin with a comprehensive pain assessment (e.g. PQRTSU),
evaluation of psychosocial factors (pain beliefs, coping strategies,
mood and social interactions)
• Physical assessment (focus on neurological and musculoskeletal
systems)
• Assessment of the IMPACT of pain on functioning and QoL are
essential (Brief Pain Inventory Tool, pain diaries)
Management of pain: Non-pharmacological
- Cognitive behavioural therapy
- Acceptance and commitment therapy
- Mindfulness-based stress reduction
- Meditation
- Hypnosis
- Biofeedback
- Chronic pain self-management
- Distraction
- Reframing
- Relaxation techniques
- Encourage exercise
- Nutrition
- Environment
Management of pain: Pharmacological
Consider the WHO pain ladder.
• Start with non-opioid medication such as
paracetamol or NSAID (ibuprofen) for mild
pain.
• Can increase to mild opioid such as codeine.
• If pain persists can increase to stronger opioid
such as morphine or similar until the patient
is pain free.
Adjuvant therapy
includes medications that
are known to enhance the analgesic effect of
opioids (often used in treating chronic or
neuropathic pain) ie. Anticonvulsants
(gabapentin, pregabalin), Tricyclic antidepressants (amitriptyline) or Corticosteroids
(dexamethasone, prednisone).
Pharmacologcial pain considerations
• Choose least invasive and most appropriate route of administration,
usually oral. Other routes of administration include: transdermal, per
rectal, subcutaneous, intravenous and intrathecal. Intramuscular
injections are becoming less common due to variations in absorption
times.
• Ensure you monitor and educate the patient about potential side effects
of the medications whether they are opioids, NSAIDs or adjuvant therapy
such as anti-convulsants and anti-depressants.
Aspirin (Salicylate)
Use for mild-moderate pain and fever. Use with caution in patients with GI
ulcers or anaemia. Administer with food or milk. Enteric coated tablets best
for long term use. Not for use in children under 12 years of age.
Paracetamol
Use for mild pain and fever. Can cause hepatotoxicity and nephrotoxicity in
large doses. First drug of choice in children with pain or fever.
Diclofenac (NSAIM)
Monitor for GI upset, rash, drowsiness, dizziness, headache, oedema and
arrhythmias
COX-2 inhibitor (NSAIM)
Contraindicated in patients with allergy to Aspirin or Sulphonamides. May
impair bone healing. Risk of heart attack and stroke. Benefit>Risk
Ibuprofen (NSAIM)
Should give with food or milk. Monitor patient for visual disturbances.
Monitor for gastric upset
Non-opiod analgesics
Aspirin (Salicylate) Paracetamol Diclofenac (NSAIM) Ibuprofen (NSAIM) COX-2 inhibitor (NSAIM)
