Pain Assessment Flashcards
Acute Pain
- Due to a recent/acute isolated injury
- Beginning and end of pain (< 3 months)
- Signs/symptoms of acute pain evident
Chronic Pain
- Multiple causes (diseases, injuries, etc.)
- Pain lasting > 3 months
- Acute pain signs/symptoms may or may not be present
Musculoskeletal components
Bones Muscle Joint: union of > 2 bones Cartilage: flexible connective tissue Ligament: short band of connective tissue that connects bones or cartilage together
Fracture
Break in a bone
Dislocation
displacement of a joint bone
Sprain
trauma to joint with ligament damage
Strain
overstretching of muscle
Somatic pain (superficial)
- throbbing, burning, or prickling caused by pain stimulation in skin or subcutaneous tissue
- **Burns, cuts, etc. caused by a physical injury
- **Based on severity, can be managed via self-care
Somatic (deep)
-dull, aching pain which is usually localized due to injury to skeletal muscles, tendons, or ligaments
**Post-operative pain, soreness after physical
**Some self-care while others should be referred
exertion
Visceral Pain
- Deep, dull, aching, squeezing, or pressure-like pain that is hard to localize due to injury to an organ
- **Cardiac chest pain, kidney stones, irritable bowel syndrome (IBS)
- **Many acute causes of visceral pain require medical management
Malignant Pain
Pain at primary cancer site and/or metastases
Non-malignant Pain
- Neuropathic: burning, tingling, numbing pain which due to nerve injury or unknown reasons
- Musculoskeletal: aching pain due to injury, chronic diseases, medications/medical treatments, or unknown reasons
Subjective Information
Pain interview
Pain assessment instruments
Objective
Patient behavior Physiological changes (more with acute pain)
Mneumonic for Assessing Pain (PQRST)
-Palliative or Precipitating factors
What makes the pain better or worse?
-Quality of pain
How would you describe the pain? Dull, aching, throbbing, stabbing, or burning?
-Region of pain location
Where is it occuring? Where is it worst? Radiating?
-Subjective description of pain Severity
How would you rate the pain (via instruments)?
-Time-related nature of pain
When was the onset? Duration? Pattern?
FLACC
- face, legs, activity, cry, consolability scale
* **For individuals unable to communicate pain
Factors to consider when assessing pain
Age Cognitive/mental status Communication Cultural & religious beliefs Medications Past medical history Socioeconomic status
Multidimensional pain instruments
Pain diary
Pain drawing
Wisconsin Brief Pain Questionnaire
McGill Pain Questionnaire
Laboratory/Testing Information
- DEXA scan for bone mineral density (BMD)
- Erythrocyte sedimentation rate (ESR)
- Rheumatoid factor
- Synovial fluid
- Uric acid
When to do self care
- Known cause of pain (acute or chronic)
- No severe impact on musculoskeletal function
- Not managed with appropriate OTC therapies
Referral to another healthcare provider
- Obvious anatomical abnormality
- Failure of optimal OTC therapies
- Suspicion for new/undiagnosed chronic musculoskeletal disease or cancer causing pain
Treatment options
- Rest
- Ice
- Compression
- Elevation
OTC medications
- Acetaminophen
- Non-steroid anti-inflammatory drugs (NSAIDs)
- **Aspirin
- **Ibuprofen (Advil, Motrin)
- **Naproxen (Aleve)
Prescription medications
- Prescription strength NSAIDs
- Tramadol
- Opioids
- Neuropathic treatment: gabapentin, pregabalin
Osteoarthritis
Localized, degenerative joint disease caused by deterioration of articular cartilage
Most common joint-related disease
OA Clinical Presentation
Asymmetrical joint involvement Joint pain Tenderness Short-lived AM stiffness (< 15 minutes) Bony spurs
Rheumatoid Arthritis
- Autoimmune disorder marked by systemic and symmetrical inflammation of synovial joints
- **Results in disability of affected joints
RA Clinical Presentation
Laboratory findings
Rheumatoid factor
Signs/symptoms Prolonged AM stiffness (> 1 hr) Swan-neck hand deformities Systemic signs Fever, rash, fatigue
Gout
- Disorder of uric acid metabolism results in increased uric acid levels
- **Results in crystal formation and inflammation
- Clinical presentation
- **Rapid onset of pain, tenderness, and swelling
- **Most commonly localized to big toe
Osteoporosis
-Decrease in bone mineral density resulting in bone fragility
- Clinical presentation
- **Kyphosis (hunching)
- **Back pain
- **Increased risk of fractures
- Screen high risk patients
- **DEXA for bone mineral density
Fibromyalgia
- Chronic disease characterized by generalized musculoskeletal pain and fatigue
- **Diagnosis of exclusion
- Clinical manifestations
- **Aching
- **Fatigue
- **Insomnia due to pain
