Pain Assessment & Mgmt Flashcards
What is pain?
An unpleasant sensory/ emotional experience that is subjectively defined.
(multidimensional, shaped by physical & psychological factors, emotional trauma)
What is the difference between direct and indirect pain?
Direct pain is due to a disease. Indirect pain is the consequence of a treatment.
What is the difference between acute and chronic pain?
Acute pain is short term and self-limiting. It usually dissipates after injury heals.
Persistent or chronic pain presents for 3 months or longer than the expected time of healing. (Subclasses: malignant or nonmalignant)
What are the 4 categories of pain? (NNCS)
Nociceptive (tissue damage)
- Somatic (localized, sharp, like a broken bone. can be superficial or deep)
- Visceral [dull, ache, can be vague. can be colicky (obstruction) or capsular (stretching)]
Neuropathic (injury to nervous system)
Central pain (caused by damage to the CNS, like a stroke)
Sympathetically maintained (e.g. complex regional pain syndrome)
Outline the steps in a full pain assessment
- Interview and review of systems
- in-depth pain and medical history
- pain assessment tools
- physical exam
- diagnostics as required to determine the cause of pain
What are considerations to keep in mind when assessing pain in someone with a cognitive impairment?
- self-report is often not useful
- all clients with or without dementia should be asked about pain
- faces scale may be unreliable if facial expressions are tense at baseline
- small behavioural changes may be an indication of pain
Is pain a normal part of aging?
No, but older adults are more likely to have pain.
Are older adults more or less sensitive to pain than others?
No sufficient evidence indicates this.
According to the RNAO what are barriers to pain assessment in the elderly?
- Less frequent reports of pain
- Choosing to suffer in silence
- Perception of pain by others
- Fear of losing self control
- Fear of addiction
- Inability or difficulty swallowing pills
What are the consequences of undertreating pain?
Depression, anxiety, falls, malnutrition, reduced cognition, impaired sleep, functional disturbances, declined social life, increased HC cost, decreased QOL
Do clinicians over or underestimate pain?
Under
What are nonverbal signs of pain?
Grimacing, wincing, moaning, rigidity, arching, restlessness, shaking, pushing, responsive behaviours, mood changes, change in routine or activity patterns, refusal to eat, not wanting to go washroom, agitation
What are some nonpharmacological pain mgmt techniques?
meditation hot/cold therapy physical therapy, exercise massage reiki acupuncture counselling (trauma ^ sensitivity to pain) stress & coping strategies functional assistance w painful activities TENS transcutaneous electric nerve stim.
What are some pharmacological pain mgmt principles
Type of pain will dictate appropriate mgmt Consider high risk meds Take OTC meds into account Follow WHO pain ladder when possible Anticipate side effects Consider pt safety Start low, go slow End of life pain mgmt is often more aggressive than other clinical settings
What are some principles for opioid use in geriatric care?
Can be an appropriate option – do not exclude from consideration!
Use small doses
May be used on a schedule or as needed
Short acting or long acting
