week 9: pain assessment Flashcards
pain
An unpleasant sensory and emotional experience
purpose of pain
Warns us of tissue damage, potential tissue damage
Elicits a reflex to keep injury damage at a minimum
Becomes bad if people continue to injure themselves; they become ill
multimodal analgesia
Preferred; several classes of medication + non-pharmacological treatments
Uses different treatments with different mode of actions (opioids, non-opioids, analgesics, anticonvulsants, hot-cold therapy, massages, stretching - medications not always the answer)
pain management strategies
Reduce pain to acceptable level as defined by the patient; though not always 100% possible
Involve patient, family, HCP’s in goal setting, strategies
Make sure you thoroughly assess what type of pain it is for appropriate treatment, don’t delay it
nociceptors
Pain-sensing nerve cells in the peripheral systems; mechanical (pressure/touch), thermal (hot/cold), and chemical types
They are activated by noxious (hurtful) stimuli, generates nerve impulses
Releases substances like substances P, prostaglandins, fast impulse
pain transmission process**
- Transduction: Finger prick, stimuli activates nociceptors; releases substance P, prostaglandin, nerve impulse is generated
- Transmission: Goes to dorsal nerve of spinal cord, then up to the brain
- Perception: Brain interprets “Oh, there’s pain” - this is all very fast
- Modulation: Brain tells you to do something about it, neurotransmitters to block impulse so you stop feeling pain
pain meds
Anti-inflammatory drugs: Decreases prostaglandin synthesis; can’t transmit
Local anaesthetic: Blocks nerve ability to generate an action potential, send messages
Opioids/Anticonvulsants/Antidepressants: Acts on the CNS
when pain isn’t properly relieved
Sympathetic NS, Fight or Flight activates:
Heart rate increases, BP, respiration is abnormal, GI slows, immune dysfunction
MSK tension, Nervous dysfunction
Psychological distress
how to address pain
At least once per shift for inpatients/once per visit for outpatients/home care
Before, During, After procedures
Following treatment to try to reduce pain (did your intervention do anything?)
OPQRSTUV
- Onset:
When did your pain start?
Palliative/Provocative:
What makes your pain better or worse? - Quality:
How would you describe your pain? (Dull, Sharp, Throbbing, Burning, Aching, Electric)
Region/Radiating:
Where is the pain and does it travel anywhere? - Severity:
How bad is your pain? (None,Mild,Moderate,Severe), How would you rate it from 0-10?
(Using other inventories, pain assessment tools) - Timing:
Is there a time of day when the pain is worse? Morning? Night? Activities? Lying still? - Understanding:
What do you think is causing the pain? - Values:
Any cultural, religious, personal/family beliefs about how you want to manage your pain?
Any medications? (“Afraid of addiction”, “Afraid of cancer”)
if the patient is verbally/cognitively intact
Ask them if they’re in any pain
Family/caregiver report if they’re children or unable to report - may be unreliable
pain assessment tools
Brief Pain Inventory: Questionnaire about pain, location, type, effects
Numerical Rating Scale (0-10, 0 = no pain, 10 = worst pain imaginable)
Visual Analogue Scale (Mark along this line from No pain —————– Worst pain)
Descriptor Scale: No pain / Mild pain / Moderate pain / Severe pain / Excrutiating pain
Faces Scale: Wong Baker or Revised Faces scale - Point to the face representing your pain
There are other, more comprehensive scales as well
cognitively impaired individuals
They also feel pain - just have difficulty communicating pain in ways we can understand
Comprehensively assess physical, environmental factors
Get as much info from as many sources; non-verbal behaviours and vocalizations
Feldt Tool to assess pain in non-verbal
pain behaviours in nonverbal individuals: absence indicators
Flat affect
Decreased interactions
Decreased intake (eat/drink)
Altered sleep
Could mean anything; process of elimination
pain behaviours in nonverbal individuals: active indicators
Rocking
Negative vocalizations (moan/groan)
Frown/grimace
Noisy breathing
Irritable/Agitated
