Pain Management

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• Pain Management

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Pain is

• an unpleasant sensory and emotional experience
  associated with actual or potential tissue damage
  or described in terms of such damage.
  (International Association for the Study of Pain)

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Pain

• Is subjective
• Interferes with the quality of life
• Must be assessed on a continuing basis
• May compromise the immune system
• May hasten death by increasing psychological
  stress

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Pain is measured by

• Pattern
• Location
• Quality
• Intensity

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Pain can be measured by

• Pattern Acute pain comes on suddenly chronic
  pain is always there
• Quality aching, squeezing, throbbing, burning,
  tingling, shooting
• Location Where does it hurt?
• Intensity on scale of 10, with 0 no pain
• History When did it start? How long did it
  last? What brought it on?

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• Aggravating/alleviating factors What makes it
  worse or better?
• Medication history When did you last take
  something for the pain? Did it help?
• Meaning of pain reactions to pain vary with
  cultural backgrounds
• Physical exam adds to information about other
  components of pain
• Reassessment necessary so needed changes can be
  made

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Assessment of pain includes

• Physical exam
• To see patient as a whole
• Psychological and cultural assessment
• To help explain response to pain
• Diagnostic work up
• To find cause of pain

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Tools for pain evaluation

• Nurses discovered they could get responses from
  children by using faces.
• Original faces ranged from 1-5
• Modified to range 1-10
• Adults respond better to horizontal numerical
  scale

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Wong-Baker FACES scale
10
Horizontal numerical scale
0 1 2 3 4 5 6
7 8 9 10
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Interference with pain control

• Caregivers
• Healthcare systems
• Patients

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Interference by caregivers

• Improper assessment of pain
• Concern that the patient might become addicted
• Concern about unpleasant side effects from
  narcotics
• Giving too little medication

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Interference by healthcare systems

• Lack of understanding about pain management
• Not enough places to go for care
• Concerns about addiction to controlled substances
• Inadequate reimbursement

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Interference by patients

• Concern about perception of being a good
  patient.
• Afraid to report pain
• Reluctant to take medicines at all
• Fear of addiction or of becoming tolerant to pain
  medicine
• Side effects of narcotics
• Cost