What is Pain

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What is Pain?

• Pain is an unpleasant sensory and emotional
  experience arising from actual or potential
  tissue damage or described in terms of such
  damage.

• Pain is whatever the experiencing person says it
  is, existing whenever he/she says it does.

McCaffery, 1969
IASP, 1979
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Common Painful Conditions in Long-Term Care
Residents

• Degenerative joint disease
• Rheumatoid/osteoarthritis
• Osteoporosis
• Fractures
• Muscle pain/stiffness
• Neuropathies
• Post stroke pain
• Skin or pressure ulcers
• Immobility

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What are the consequences?

• Affects overall quality of life
• Depression
• Emotional distress
• Decreased socialization
• Disturbed sleep and appetite

• Reduced mobility and ambulation
• Slow rehabilitation
• Agitated behavior
• Slowed healing
• Increased health care utilization
• Increased costs

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Five-step Ladder to Optimal Pain Management
Communicating the understanding
Legitimizingthe pain
Believing theperson has pain
Understanding thepain experience
Getting to know the pain
Fink, 1996
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Getting to Know the Pain

• Words
• Intensity
• Location
• Duration
• Aggravating/Alleviating Factors

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Intensity

• Quantitative measurement scales
• Numeric Rating Scale (NRS)
• Verbal Descriptor Scale (VDS)
• Faces Scales (Wong-Baker, Bieri)
• Pain Thermometer
• Questions to ask
• If 0 is no pain and 10 is the worst possible
  pain, what is your pain right now, in the past 24
  hours (since lunch time yesterday), since you
  received your pain medicine?
• Where do you want your pain to be?

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The Faces Pain Scale Revised (FPS-R)
The Bieri Faces Pain Scale
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Pain Thermometer
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Reasons Why Residents Dont Request Pain
Medication

• Concerned about pain medication
• Im afraid of getting hooked.
• If used too early, it wont work later.
• I dont want to get constipated.
• Stoic Pain not that bad, I can handle it
• Anticipate staff response not believed
• Not wanting to bother staff
• Pain is a part of aging just need to bear it.
• Fate/Passivity nothing helps
• Physician wont order nurse wont give
• Self-management strategies

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Common Pain Behaviors in Cognitively Impaired
Elderly Persons

• Facial Expressions
• Verbalizations, Vocalizations
• Body Movements
• Changes in Interpersonal Interactions
• Changes in Activity Patterns/Routines
• Mental Status Changes

Observe at rest movement
JAGS, 2002 50S205-S224
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Pain Assessment Tools for Use in the Cognitively
Impaired Nonverbal Resident

• Discomfort in Dementia of the Alzheimers Type
  (DS-DAT)
• Modified DS-DAT
• Checklist of Nonverbal Pain Indicators (CNPI)
• Assessment of Discomfort in Dementia Protocol
  (ADD)
• Pain Assessment in Advanced Dementia (PAINAD)
• Pain Assessment for the Dementing Elder (PADE)
• The Pain Assessment Scale for Seniors with Severe
  Dementia (PACSLAC)
• Nursing Assistant-Administered Instrument to
  Assess Pain in Demented Individuals (NOPPAIN)

Review of pain scales by Dr. Keela Herr
colleagues - www.coh.org