Pain Assessment

1
Pain Assessment

• Basics for Healthcare Providers
• The Iowa Pain Management Initiative
• From Department of Pain Medicine and Palliative
  Care, Beth Israel Hospital

2
Clinician-Related Barriers
to Pain Assessment

• Lack of pain management training in medical
  school
• Insufficient knowledge
• Lack of pain-assessment skills
• Rigidity or timidity in prescribing practices
• Fear of regulatory oversight

3
Patient-Related Barriers
to Pain Assessment

• Reluctance to report pain
• Reluctance to take opioid drugs
• Poor adherence
• Reluctance to ask for drugs
• Inappropriate fear of addiction

4
System-Related Barriers
to Pain Assessment

• Low priority given to symptom control
• Unavailability of opioid analgesics
• Inaccessibility of specialized care
• Lack of insurance coverage for outpatient pain
  medication
• RN staffing issues
• Inappropriate fear of addiction

5
Pain Assessment Goals

• Characterize the pain
• Infer pathophysiology
• Evaluate physical and
  psychosocial comorbidities
• Assess degree and nature of disability
• Develop a therapeutic strategy

6
Characterize the Pain

• Temporal featuresonset, duration, course,
  pattern
• Intensityaverage, least, worst, and current pain
• Locationfocal, multifocal, generalized,
  referred, superficial, deep
• Qualityaching, throbbing, stabbing, burning
• Exacerbating/alleviating factorsposition,
  activity, weight bearing, cutaneous stimulation

7
Pain Assessment Tools

• Pain intensity scales
• Verbal rating
• Numeric scale
• Visual analogue scale
• Scales for children

8
Physical Exam
9
Nociceptive Pain

• Presumably related to ongoing activation of
  primary afferent neurons in response to noxious
  stimuli (eg, tissue injury)
• Pain is consistent with the degree of tissue
  injury
• Subtypes
• Somatic well localized, described as sharp,
  aching, throbbing
• Visceral more diffuse, described as gnawing or
  cramping

10
Neuropathic Pain

• Pain believed to be sustained by aberrant
  somatosensory processing in the peripheral or
  central nervous system (eg, nerve injury)

11
Idiopathic Pain

• Pain in the absence of an identifiable
  physical or psychologic cause (eg,
  fibromyalgia)
• Pain is perceived to be excessive for the
  extent of organic pathology

12
Psychogenic Pain

• Pain sustained by psychologic factors
• More precisely characterized in psychiatric
  terminology
• Patients have affective and behavioral
  disturbances
• Patients with organic component often have
  concurrent psychological contributions and
  co-morbidities

13
Pain Syndromes
14
Identify Pain Syndromes

• Syndrome identification can direct assessment and
  predict treatment efficacy
• Cancer pain syndromes
• Bone pain
• Pathologic fracture
• Cord compression
• Bowel obstruction
• Non-cancer-related pain syndromes
• Atypical facial pain
• Failed low-back syndrome
• Chronic tension headache
• Chronic pelvic pain of unknown etiology