What is Pain? n “Pain is an unpleasant sensory and emotional experience arising from actual or...
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Transcript of What is Pain? n “Pain is an unpleasant sensory and emotional experience arising from actual or...
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.”
IASP, 1979 McCaffery, 1969
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
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
Five-step Ladder to Optimal Pain Management
Communicating the understandingLegitimizing
the painBelieving theperson has painUnderstanding the
pain experienceGetting to know the pain
Fink, 1996
Getting to Know the Pain
Words Intensity Location Duration Aggravating/
Alleviating Factors
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?”
The Faces Pain Scale Revised (FPS-R)
The Bieri Faces Pain Scale
Pain Thermometer
Reasons Why Residents Don’t Request Pain Medication
Concerned about pain medication “I’m afraid of getting hooked.” “If used too early, it won’t work later.” “I don’t 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 won’t order; nurse won’t give Self-management strategies
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
JAGS, 2002; 50:S205-S224
*Observe at rest & movement
Pain Assessment Tools for Use in the Cognitively Impaired Nonverbal Resident
Discomfort in Dementia of the Alzheimer’s 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