Chapter 11 - Pain Assessment

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Questions and Answers

Which of the following is NOT a typical effect of pain on a person's life?

  • Impact on quality of life
  • Reduced sense of well-being
  • Strain on financial resources
  • Improved family and friend interactions (correct)

Neuropathic pain follows the typical phases of nociceptive pain.

False (B)

What are the two main processes that lead to the development of pathologic pain?

nociceptive and neuropathic processing

Pain is often called the _____ vital sign.

<p>5th</p> Signup and view all the answers

Which of the following best describes the role of nociceptors?

<p>To detect and transmit painful sensations to the central nervous system (C)</p> Signup and view all the answers

Match the following phases of nociceptive pain with their description:

<p>Transduction = A noxious stimulus occurs in the periphery Transmission = Pain impulse moves from spinal cord to brain Perception = Conscious awareness of painful sensation Modulation = Body slows or stops the processing of pain stimuli</p> Signup and view all the answers

Which of the following is a characteristic of neuropathic pain?

<p>It results from a lesion or disease in the somatosensory nervous system (B)</p> Signup and view all the answers

Nociceptive pain cannot turn into neuropathic pain over time.

<p>False (B)</p> Signup and view all the answers

Which of the following is an example of neuropathic pain?

<p>Sciatica (D)</p> Signup and view all the answers

Visceral pain is often described as sharp and burning.

<p>False (B)</p> Signup and view all the answers

What does the acronym FLACC stand for in pain assessment?

<p>Face, Legs, Activity, Cry, Consolability</p> Signup and view all the answers

Pain that is felt at a particular site but originates from another location is called ______ pain.

<p>referred</p> Signup and view all the answers

Match the following pain types with their descriptions:

<p>Acute pain = Short-term pain that resolves after injury heals Chronic pain = Pain that lasts for 6 months or longer Breakthrough pain = Transient pain spikes in a controlled pain syndrome Phantom pain = Pain felt in an amputated extremity</p> Signup and view all the answers

Which of the following is the most reliable indicator of pain?

<p>Self-report (C)</p> Signup and view all the answers

Chronic pain always stops when the injury heals.

<p>False (B)</p> Signup and view all the answers

The _____ rating scale is the most common pain-rating scale.

<p>numeric</p> Signup and view all the answers

What does the 'U' stand for in the PQRSTU pain assessment tool?

<p>Understanding</p> Signup and view all the answers

Which of the following describes deep somatic pain?

<p>Aching or throbbing (A)</p> Signup and view all the answers

Aging adults are less likely to experience pain compared to younger adults.

<p>False (B)</p> Signup and view all the answers

The Brief Pain Inventory asks the patient to rate pain within the past ____ hours.

<p>24</p> Signup and view all the answers

List two common behaviors associated with acute pain.

<p>Guarding, grimacing, vocalizations, agitation, restlessness, stillness, diaphoresis, or change in vital signs</p> Signup and view all the answers

When assessing pain in an infant, it is most appropriate to use what kind of approach?

<p>A multidimensional approach. (A)</p> Signup and view all the answers

Match the following pain assessment tools with the appropriate patient populations:

<p>FLACC = Infants and young children under 3 years old Face scales = Children aged 4-5 years old Verbal descriptor scale = Adults who can describe their pain using words Numeric rating scale = Most common adult pain scale utilizing numbers</p> Signup and view all the answers

Flashcards

Pain

An unpleasant signal that something hurts, feels bad, or is an unpleasant physical feeling.

Nociceptive Pain

Pain that arises from stimulation of intact nerve fibers in the periphery and CNS.

Neuropathic Pain

Pain that arises from damage or dysfunction in the somatosensory nervous system.

Transduction (Pain Process)

The process of converting a noxious stimulus into a pain signal.

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Transmission (Pain Process)

The transmission of the pain signal from the periphery to the spinal cord and then to the brain.

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Perception (Pain Process)

The conscious awareness of the pain sensation.

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Modulation (Pain Process)

The modulation of the pain signal, where the body tries to reduce the intensity of the pain.

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Nociceptors

Specialized nerve endings that detect painful stimuli.

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Visceral pain

Pain originating from internal organs like the stomach, intestines, or gallbladder. It often feels dull, deep, squeezing, or cramping. It can be caused by injury, tumor, ischemia, distention, or severe contraction.

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Somatic pain

Pain originating from musculoskeletal tissues or body surfaces. Examples include pain from muscles, bones, joints, or skin. It's usually well localized.

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Referred pain

Pain felt in a specific location but originating from a different site. An inflamed appendix causing pain in the belly button area is an example.

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Phantom limb pain

Pain felt in a limb that's been amputated. It's a real experience, even though the limb is missing.

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Acute pain

Pain that's short-term and resolves after the injury heals. It follows a predictable course and disappears as the healing process completes.

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Chronic pain

Pain that lasts for 6 months or longer. It persists even after the injury has healed and can be categorized as malignant (cancer-related) or nonmalignant.

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Breakthrough pain

A sudden spike in pain intensity that occurs in someone with otherwise controlled pain. It can be caused by medication wearing off or other factors.

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OLD CARTS

A method used to assess pain by considering factors like Onset, Location, Duration, Characteristics, Alleviating/Aggravating Factors, Radiating Factors, Timing, and Severity.

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PQRSTU

A method used to assess pain by considering factors like Provocative/Palliative, Quality/Quantity, Region/Radiation, Severity, Timing/Treatment, and Understanding.

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Numeric rating scale

A pain scale that uses numbers from 0 to 10, with 0 being no pain and 10 being the worst possible pain.

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Verbal descriptor scale

A pain scale that uses words to describe the patient's pain experience, ranging from 'no pain' to 'unbearable pain'.

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Visual analogue scale

A pain scale that uses a 10cm line, where the patient marks their pain level from 'no pain' to 'maximum pain'.

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FLACC scale

A pain assessment tool used for infants and young children under 3 years old, evaluating their facial expressions, leg movements, activity, crying, and consolability.

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Face scales

A tool for assessing pain in children aged 4-5 years old. It shows different faces representing pain levels, allowing children to choose the face that best matches their pain.

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Infant pain assessment

A tool used to assess pain in infants by observing their behaviors and physiological cues.

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Brief Pain Inventory

A detailed pain questionnaire that asks patients to rate pain intensity and its impact on areas like mood, movement, and sleep. It's often used for chronic pain.

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McGill Pain Questionnaire

A questionnaire that asks patients to rank pain descriptors based on their intensity and provide an overall pain rating. It's used for more comprehensive pain assessment, often for chronic pain.

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Study Notes

Pain Assessment

  • Definition of Pain: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It's a signal that something is wrong.

  • Importance of Pain Assessment: Routine pain assessment is crucial in all health settings, considered the 5th vital sign, significantly impacting a patient's quality of life, interactions, and well-being. It's a frequent reason for seeking healthcare.

  • Types of Pain Processing:

    • Nociceptive Pain: Pain stemming from stimulation of nociceptors, specialized nerve endings, signaling actual or threatened tissue damage. It involves four phases: transduction (initial stimulus), transmission (impulse to spinal cord), perception (awareness), and modulation (pain reduction).
    • Neuropathic Pain: Pain arising from damage or disease affecting the somatosensory nervous system. It's characterized by abnormal processing of pain signals and often more challenging to treat and assess, sometimes developing from poorly controlled nociceptive pain.

  • Sources and Types of Pain:

    • Visceral Pain: Originates from internal organs, often perceived as dull, deep, squeezing, or cramping. Caused by organ injury, ischemia, or distention. Frequently associated with autonomic responses (vomiting, nausea, pallor, sweating).
    • Somatic Pain: Arises from musculoskeletal tissues or body surface. Deep somatic pain (e.g., joints, muscles) is often aching or throbbing, while cutaneous pain (e.g., skin) is sharp or burning. Caused by pressure, trauma, or ischemia. Usually localized.
    • Referred Pain: Pain felt in one location but originating from another area. E.g., Appendix pain may be felt in the periumbilical area.
    • Phantom Pain: Pain felt in an amputated limb

  • Classification by Duration:

    • Acute Pain: Short-term, self-limiting pain, often following a predictable trajectory, resolving after injury heals.
    • Chronic Pain: Diagnosed when pain lasts 6 months or longer, can be malignant (cancer related) or non-malignant, and persists beyond the healing process.
    • Breakthrough Pain: Transient increase in pain level in a patient with otherwise controlled pain. Can be caused by end-of-dose medication failure.

Pain Assessment Tools & Methods

  • Self-report (Subjective): Essential for pain assessment. Everyone experiences pain differently. Different scales are used according to a patient's ability, purpose, and time constraints.
  • Pain Rating Scales:
    • Numeric Rating Scales (NRS): Common scale (0-10).
    • Verbal Descriptor Scale: Uses words to describe pain intensity (e.g., no pain to unbearable pain).
    • Visual Analog Scale (VAS): Patient marks a line indicating pain intensity (0-10 cm).
  • Nonverbal Assessment Tools:
    • FLACC Scale: For infants and young children (Face, Legs, Activity, Cry, Consolability).
    • Face Scales: Useful for older children (4-5 years old).
    • Pain Assessment in Advanced Dementia (PAINAD): Used with dementia patients focusing on breathing, vocalization, facial expressions, body language, and consolability.
  • More Comprehensive Assessments:
    • Brief Pain Inventory: Chronic pain patients. Rates pain in relation to daily life impact (mood, walking, sleep etc.)
    • McGill Pain Questionnaire: Chronic pain patients. Asks patients to rank descriptors in terms of intensity and provide overall pain ratings.

Pain Behaviors

  • Nonverbal Behaviors: Important for assessing pain in individuals who can't verbally communicate it. Behaviors vary based on acute or chronic nature of the pain, age, culture, and gender expectations.
  • Acute Pain Behaviors: May include guarding, grimacing, vocalizations, agitation, restlessness, stillness, sweating, or changes in vital signs.
  • Chronic Pain Behaviors: Greater variability than acute pain behaviors. May include bracing, rubbing, diminished activity, sighing, and changes in appetite.

Developmental Considerations in Pain Assessment

  • Infants: Employ a multi-faceted approach, considering their limited communication skills.
  • Aging Adults: Pain is not considered normal in aging adults; be vigilant and proactive in assessing pain. They may deny pain to avoid losing independence. Observe activities, toileting, and any changes in routine.
  • Individuals with Dementia: Pain is still present and they may communicate by nonverbal cues, using a scale like the PAINAD.

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