Part 1 Assessment of Pain.docx

Part 1: Assessment of Pain Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in such terms as damage. International Association of the Study of Pain (IASP 2010) Unidimensional Pain Assessment Measure the subjective/...

Part 1: Assessment of Pain Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in such terms as damage. International Association of the Study of Pain (IASP 2010) Unidimensional Pain Assessment Measure the subjective/patient-reported SEVERITY of pain Numeric Rating Scale (NRS) Verbal Descriptor/Rating Scale (VDS) Baker Wong Faces scale Visual Analog Scale (VAS) VRS = Verbal Rating Scale Multidimensional Pain Assessment Measures the subjective/patient-reported pain severity, location, sensation, affect, functional status (impact on activities of daily livings) McGill Pain Questionnaire Brief Pain Inventory VHA Pain Management Multidimensional Pain Symptom Analysis Precipitating/previous therapy Quality Region/ radiating Severity Temporal You-associated symptoms P – Precipitating Factors Precipitating What helps to relieve pain? What makes it worse? Previous Therapy Medications Herbal and natural products Coping strategies Q - Quality What does the pain feel like? Aching, deep, dull, throbbing, sharp, well localized (somatic nociceptive pain) Diffuse, gnawing, cramping, squeezing, pressure, distant sites (visceral nociceptive pain) Burning, numb, radiating, shooting, stabbing, tingling (neuropathic pain) R - Radiation Region = location/ Radiating Where does it hurt? Does it spread or radiate to other areas? S - Severity S=severity Use a pain scale How much does it hurt Now? At its worst? At its best? On average? Before and after medication? After exercise? T - Temporal Temporal Onset Duration Frequency Patterns Acute, current, or chronic? You – Associated Symptoms How does the pain affect you? Work Activities of daily livings Mood Relationships Sleep Appetite Pain Assessment can be a challenge, but we have the tools for it! Pediatrics CRIES, NIPS, FLACC Read this reference: https://www.mypcnow.org/fast-fact/pediatric-pain-assessment-scales/ Geriatrics PAINAD https://www.mdcalc.com/calc/3701/pain-assessment-advanced-dementia-scale-painad Non-English Speaking British Pain Society Pain Scale in multiple languages https://www.britishpainsociety.org/british-pain-society-publications/pain-scales-in-multiple-languages/ Setting a Treatment Goal can have Multiple Dimensions! Treatment goals should be patient-centered considering what matters the most in their lives The goal in pain management does not need to be “no pain”, and in many cases, it is not realistic, almost misleading to set a goal of “no pain” for all patients Individualized pain goal (“I want to reduce my pain to a 4 when driving to Dallas to visit my grandkids.”) Functional goal (“I want to be able to do gardening.”) Reduce dependency/tolerance of medications (“I want to stay away from opioid because it makes me sleepy and I can’t focus on writing my journal.”) Monitor medication-related aberrant behavior Improve quality of life (“I want to feel well enough to organize my family album for my kids after I die.”) Classifications of Pain Acute Pain < 1 month Commonly has identifiable causes (e.g. trauma, injury, acute illness, labor, surgery, cancer) Chronic Pain ≥ 1 month Higher risk for dependence and tolerance to drugs Psychological component (insomnia, depression) Types of Pain Somatic Pain Visceral Pain Neuropathic Pain Cause Tissue damage to skin, soft tissue, muscle or bone Pain in the visceral organs such as gallbladder, intestine, liver (may be accompanied by nausea, vomiting or sweating) Injury or inflammation of nerves. Often coexists with somatic or visceral pain. Descriptors Aching Gnawing Deep Dull Sharp, stabbing Cramping, squeezing Pressure Full, bloated AllOver Gassy Burning Electric Numb Radiating, lancing Shooting, stabbing Tingling Hypersensitive skin Distribution Well localized –patients can often point with one finger to the location of their pain e.g. Bonemetastases, decubitusulcer Referred: Kidney stone – back pain Liver capsule –shoulder Colicky severe abdominal pain that comes and goes, may come in waves Bowel obstruction Gallstone Radicular: single or multiple nerve roots Herpes zoster Sciatica Stocking-glove: Fingers and toes Diabetic or chemotherapy induced neuropathy How Analgesics are Used? Based on your multidimensional pain assessment and a review of the patient’s past medical histories, the first step is to identified the type of pain that a patient is experiencing (somatic, visceral, neuropathic). A patient can present with more than one type of pain in different locations. Your treatment plan should address all the pain experienced. Acetaminophen Mild to moderate pain Somatic and visceral As a single agent or combined with an opioid Treats fever, headache, muscle, and general pain NSAIDS Mild to moderate Somatic and visceral pain As a single agent or combined with opioid Treats inflammatory states in musculoskeletal system Opioids Moderate to severe pain as a single agent or combined with APAP or NSAIDS Effective for somatic, visceral, and neuropathic pain Antiepileptic Moderate to severe neuropathic pain Examples: Gabapentin, Pregabalin Antidepressants Moderate to severe pain as a single agent of combined with other synergistic drugs Treats neuropathic pain and mood disorders Tricyclic antidepressants and SNRIs Others Corticosteroids: for moderate to severe somatic and visceral pain Example: dexamethasone