Chapter 9 pain.pdf

Pain and comfort Objectives: Define the concept of pain Identify factors that affect the elders pain experience Identify barriers that interfere with pain assessment and treatment Describe data to include in pain assessment Discuss pharmacological and non- pharmacological pai...

Pain and comfort Objectives: Define the concept of pain Identify factors that affect the elders pain experience Identify barriers that interfere with pain assessment and treatment Describe data to include in pain assessment Discuss pharmacological and non- pharmacological pain management therapies Develop a nursing plan of care for an elder with pain © Ma'en Aljezwi 1  Introduction Pain: an unpleasant sensory and emotional experience associated with actual or potential tissue damage Always subjective A sensation Always unpleasant Fifth vital sign Pain is a personal experience with different perceptions and reactions © Ma'en Aljezwi 2 Variations in pain response © Ma'en Aljezwi 3  Pain and age In young adults, pain is frequently the result of an acute event which resolves when the underlying cause is treated In midlife and beyond, the pain experience become more complex, acute pain occurs in the presence of co-morbidities including chronic diseases More likely a multi dimensional pain (physical, psychological) © Ma'en Aljezwi 4 Types of pain sensation © Ma'en Aljezwi 5  Pain in the older adults Pain in later life tends to be persistent moderate to sever The most common causes of none cancer pain in late life are musculoskeletal in nature, especially from arthritis and degenerative spinal conditions Neuralgias also is common, could result from DM, peripheral vascular disease, herpes zoster, and other syndromes © Ma'en Aljezwi 6  Pain in elders with cognitive impairment Elders with cognitive impairment are usually untreated or undertreated for pain There is no evidence that people with cognitive impairment feel less pain than normal people But there is an influence on pain interpretations May have altered affective response © Ma'en Aljezwi 7  Pain in elders with cognitive impairment Those with dementia may have altered affective response to pain, due to their inability to cognitively process the painful situation in the context of prior pain experience, attitude, knowledge, and beliefs As a result, responses to painfull experience may be different from the typical response of a normal person © Ma'en Aljezwi 8  Pain in elders with cognitive impairment Older people with mild to moderate cognitive impairment can provide valid reports of pain self-reported scales People with more sever impairment and loss of language skills may be unable to communicate with the presence of pain in a manner that is easily understood © Ma'en Aljezwi 9 Pain assessment © Ma'en Aljezwi 10 Additional factors for assessing pain in the elderly © Ma'en Aljezwi 11  Non-verbal expression of pain For those who can not communicate verbal e.g. people with dementia or cognitive impairment , communication of pain usually occurs through changes in behavior Such as agitation, aggression, increased confusion or passivity Regular assessment, use of standardized tools with consistent documentation is very important © Ma'en Aljezwi 12 Barriers to pain management in older adults © Ma'en Aljezwi 13  Pain rating scales for older adults They are now a standard of care Patients with persistent pain is asked to rate worst and best pain Are used to evaluate the pain treatment modalities For cognitively impaired persons the numeric rating scale may be a good first choice Pain scale revised show series of faces, was developed for children, but may be effective in older adults © Ma'en Aljezwi 14 © Ma'en Aljezwi 15 Face assessment scale © Ma'en Aljezwi 16 Numeric rating scale © Ma'en Aljezwi 17 The Gaston-Johanson painometer © Ma'en Aljezwi 18  Interventions: providing comfort The frequency of polypharmacy and chance of interactions causes some to hesitate, increasing the potential for under treated pain Socially, people think that pain is a natural part of aging of full relief is not possible, even when quality of life is compressed © Ma'en Aljezwi 19  Pharmacological interventions In general analgesics (non opioid and opioid) and adjuvant medications (antidepressants, anticonvulsant, herbal preparations) are used to control pain in older adults Age related changes may affect the use of some medications The goal is adequate pain relief to preserve function © Ma'en Aljezwi 20  Pharmacological interventions Non-opioid agents: Acetaminophen (maximum dose 4g/day) and NSAIDs are the non opioid most commonly used in older adults They are used when pain is inflammatory in nature For renal and liver impairments dose must be adjusted These drugs do not cause GI symptoms © Ma'en Aljezwi 21  Pharmacological interventions Opioids: used for long term management for moderate to severe pain May be preferred for their predictable rate of adverse reactions Due to a number of age related changes, opioids may produce a grater analgesic effect, a higher peak and longer duration © Ma'en Aljezwi 22  Pharmacological interventions Adjuvant drugs: antidepressants, anticonvulsant and other agents that can alter neural functioning They are used in combinations with analgesics or alone © Ma'en Aljezwi 23  Pharmacological interventions Other drugs: their use depend on situation and the cause of pain Corticosteroids are used to control pain associated with inflammation © Ma'en Aljezwi 24  Non pharmacological measures Energy or touch therapy Transcutaneous electrical nerve stimulation Acupuncture Relaxation and meditation Music Hypnosis Activity Cognitive Behaviour therapy © Ma'en Aljezwi 25