Introduction to Pain and Pain Assessment PDF

Introduction to Pain and Pain Assessment MATT TOWNSEND E: [email protected] Learning Outcomes: By the end of this session, students will be able to: Define pain Demonstrate an introductory awareness to the ana...

Introduction to Pain and Pain Assessment MATT TOWNSEND E: [email protected] Learning Outcomes: By the end of this session, students will be able to: Define pain Demonstrate an introductory awareness to the anatomy and physiology of pain Understand the three different types of pain Interpret physiological signs of pain as well as patient cues to pain Recognise the consequences of unrelieved pain Demonstrate an awareness of nursing pain assessment in clinical practice  Over to you… What does ‘pain’ mean to you?  “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” (International Association for the Study of Pain [IASP], 2020) (Pyle, “ […] [Pain is] a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive and social components” (Williams & Craig, 2016) “ Pain is a mutually recognizable somatic experience that reflects a person’s apprehension of threat to their bodily or existential integrity” (Cohen & Quintner, 2018) 6 key notes on the etymology of the word: Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons Through their life experiences, individuals learn the concept of pain A person’s report of an experience as pain should be respected Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological wellbeing Verbal description is only one of several behaviours to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences of pain (IASP, 2020) Anatomy and Physiology of Pain Nociceptors – Receptor responding to stimuli that could be potentially harmful to the body’s tissues. Defence and Protective measure. 3 different types of stimulus Mechanical Thermal Chemical Hitting Knee Temperature Pinching Chemical extremes Pin Prick burns that could be Acids Overstretchin damaging to Alkalis g the body’s Irritants tissues Types of Pain 1. Somatic Pain Pain that we can localise Associated with skin, mucous membranes, muscles and joints Can be replicated by touching or moving the area Can be: Superficial – involving skin or surface damage Deep – Muscles or joints (aching, throbbing, burning) Usually mechanical or thermal Rapid onset 2. Visceral Pain Pain inside the body – Organs Nociception stimuli from within the organs Difficult to localise Responsible for deep, throbbing or aching pains Can be responsible for referred pain and surface perception of the pain (e.g. Myocardial Infarct [MI]) Can trigger nausea and vomiting 3. Neuropathic Pain Pain that occurs when the nerves themselves are damaged No nociception involvement Nerve damage will create the perception of pain – can be caused by: Trauma Surgery Chemotherapy Cancers Common conditions: Diabetes Phantom Limb Pain Carpal Tunnel Syndrome Herniated discs  Physical signs of pain Tachycardia Hypertension Tachypnoea Diaphoresis Pallor Decreased peripheral circulation Pupil dilation  Patient cues of pain Facial expressions Vocalising Crying/Moaning Guarding Pursed Lips Restless Clenching teeth Agitated Combativeness Insomnia Opening eyes wide Poor appetite Withdrawal Pain Assessment  Assessing Pain Gold standard is for the patient to self- Visual Analogue report their pain (due to the subjectivity Scales of the pain experience) Basic pain assessment incorporated into the NEWS chart NHS Wales advocate the ‘Mild, Moderate, Severe’ approach for initial assessment Abbey Pain Scale Visual analogue scales available for those needing support Abbey Pain Scale available for those patients unable to verbalise their pain PQRST mnemonic Provoking / Palliation – P What brings the pain on? | What makes it better/worse? | What are you taking? What have you taken? Quality – Q Describe the pain | What does it feel like? Region and Radiation – R Where is the pain primarily located? | Is it migrating or radiating to somewhere else? Severity – S How severe is it? | What about at its best/worst? | How does it affect your day-to-day activities? Time – T When did/does the pain start? | Is it constant/intermittent? | How long does it last (duration)? | Particular time of day/night it is better/worse? Visual Analogue Scales (Abbey et al., 2004) Pain Manageme nt Pharmacological Regular analgesic management PO, TOP, PR, SC, IM, IV Pro Re Nata (PRN (as needed)) medications Continuous administration (e.g. Syringe Drivers, ITU) Patient Controlled Analgesia (PCA) ‘Stat’ / ‘Bolus’ doses of medications Time critical medications (e.g. MST)  Step 3 WHO Strong in Analgesic opioid (e.g. ing morphine) as +/- non- e Ladder cr r in o *** opioid +/- adjuvant ing y*Step * 2 Moderate – s t it rsi ns Severe pain e Weak opioid pe int in (e.g. *Pa codeine) ** +/- non- ** opioid +/- adjuvant Step 1 Mild - Non-opioid Moderate (e.g. pain Pain aspirin, Controlled paracetamo  l, or NSAID) +/- adjuvant Mild pain Non-Pharmacological Mobilisation Thermotherapy (Heat, Cold) Physiotherapy Hydrotherapy Osteopathy Acupuncture Regular repositioning / relief Meditation Yoga Questions? E: [email protected] References Abbey, J., Piller, N., De Bellis, A., Esterman, A., Parker, D., Giles, L., & Lowcay, B. (2004). The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. International Journal of Palliative Nursing, 10(1), 6-13. doi: 10.12968/ijpn.2004.10.1.12013. Cohen, M., & Qquintener, J van RS. (2018). Reconsidering the International Association for the Study of Pain definition of pain. Pain Reports., 8, e634. doi: 10.1097/PR9.000000000000634. Pyle, N. W. (2019). Strange Planet. Wildfire. Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X-J., Stevens, B., Sullivan, M., Tutelman, P., Ushida, T., & Vader, K. (2020). The revised ISAP definition of pain: concepts, challenges, and compromises, Pain, 161(9), 1976-1982. doi: 10.1097/j.pain.000000000001939. Williams, A. C., &Craig, K. D. (2016). Updating the definition of pain. Pain, 157, 2420-2423.