Lecture 2: The Assessment and Measurement of Pain PDF

Lecture 2: The Assessment and Measurement of Pain Pain Assessment and Management Dr. Majdi Rababa  Learning Objectives The objectives of this lecture are to:  recognize the rationale for pain assessment and measurement  understand the various components of...

Lecture 2: The Assessment and Measurement of Pain Pain Assessment and Management Dr. Majdi Rababa  Learning Objectives The objectives of this lecture are to:  recognize the rationale for pain assessment and measurement  understand the various components of comprehensive pain assessment  identify the frequently utilized pain assessment and measurement tools  select an appropriate tool for a particular patient population  Introduction Assessment of pain refers to evaluation of the overall characteristics of the patient's pain experience (PQRSTAU). Pain measurement is asking the patient to give a numerical value to their subjective experience of pain intensity and associated distress.  Introduction The only way to really understand a person's pain experience is to ask him or her about that experience (subjective data). International organizations mandate pain as the fifth vital sign.  Benefits of Biopsychosocial Pain Assessment, Measurement and Documentation 1. The effectiveness of pain interventions can be monitored easily, over time. 2. Pain-related improvements or disimprovements can quickly be identified. 3. The patient is viewed as a person. Assessment and treatment of pain focus on rehabilitation and a maximal improvement in the health and quality of life of the patient.  Basic Pain Measurement Terms: Pain Threshold Pain (perception) threshold: the level at which the person perceives a noxious stimulus as painful. Pain threshold is almost the same from person to person, but cultural and gender differences play a role in what people consider acceptable in disclosing about their pain experience.  Basic Pain Measurement Terms: Pain Tolerance Pain tolerance: the amount of pain a person can tolerate before considering the pain unbearable and withdrawing from it. It varies from person to person and it can change depending on familiarity with the stimulus and the context. Cultural views about the acceptability of pain expression, as well as subjective pain beliefs, play a role in determining how much pain people can tolerate.  Basic Pain Measurement Terms: The Pain Sensitivity Range and The Drug Request Point The pain sensitivity range (PSR) is the mathematical difference between the pain tolerance level and the pain threshold. The drug request point is when a client considers the level of pain at which they would require a mild analgesia.  Pain Assessment and Measurement It is important to assess and measure the patient's pain to treat and control that pain. This can be thought of as a three-step process: 1. Comprehensively assess, measure and document the patient's biopsychosocial pain experience; usually the nurse and physician work together to reduce patient burden.  Pain Assessment and Measurement 2. The multidisciplinary care team utilizes the information provided by the patient to formulate an interdisciplinary management plan with appropriate pharmacological and nonpharmacological interventions, as required. The plan is documented by the nurse.  Pain Assessment and Measurement 3. After an appropriate time interval the nurse reassesses, re-measures and re-documents the patient's pain as the fifth vital sign, reporting changes in the patient's health status to the care team. The nurse develops competencies to be able to advocate for improvements in the patient's pain treatment, as required.  Pain Assessment and Measurement Patients with acute pain will most likely require a straightforward rating-scale-type measurement of pain. Patients with chronic pain of a malignant or non-malignant origin require ongoing assessment of pain and how it impacts on the domains of quality of life Domains of Pain Assessment TYPES of PAIN  The Concept of Referred Pain Pain symptoms resulting from visceral afferents are often felt in a location different from the organ itself. It is considered to be a convergence of information from somatic structures and viscera at multiple sites of the central nervous system. The Impact of Chronic Pain on Quality of Life Initial Pain Assessment Tool Pain Assessment Tools Pain Assessment Tools Pain Assessment Tools Assessing Pain for Specific Populations CPOT: Critical-Care Pain Observation Tool: for patients in critical care units. The CPOT used to assess intubated or sedated patients pain based on: o Facial expressions o Muscle tension and movement o Compliance with ventilated breaths for intubated patients or o Vocalized pain for non-intubated patients. CPOT: Critical-Care Pain Observation Tool CPOT: Critical-Care Pain Observation Tool  The Assessment of Pain and Discomfort in Neonates The CRIES Scale: 0-10 scale