LECTURE 6: Assessing Pain CLASSIFICATION OF PAIN

PHANTOM PAIN
perceived in nerves left by a missing, amputated
“The PAIN you feel today, Will be the STRENGTH
or paralyzed body part
you feel tomorrow”

PAIN INTRACTABLE PAIN

high resistance to pain relief
“An unpleasant sensory and emotional isn't curable
experience, which we primarily associate with to reduce discomfort
tissue damage or describe in terms of such
damage or both”
PATHOPHYSIOLOGY
-International Association for the Study of Pain
(IASP)  Transduction
 Transmission
“ Pain is whatever the person says it is.”
 Modulation
-McCaffery and Pasero (1999)
PHYSIOLOGICAL RESPONSE TO PAIN

 Anxiety, fear, hopelessness,

CLASSIFICATION OF PAIN sleeplessness suicidal thoughts
 Facial grimaces, focus on pain, crying,
DURATION frowning
•Acute
 ↑blood sugar, ADH, Epi/NE, adrenal
•Chronic non malignant
hormones
•Cancer Pain
 Muscle spasms
 ↑HR, RR, BP
LOCATION
 ↓ gastric and intestinal motility, urine
•Radiating
output
•Referred

SEVEN DIMENSIONS OF PAIN

CLASSIFICATION OF PAIN: ETIOLOGY
 Physical
NOCICEPTIVE PAIN
 Sensory
•Somatic
 Behavioral
•Visceral
 Sociocultural
•Cutaneous
 Cognitive
 Affective
NEUROPATHIC PAIN  Spiritual
•Peripheral neuropathic pain
•Central neuropathic pain
CONCEPTS OF PAIN

PAIN THRESHOLD - least amount of stimulus

needed for a person to label as pain sensation
PAIN TOLERANCE - maximum amount of painful
stimuli a person is willing to withstand without
seeking avoidance of pain/ relief
HYPERALGESIA / HYPERPATHIA - heightened
response to painful stimuli
ALLODYNIA - pain felt on nonpainful stimuli
DYSESTHESIA - unpleasant abnormal sensation
PAIN ASSESSMENT
 Age
 Culture
 PQRST/ COLD SPA
DEVELOPMENTAL LEVEL/ AGE
 Pediatric variations
 Geriatric variations
UNCONSCIOUS, COGNITIVELY IMPAIRED,
ELDERS WITH DEMENTIA, INTUBATED CLIENTS,
INFANTS AND PREVERBAL TODDLERS
 Self-report
 Search for potential causes of pain
 Observe patient behaviors
 Surrogate reporting
 Attempt analgesic trial
- McCaffery and Pasero (1999) Hierarchy of
Pain Assessment
QUESTT PRINCIPLES FOR PAIN IN CHILDREN
Question the child
Use pain-rating scales
Evaluate behavior and physiological changes
Secure parents’ involvement
Take cause of pain into account
Take action and evaluate results
CULTURAL EXPRESSIONS OF PAIN
ASIAN AND ASIANAMERICAN
 Pain is natural
 Use mind over body; positive thinking
 Pain is honorable
 Pain may be caused by transgressions
and helps in achieving higher
spirituality
 Stigma against narcotic use
--underreporting of pain
AFRICAN-AMERICAN
 Pain is a challenge to be fought
 Pain is inevitable and is to be endured
 Pain is stigmatized
 Pain may be a punishment from God
 God and prayer will help more than
medicine
HINDU
 Pain must be endured as part of
preparing for the next life in cycle of
reincarnation
 Must remain conscious when nearing
death to experience the vents of dying
and rebirth
NATIVE AMERICAN
 Pain is to be endured
 May not ask for medication due to
respect for caregivers who should
know their needs
 Metaphors and images from nature
are used to describe pain
HISPANIC
 Pain response is often expensive
 Pain must be endured to perform
gender role duties
 Pain is natural, but may be a result
of sinful or immoral behavior
JEWISH
  Pain is expressed openly with much
complaining
 Pain must be shared, recognized,
and validated by others so that
experience is affirmed.

BARRIERS TO PAIN ASSESSMENT

Based on Beliefs
 Based on culture
Based on physical Condition
 Disease, illness, injury
 Pt. expresses few pain-related
behaviors
Based on Healthcare Providers’ Beliefs
 Judgment
 Pain acknowledgement

PAIN ASSESSMENT SCALE

ASSESSMENT SCALE: OLDER ADULTS

•Numeric Rating Scale (NRS) best for older

adults without cognitive impairment

•Faces Pain Scale for adults with cognitive

impairment

ASSESSMENT SCALE: INFANTS AND CHILDREN

•N-PASS: Neonatal Pain, Agitation, and

Sedation Scale

•FLACC Scale: Face, Legs, Activity, Cry, and

Consolability