Pain Management Study Guide

Assessment of Pain can not be delegated to AP

Nurses Assumption of Pain:

● Limit ability to offer pain meds

● Don’t believe patient if they don't appear in pain
● Must accept pt report of pain
● Must view pain through pt eyes

Types of Pain

● Nociceptive Pain: Normal stimulation of special peripheral nerve endings called

nociceptors; Treatment: opioid or nonopioid
○ Somatic: bones, joints, muscles, skin or connective tissue
○ Visceral: Internal organs (gastrointestinal tract and pancreas)

● Neuropathic Pain: Arises from abnormal or damaged pain nerves (somatosensory

nervous system); treatment: Adjuvant analgesics

Factors Influencing Pain

● Age: Infants can’t verbalize or understand pain; Older pts have multiple pathologies that
cause pain
● Fatigue: Increase sensitivity to pain
● Genetics: can increase or decrease pain sensitivity
● Neuro Function: Influence pt reception or perception of pain

Social Factors Influencing Pain

● Previous Experience: If pt received adequate relief in the past, pain sensitivity can
decrease; if not, can increase
● Family and Social: support can decrease sensitivity to pain or offer distraction
● Spiritual: Positive spiritual coping practices can offer hope and strength

Psychological Factors

● Attention: Amount of attention pt gives to pain can influence pain perception

 ● Anxiety and Fear: Degree and quality of pain influences its meaning; Pain is perceived
differently if it suggests loss, threat, punishment or challenge
● Coping Style: Influence ability to deal with pain; Positive coping style can decrease pain

Cultural Factors

● Cultural background (ethnicity) affects the meaning of pain, how its perceived and how
pt expresses pain

Assessment

Through the pts eyes

● Ask pt about pain level and tolerable level of pain

Pain Scales

● Numerical: 0 (no pain) - 10 (worst pain ever felt)

● Verbal Descriptive Scale: a line with 2 to 6 word descriptors;
○ NO pain; mild pain; moderate pain; severe pain; unbearable pain
● Visual Analog Scale: Line with 2 endpoints (No pain to Unbearable pain)
● Wong-Baker Face Pain Rating Scale: Pain scale using different faces (with description
of pain; 0 to 10);
○ Commonly used for children, pt who speaks another language, neuro disorders,
communication issues, stroke victims)

Nursing Assessment Questions

Current Pain (Modify Assessment for pt age, cognitive ability, culture, language and other
factors)

PQRSTU

● Palliative or Provocative: What makes pain worse; what makes it better; what brings it
on
● Quality: Describe your pain for me? Descriptive terms: sharp, dull, aching, torturing,
throbbing etc.
 ● Region (Location): Area of pain; Location: Anatomical landmarks (superficial deep,
referred or radiating)
● Severity: On a scale of 0 to 10, how bad is your pain? What is the worst pain or average
pain in the last 24 hrs? [ Use pain scales: numerical, verbal description, visual analog,
wong baker]
● Timing: Onset, duration, frequency; Do you have pain all the time or sometimes
(intermittent or constant); Day or night? How often?
● U (YOU): Effect of pain; What are you not able to do because of your pain? What can
we do (ie modify environment)

Clinical Approach to Pain Assessment and Management

ABCDE

● Ask about pain regularly; Assess systematically

● Believe pt in their report of pain and what relieves it
● Choose pain control options suitable for pt and environment
● Deliver interventions in timely, logical and coordinated fashion
● Empower pt and allow control over course to greatest extent

Physical Exam

Effects of Pain on pt

● Behavioral:

○ Vocalizations: Moaning crying etc

○ Facial Expressions: Clenched teeth, grimace
○ Body Movement: Restlessness, increased hand and finger movements, rhythmic
or rubbing motions
○ Social interaction: reduced attention span
○ Reduced interaction with environment or social contacts

● Influences on activities of daily living

○ Can't bathe or dress
○ Can't use utensils or sit on toilet
○ Reduced ability to work

● Concomitant symptoms: usually increase with pain severity; Include: headache, urge to
urinate, nausea, depression, restlessness
Implementation

Non Pharmacological Pain Interventions: Alone or combination

● Cognitive-behavioral: change pt perception on pain, alter pain behavior and provide pt

with feeling of control
● Distractions: reticular activating system inhibits painful stimuli if a pt receives sufficient
sensory input
● Guided Imagery and Relaxation: prayer, meditation, yoga
● Music Therapy: improved respiration, lower BP, improve cardiac output, reduced heart
rate and muscle tension
● Cutaneous Stimulation: stimulation of skin through massage, warm bath, cold
application; Acupressure
● Herbs, acupuncture,

Acute Care: Pharmacological Pain therapy

● Analgesic
● Nonopioids: acetaminophen and nonsteroidal anti inflammatory drugs (NSAIDS)
● Opioids
● Adjuvants/ coanalgesic: enhance analgesics or have analgesic properties
● Patient-controlled analgesia: drug delivery system that allows pt to self administer pain
meds
● Topical or transdermal
● Local via injection
● Perineural local anesthetic infusion
● Epidural analgesia