INTRODUCTION

The word pain originates from the Latin word 'POENA' meaning a fine or a penalty. • Pain
often describe as an unpleasant sensation that can vary from mild, localized to severe distress.
• Pain provide mechanism to warm about the potential physical harm. • Pain is multi-factorial
phenomenon. It is an individual, unique experience that they may be difficulty for client to
describe or explain and is often difficulty to recognize, understands and assess
DEFINITION

Acc to WHO pain is an intensive sensation or an obsessing attention.

Mc Caffery and Pasero (1999)say it best by defined pain as "whatever the person
experiencing it says is, existing whenever (he/she) says it does"

According to Carpenito , pain is defined as a state in which an individual experiences and

reports the presence of severe discomfort or an uncomfortable sensation.

CLASSIFICATION Based on
• duration Based on
• intensity Based on
• etiology

Classification Based on duration

 Acute
 Chronic

 Acute: It is a relatively brief sensation, usually less than six months duration usually a
response to a specific trauma forms the basis for danger warnings and subsequent
learning
. - Recent in onset –

-Symptomatic of primary injury or disease

-Specific and localized –

- Severity associated with injury or disease

- Responds favourable to drug therapy

- Diminished with healing

-Associated with sympathetic nervous system responses such as hypertension, tachycardia,

restlessness and anxiety.

 Chronic:
It lasts more than six months exists beyond the time for normal organic healing. The pain
begins to impair other functions. Patients may begin to experience learned helplessness and
hopelessness. This leads to the classic signs of depression (lethargy, sleep disturbance,
weight loss). He may quit work and adopt a self-imposed invalid existence.

-remote onset

- Uncharacteristic of injury or disease

- Nonspecific and localized

- Severity out of proportion to stage of injury or disease

- Responds poorly to drug therapy

- Persists beyond healing stage

Categories of Chronic Pain

• Chronic recurrent pain: Benign condition consisting of intense pain alternating with
pain-free periods, e.g. migraine, Tension headaches, and endometriosis

• Chronic intractable-benign pain: Benign condition where pain is persistent with no pain
free periods, although the pain may vary in intensity eg low back pain •

Chronic progressive pain: Malignant condition where pain is continuous and increases in
intensity as the organic condition worsens .eg cancer and arthritis.

Based on intensity

 Mild
 Moderate
 Severe
 Mild pain : pain scale reading from 1 to 3 is considered as mild pain.
 Moderate pain : pain scale reading from 4 to 6 is considered as moderate pain.
 Severe pain : pain scale reading from 7 to 10 is considered as severe pain.
Based on etiology

 Nociceptive pain
 Neuropathic pain

Nociceptive pain
• Nociceptive pain is experienced when an intact, properly functioning nervous system
sends signals that tissues are damaged, requiring attention and proper care.
• Ex : the pain experienced following a cut or broken bone alerts the person to avoid further
damage until it is properly healed.
• Once stabilized or healed, the pain goes away.

A. Somatic pain
• This is the pain that is originating from the skin, muscles, bone, or connective tissue.
• The sharp sensation of a paper cut aching of a sprained ankle are common examples of
somatic pain.
Neuropathic pain
• Neuropathic pain is associated with damaged or malfunctioning nerve due to illness,
injury or undetermined reasons.
• Ex : Diabetic peripheral neuropathy
Phantom limb pain
Spinal cord injury pain
• It is usually chronic.
• It is described as burning, "electric-shock" and tingling, dull and aching.
• Neuropathic pain tends to be difficult to treat.
• Neuropathic pain is two types based on which parts of the nervous system damaged.
 Peripheral neuropathic pain : Due to damage to peripheral nervous systen . Ex:
phantom limb pain.
Central neuropathic pain : Results from malfunctioning nerves in the central nervous
system

THEORIES OF PAIN

THE SPECIFICITY AND PATTERN THEORY:

In 1998 ,Von Frey described that body has a separate sensory system for perceiving pain just
as it does for hearing and vision .It describes the nerve impulses of varying intensity
terminating in pain centres in the forebrain. Pain is an independent sensation which responds
to damage and transfer signal to the target centre in the brain. Major deficit of specificity and
pattern .This theory does not explain referred pain which can be triggered by mild
stimulation of normal skin .inability to explain some of the characteristics of clinical pain.

THE GATE THEORY:

In 1965 ,Melzack and wall proposed the gate control pain theory,which was the first one
rccognizing the psychological aspects of pain are as important as physiological aspects.

Theory suggests that nerve fibres that contributes to pain transmission converage at a site in
the dorsal horn of the spinal cord. This site is thought to act as a gating mechanism that
determines which impulse will be blocked and which will be transmitted to the thalamus. The
image gate is useful in teaching clients and their families about pain relief measures. If the
gate is closed, the signal is stopped before it reaches the brain , where perception of pain

occurs . if the gate is open , the signal will continue on through the spino thalamic tract to the
cortex and the client will feel the pain. Whether the gate is opened or closed is influenced by
impulses from peripheral nerves and nerve signals that descend from the brain.

If a person is anxious , the gate can be opened by signals sent for the room down to the
mechanism in the dorsal horn of the spinal cord. On the other hand , if the person has had
positive experience with the pain control in the past, the cognitive influence can send signals
down to the gating mechanism and close it.
Pain could be relieved by blocking the transmission of pain impulse to the brain by both
physical modalities and by altering the individual thought processes ,emotions or other
behaviours.

SENSORY INTERACTION THEORY

In 1959 , Noordenbos explained that rapidly conducting large fibres pathways inhibit activity
in slowly conducting small fibres pathways which convey noxious information. increased
ratio of large to small fibres activity results in more inhibition in nociceptive pathways.

ETIOLOGY:

 Age – it influences its perception and expression of pain. Dangerous misconception

exists regarding the management of pain in older adults.
Factors related to aging ,decrease blood flow , decrease transmission of pain
 Sociocultural influences- it affects the way in which a patient tolerates pain interprets
the meaning of pain and reacts verbally and nonverbally to the pain.
 Emotional status- it influences the pain perception
 Anxiety increases the perception of pain and in turn it causes anxiety
 Fatigue , depression , lack of sleep.
 Previous experiences in pain

PATHOPHYSIOLOGY OF PAIN

Consists of the Following Mechanisms •

Pain Transduction

Pain Transmission

Pain Modulation

Pain Perception

 Pain Transduction-
It begins in the periphery when a pain-producing stimulus sends an impulse across the
peripheral nerve fibres. It refers to conversion of chemical information in the cellular
environment to electrical impulses that moves toward the spinal cord. The phase is initiated
by cellular disruption during which the affected cells release various chemical mediators
neurotransmitters such as prostaglandins, bradykinin, serotonin and histamine that react to
painful stimuli. Two type of peripheral nerve fibres conduct painful stimuli: the fast
myelinated A-delta fibers and the slow unmyeliated C fibers.

The A fibers send sharp, localized and distinct sensation that localize the source of pain and
detect its intensity. The Chiles relay impulses that are poorly localized, burning and
persistent, e.g. after stepping on a nail, a person initially feels a sharp Localized pain which is
a result of A fiber transmission. Within few seconds, the pain becomes more diffused and
widespread until the whole foot aches because of C fibers. The C fibers remain exposed to
the chemicals released when the cells are damaged When the A delta fibers and C fibers
transmit impulse from the peripheral nerve fibers, biochemical mediator at that activates or
sensitize the pain will respond.

Neuroregulators

Are the substance that affects the transmission of nerve fibres.play an important role in pain
experience .The substance is found at the site of nociceptors,at the nerve terminal. Within the
dorsal horn of the spinal cord. These are two types: Neurotransmitters and neuromodulators

Neurotransmitters

These are the substances that send electrical impulse across the synaptic cleft between the
two nerve fibres .

Serotonin: It releases from the brainstem and dorsal horn to inhibit pain transmission.

Prostaglandin: these are generated from the breakdown of phospholipids in the cell
membrane.

Neuromodulators

• Bradykinin –it is released from the plasma that leaks from surrounded blood vessel at the
site of injury. it binds to receptor on peripheral nerves, increasing pain stimuli.

• Endorphins and dynorphins: These are located within the brain and spinal cord causes
analgesia.

 Pain Transmission
It is the movement of pain impulses from the site of transduction to the brain. Three segments
are involved in nociceptive signal transmission. Nociceptors are the free nerve endings in the
skin that respond only to intense, potentially damaged stimuli). i.e Transmission along the
peripheral nerve fibers to the spinal cord • Dorsal horn processing • Transmission to the
thalamus and cerebral cortex.

 Pain Modulation
Involves the activation of descending pathway that exert inhibitory or facilitatory effects on
the transmission of pain. Depending on the types and degree of modulation , nociceptive
stimuli may or may not be perceived pain. Modulation is a pain signal occurs at the level of
the periphery.it release chemicals such as serotonin and GABA that can inhibit pain
transmission The high degree of processing of the sensory impulses occur at this level.

 Perception of Pain
Perception is the point at which a person is aware of pain. Pain stimuli are transmitted up the
spinal cord to the thalamus and midbrain. From the thalamus, fibres transmit the pain
message to the various areas of the brain, including frontal lobe and limbic system.
Perception gives awareness and meaning to pain so that a person can then react. The reactions
to pain are the psychological and behavioural responses that occur after pain perception.

SIGN AND SYMPTOMS

System Signs and symptoms

Endocrine system Increase ACH , increase cortisol, decrease

insulin

Metabolic Insulin resistance , hypergylcemia

Cardiovascular system Increase heart rate , increase cardiac output;

hypertension

Respiratory system Decrease flow and volume , atelestasis ,

hypoxemia

Genitourinary system decrease urine output , urinary retention ,

fluid overload

Gastrointestinal system Decrease bowel and gastric motility

Musculoskeletal system Muscle spasm , fatigue , immobility .

Cognitive Urge to obtain relief, anxiety and fear ,

irritability , sleep deprivation , reduced
appetite

PAIN ASSESSMENT IN ADULT

ABCDE for Pain Assessment and Management

• Ask about pain regularly • Base the treatment plan on patient assessment • Choose pain
control options appropriate for the patient • Deliver interventions timely, logically and a
coordinated fashion, and manage side effects

Assessment of Pain( ACCORDING TO GIL WAYNE UPDATED ON OCTOBER

13 ,2023)

1. USING PQRST pain assessment mnemonic

 PROVOKING FACTORS- what makes your pain better or worse?

 QUALITY: Tell me what its exactly like . is it sharp pain, throbbing pain or dull
pain, stabbing ect?
 REGION- show me where your pain is?
 SEVERITY- ask your pain to rate pain by using different pain rating methods .
 TEMOPRAL-onset,duration , frequency .does it occur all the time or does it come
and go?
2. Assess the location of the pain by asking to point to the site that is discomforting
3. Perform history assessment of pain.
4. Determine the client perception of pain-it provides the opportunity for the client to
express in their own words how they view the pain and the situation to gain an
understanding of what pain means to the client.

PAIN SCALE
 A pain scale measures a patients pain intensity or other features. Pain scales are based
on self-report, observational , or physiological data. Self-report is considered primary
and should be obtained if possible. Pain scales are available for neonates.

Examples of Pain Sales

• Simple Descriptive Scale:

1--------------1-----------1-----------------1----------1-----------1-------------1

No pain mild moderate severe very severe worst

 The Brief Pain Inventory - is a medical questionnaire used to measure pain, developed
by the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation
in Cancer Care.
 Verbal pain scale- as the name suggest to to describe pain . words such as a no
pain ,mild pain, and moderate pain and severe pain are used to describe pain levels a
score of 0 to 3 is assigned +to each of those word pairs and is used to measure the pain
level..
 The neuropathic pain scale- questionnaire - is particularly designed for people suffering
from pain due to nerve disease. or damage (neuropathic pain). This type of pain can feel
very strange and be difficult to describe. This questionnaire involves rating descriptions
of the pain (such as hot or itching) from one to ten. •
 McGill Pain Questionnaire (MPO): It contains a list of descriptive words to choose, to
indicate the intensity and character of the pain, with a drawing of a body on which you
draw in where the pain affects you.
 The Multidimensional Pain Inventory (MPI): It consists of a set of empirically derived
scales designed to assess chronic pain patients psychosocial state.
 Numeric Rating Scale (NRS-11): A numerical scale with the range of 0 to 10 is
another type of pain scale that is used. The words 'no pain' are indicated by the 'O'
and 'worst pain possible are indicated by '10? You are asked to choose a number from
O to 10 that best reflects your level of pain.

1----------1--------1-------1------1-----1-------1------1-------1-------1

1 2 3 4 5 6 7 8 9 10
Wong-Baker FACES Pain Rating Scale:

With the Wong-Baker pain scale, six faces are used that are numbered 0 to 5 underneath: -
Face 0 is a happy face (no hurt)

- Face 1 is still smiling (hurts a little bit) –

Face 2 is not smiling or frowning (hurts a little more)

- Face 3 is starting to frown (hurts even more)

– Face 4 is definitely frowning (hurts a whole lot)

- Face 5 is crying although you do not have to cry to choose this face (hurts the worst) Le
FACE pain scale would be particularly useful for children who may not have verbal skills to
express the pain level.

 Visual analog scale (VAS):

VAS or visual analogue scale uses a vertical or horizontal line with words that convey ‘no
pain’ One end and 'worst pain' at the opposite end. You are asked to place a mark along the
line that indicates your level of pain

 PAIN AND DIARY: Patient may be asked to complete a pain diary. This involves
recording, usually for one week, level of pain (on a pain scale) several times a day,
and making notes on activities or other things that seem to worsen the pain, as well as
of any medication you take and the effect it has. This can be very helpful in
establishing whether there is any particular pattern to the pain, or any triggers that
could be avoided.
 Physical Examination Some form of physical examination is likely to be required in
the assessment of pain. Precisely what form this takes will obviously vary according
 to the type and site of pain. Physical examination may be done either to look for a
possible cause for the pain, or to rule out possible serious disease. Sometimes areas
other than the painful area will need to be examined. Tests and procedures to check
for the underlying causes of pain are as follows: Laboratory Tests • Blood tests•
Computerized tomography (CT scan) • Electromyography.

PAIN ASSESSMENT IN PEDIATRIC:

Pain assessment in infants and children is also challenging due to the subjectively and
multidimensional nature in pain . The dependence on others to assess pain ,limited language
comprehension and perception of pain expressed contextually in some children it can be
difficult to distinguish between pain.

1.FLACC SCALE:

The acronym FLAC stands for Face , Legs , Activity ,Cry and Consolability.

Behavioural

 2 months 8 years and also used upto 18 years for children with cognitive impairment
and development disability .
 It may be difficult to assess children with cognitive impairment are nonverbal . ask
the parent or carer to help you explain their child pain behaviour.

FLACC has a high degree of usefulness for cognitively impaired and many critically ill
children.

Wong baker faces pain scale 3-18years

Face 0 is very happy because he is not hurt at all , Face2 hurt just a little bit , face 4 hurt a
little more, face 6 hurt even more , face 8hurts a whole lot , face 10 hurt and cries .

Visual analogue scale/numerical rating scale

 On a scale of 0-10 , with 0 being no pain and 10 being the worst pain you can imagine
.
 Self reporting pain tool for children aged 5 years and above.

MANAGEMENT OF PAIN

The World Health Organization (WHO) recommends a pain ladder for managing analgesia
which was first described for use in cancer pain, but can be used by medical professionals as
a general principle when dealing with analgesia for any type of pain. In the treatment of
chronic pain, whether due to malignant or benign processes, the three-step WHO Analgesic
Ladder provides guidelines for selecting the kind and stepping up the amount of analgesia.
The exact medications recommended will vary with the country and the individual treatment
center, but the following gives an example of the WHO approach to treating chronic pain
with medications. If, at any point, treatment fails to provide adequate pain relief, then the
doctor and patient move onto the next step.

PHARMACOLOGICAL MANAGEMENT

WHO HEALTH ORGANIZATION ANALGESIC LADDER- as a

It was originally published in 1986 for the management of cancer pain. It is now widely used
by the medical professionals for the management of all types of pain. The general principle is
to start with the first step drugs and then climb the ladder if pain is still present. The
medications range from common over the counter drugs at the lowest rung , to strong
opioids.

Three main principles of the WHO analgesic ladder are “ By the clock, by the mouth ,
by the ladder”

BY THE CLOCK

To maintain freedom from pain , drugs should be given by the clock or around the clock
rather than only on demand. This means the are given on a regularly schedule basis. The
frequency will depend on whether it is a long or short acting preparation.

BY THE MOUTH

The oral route is usually the preferred route for ease of use in a variety of care setting .
however it may not be possible for all patients (eg . end of life , unconscious , swallowing
issues ) when the oral route is not feasible , the least invasive route should be considered (eg.
Sublingual or sub cutaneous before intravenous) the intramuscular should never be used.

BY THE LADDER

If pain occurs there should be prompt administration of drugs in the following order:

 Non opioids analgesics .patient can get relief for mild pain acute intermittent pain
such as headache their action is to inhibit synthesis of prostaglandin , thus inhibiting
the inflammation response . NSAIDS act on the peripheral nerve receptors to reduce
transmission. Eg. Acetaminophen , aspirin
 Opioid analgesics – it is commonly used in mild to moderate pain . they produces
analgesia by attaching to the opioid receptors in the brain. Eg codeine , oxycodone .
 these drugs are prescribed in combining an opioid and non opioid analgesic along
with adjuvant drugs.
 Then strong opioids eg morphine until the patient is free of pain.drugs are
recommended for moderate to severe pain when step two drugs provide no relief .
these drugs are effective for moderate to severe pain because they are potent and long
lasting drug , can be delivered via many routes of administration . eg morphine ,
pentazocine .
 Adjuvant drugs used for pain management
Corticosteroid –dexamethasone , antidepressant – amitriptyline , anticonvulsants –
gabapentin , anxiolytic - diazepam

Management of Pain Drug Therapy Equianalgesic Dose It refers to a dose of one

analgesic that is equivalent in pain relieving effects compared with another analgesic. This
equivalence permits substitution of analgesics in the event that a particular drug is ineffective
or causes intolerable side effects. Generally, equianalgesic doses are provided for opioids and
are important because there is no upper dosage limit for many of these drugs.

Placebo response

The term placebo comes from the latin word meaning.it consists of an inactive substance
often given to satisfy a persons demand for a drug . the person ,unaware of the placebo
properties, may find it is effective for the pain relief . pain reduces anxiety.

NON PHARMACOLOGICAL THERAPY FOR PAIN:

 May contribute to the effective analgesia and rare often well accepted by patients .
Non pharmacological pain management strategies can reduce the dose of an
analgesic . Relaxation- is ,mental and physical freedom from tension or
stress .relaxation techniques educe muscle tension, oxygen consumption ,pulse, blod
pressure , respiration and lessen anxiety . pain causes stress,which in turn , can
aggravate the pain. complementary techniques like deep relaxation technique.
 Massage –hands on treatment in which a therapists manipulates muscles and other
soft tissues to improve health and well being.massage stimulates the circulatory and
lymphatic systems, lowers blood pressure ,relieves joint pain, reduces
swelling ,improves sleep and releases endorphins.
 Vibration
 yoga
 Transcutaneous electrical nerve stimulation- TENS has been used to treat patients
with various pain conditions , including neck and low back pain . A TENS unit is a
portable ,pocket sized ,battery powdered device which attaches to the skin. TENS is
used in chronic pain conditions and not indicated in the initial management of acute
cervical or lumbar spine pain.
  Acupuncture-this needle blocks the meridian which stops or decrease the pain.it is an
alternative intervention to help control discomfort from disorders such as
headache ,low back pain, menstrual cramps.
 Hot fomentation
 Cryotherapy
 Exercise-motion exercise ,walking ,stretching ,yoga , to reduce pain and maintain
muscle strength . patients who are immobile can have their muscle and joints moved
for them to maintain joint and muscle flexibility and tissue health.
 COGNITIVE THERAPY:
 Distraction-teaches client to focus attention on something other than pain. distraction
alone may relieve mild pain but is best used before pain begins or soon there after.
techniques includes counting objects ,reading, or watching television , auditory –
listening music . tactile kinaesthetic –holding or stroking a loved person ,pet or toy
 Hypnosis-achieving a n intense state of relaxation , or trance and receiving
suggestions to alter sensations ., behaviour ,feelings or thoughts. Hypnosis is a
technique that produce a subconscious state accomplished by suggestions made by
hypnotist has been used successfully in many instances to control pain.

SURGICAL THERAPY:

 NERVE BLOCKS: nerve blocks are used to reduce pain by temporarily or

permanently interrupting transmission of nociceptive input by application of local
anaesthetics or neurolytic agent.

 NEUROAUGMENTATION:

It involves electrical stimulation of the brain and the spinal cord.

 NEUROABLATIVE TECHNIQUES:This technique destroy nerves .Thereby

interrupting pain transmission . those destroying the sensory division of a peripheral
or spinal nerve are classified as neurectomies, rhizotomies and sympathectomise

 RHIZOTOMY:Interruption of the anterior or posterior nerve root area close to spinal

cord. If the course of pain can be accurately delineated by segmented boundaries and
is limited to few division , rhizotomy should provide permanent relief . such
conditions include traumatic lesions of peripherals nerves , operations scars .

NURSING MANAGEMENT OF PAIN:

ASESSMENT:

 Be aware of your own values and expectations about pain behaviours.

 Pain assessment tools are the most effective method to identify the presence and
intensity of pain in client.

SUBJECTIVE DATA:
 A client threshold and pain tolerance level should be assessed . pain threshold is the intensity
level where a person feels pain.it varies with each individual with the type of pain.assess the
location,onset and duration and intensity of pain.

OBJECTIVE DATA:

Is a different picture depending on the type of pain the client is experiencing.

Recording pain assessment: a flow sheet provides a place to document most of the
information used to make pain management decision including pain ratings ,vital
signs ,analgesic administered and the level of arousal.

Nursing diagnosis Goal Intervention Expected outcome

Acute pain related to To reduce pain to -perform a comprehensive Pain will be reduced to
actual or potential some extent . assessment of pain location with some extent.
tissue damage score.
secondary to -control environmental factors that
metastatic tumor as affect pain such as room temperature
evidenced by facial , lightning and noise
expression , asking -teach relaxation techniques.
questions and -give analgesics as ordered ,
restlessness. document pain score and before and
after medications
- non pharmacological therapy like
exercise, massage , transcutaneous
electrical nerve stimulation.

Altered breathing Maintain effective -assess respiration , check pulse Breathing pattern will
pattern related to breathing pattern. oximetry reading. be maintained and spo2
infection secondary -administer oxyegen as per doctors will be maintained.
to disease process as advice.
evidenced by -proper positioning as per patients
patients complain of tolerance i.e semi fowlers position
dyspnea and low -Administer bronchodilators as
pulse oximeter prescribed.
reading.

Activity intolerance To increase the ` -monitor vital signs Clients tolerance to

related related to clients tolerance to -monitor ability to perform activity activity will be
chest tube drainage activity. -provide assistance to perform increased.
secondary to disease activity of daily living.
condition as -provide adequate rest in between
evidenced by fatigue activities.
,decreased activity
level
Nursing diagnosis Goal Intervention Expected outcome

5. Self care to perform Assess the strength of the patient to perform The patient will be
deficit related daily living ADL independently. able to perform
to surgery activities. some daily living
secondary to activities with an
disease process -all nursing care like back care , sponge , mouth assistance.
as evidenced care , catheter care and drainage care must be
by fatigue and provided or given .
decreased v
mobility.
- encourage for early ambulation.

A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-
Centered Design Approach
Abstract

Background:Patients with chronic pain face several challenges in using clinical tools to help
them monitor, understand, and make meaningful decisions about their pain conditions. Our
group previously presented data on Pain imation, a novel electronic tool for communicating
and assessing pain.

Objective:This paper describes the human-centered design and development approach

(inspiration, ideation, and implementation) that led to the creation of Painimation.

Methods:We planned an iterative and cyclical development process that included stakeholder
engagement and feedback from users. Stakeholders included patients with acute and chronic
pain, health care providers, and design students. Target users were adults with acute or
chronic pain who needed clinical assessment and tracking of the course of their pain over
time. Phase I (inspiration) consisted of empathizing with users, understanding how patients
experience pain, and identifying the barriers to accurately expressing and assessing pain. This
phase involved understanding how patients communicate pain symptoms to providers, as well
as defining limitations of current models of clinical pain assessment tools. In Phase II (ideate)
we conceptualized and evaluated different approaches to expressing and assessing pain. The
most promising concept was developed through an iterative process that involved end users
and stakeholders. In Phase III (implementation), based on stakeholder feedback from initial
designs and prototypes of abstract pain animations (pain imations), we incorporated all
concepts to test a minimally viable product, a fully functioning pain assessment app. We then
gathered feedback through an agile development process and applied this feedback to
finalizing a testable version of the app that could ultimately be used in a pain clinic.
Results:Engaging intended users and stakeholders in an iterative, human-centered design
process identified 5 criteria that a pain assessment tool would need to meet to be effective in
the medical setting. These criteria were used as guiding design principles to generate a series
of pain assessment concept ideas. This human-centered approach generated 8 highly visual
painimations that were found to be acceptable and useable for communicating pain with
medical providers, by both patients with general pain and patients with sickle cell disease
(SCD). While these initial steps continued refinement of the tool, further data are needed.
Agile development will allow us to continue to incorporate precision medicine tools that are
validated in the clinical research arena.

CONCLUSION:

Nurses are often the first health care professional to encounter the person in pain. So the
relationship of patient and nurses can have an important part in the care of person with pain

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SUBMITTED TO : SUBMITTED BY:

Madam S . Chakraborty Tshering Ongmu Tamang

Senior Lecturer M.Sc nursing part I

W.B.G.C.CO.N SSKM W.B.G.C.O.N. SSKM