3. According to Katz and Melzack, pain is a
personal and subjective experience that
can only be felt by the sufferer.
According to McCaffery pain is whatever
the experiencing person says it is and
exists whenever they say it does.
4. TYPES OF PAIN
ACUTE PAIN
CHRONIC PAIN
CUTANEOUS PAIN
DEEP SOMATIC PAIN
VISCERAL PAIN
REFERRED PAIN
NEUROPATHIC PAIN
PHANTOM PAIN
12. Behavioral
characteristics
Facial expressions- grimace, clenched teeth,
wrinkled forehead, crying
Body movements -restlessness, immobilization,
muscle tension, protective movement of body
parts
Social interaction- avoidance of conversation &
contacts
29. Why is control important
Delays post op recovery
Increases morbidity
Delays return to normal function
Restricts mobility -> thromboembolism
Catecholamine release
Pulmonary dysfunction
30. Assessment
Pre op prediction
Post op subjective assessment
Post op objective assessment
31. Initial Pain Evaluation
The initial evaluation of pain should include a
description of the pain using the PQRST
characteristics:
P Palliative or provocative factors: ‘What makes it
less intense?’
Q Quality: ‘What is it like?’
R Radiation: ‘Does it spread anywhere else?’
S Severity: ‘How severe is it?’
T Temporal factors: ‘Is it there all the time, or does it
come and go?’
32. To study the effects of both physical and non-physical influences on
patient well-being, an instrument
must assess more dimensions than the intensity of pain or other
physical symptoms. Several validated
questionnaires to assess various QoL dimensions are available,
including the Medical Outcomes Short-Form
Health Survey Questionnaire 36 (SF-36), and the European
Organisation for Research and Treatment of Cancer
Quality of Life Core Questionnaire (EORTC QLQ-C30) (26-30).
There are several rating scales available to assess pain. Rating pain
using a visual analogue scale (VAS, Figure
1) or collection of VAS scales (such as the brief pain inventory) is an
essential part of pain assessment. Its
ease of use and analysis has resulted in its widespread adoption. It is,
however, limited for the assessment of
chronic pain.
33. Pre op assessment
Past medical and surgical history
Current Rx (prescribed and illicit)
Allergies
Past pain history and treatments
Patients expectations of pain
Advice re pain Mx and modes of delivery
How we measure pain and patients reporting
43. ABCDE for pain assessment
&management
Ask about pain regularly
Believe the patient and family in their reports &what
relieves it
Choose pain control options appropriate for the
patient
Deliver interventions timely, logical &coordinated
fashion
Empower patient and their families
44. JCAHO Standards for postoperative
pain management are:
Recognize patients’ rights to appropriate
assessment and management of pain
Screen for pain and assess the nature and
intensity of pain in all patients
Record assessment results in a way that allows
regular reassessment and follow-up
Determine and ensure that staff are competent
in assessing and managing pain.
Address pain assessment and management
when orienting new clinical staff
45. Standards Contd..
Establish policies and procedures that support
appropriate prescribing of pain medications
Ensure that pain doesn’t interfere with a patient’s
participation in rehabilitation
Educate patients and their families about effective
pain management
49. PRINCIPLES OF PHARMACEUTICAL
PAIN MANAGEMENT
Provide medication in adequate doses.
Utilize a preventive approach to pain relief. Use
round the clock dosing with rescue medication
available.
Closely assess clients with particular diligence
with first doses or when medication dose or the
type is changed
Combinations of analgesics may be more
effective than those given singularly.
50. PRINCIPLES CONTD.
Understand and be prepared to treat side
effects of medications
avoidance of non-life threatening side
effects (such as constipation, nausea,
pruritis) more important that providing pain
relief. These concomitant conditions are
easily treated.
Additions of adjuvant medications enhance
pain relief.
51. Principles contd.
Believe the patient’s report of pain.
Maintain a therapeutic relationship that
facilitates mutual trust.
Do not use placebos for pain.
incorporate the goal of total pain relief into
the pain management regimen
operate as a team to provide the most
effective pain relief outcomes
52. PRINCIPLES CONTD.
Asking for pain medication reflects the need for
pain relief in 99.9% of people with pain and
doses does not reflect an addictive personality.
Recognize that respiratory depression is a rare
occurrence, occurring most commonly among
clients who are over sedated. Respiratory
depression rarely occurs after the first few
doses of an opioid.
53. Principles contd.
Only the patient and no one else can determine the
amount of pain experienced
There are no objective indicators that can be
observed by another
65. Practicalities
Pre op assessment
Prediction of pain
Preempt with preventative Rx
Assess post op subjectively and objectively
Treat with appropriate Rx
Assess response
Modify Mx