5. Acute vs. Chronic Pain
Acute Pain
• Pain duration of less than 3 to 6 months
• Causes activation of nociceptive pain pathway at site
of tissue damage/injury
• Resolves with healing of underlying pathology
• Lack of treatment may lead to chronic pain
Chronic Pain
• Pain duration of more than 3 to 6 months
• Pain which persists beyond course of acute disease
or after healing of tissue
• May be caused by injury or disease
9. Principles of Pain Assessment
• Pain should be assessed in all patients (JCAHO Standard
PE 1.4, 2000)
• Patient’s self-report is the single most reliable indicator
of pain absent of objective report
• Physiological and behavioral signs of pain (tachycardia,
grimacing, etc. ) are neither sensitive nor specific for pain
• Uniform threshold of pain does not exist because pain
tolerances vary among individuals
• Unrelieved pain causes adverse health effects both
physically and psychologically
• Assessment should address physical and psychological
aspects of pain
Pain is also multidimensional, so multiple aspects (sensory, affective, cognitive) of the pain experience must be considered
Pain is subjective, so no objective measures of pain exist.
The nature of the assessment varies with multiple factors (e.g. purpose of the assessment, the setting, patient population, clinician, so no single approach is appropriate for all patients or settings.
On admission it is important to distinguish if the patient is having chronic pain
Acute-on-chronic pain: acute pain flare superimposed on underlying chronic pain
Categories of pain, pain assessment, pain reassessment
Nociceptive (Somatic/Visceral): represents normal response to injury of tissues such as skin, muscles, organs, joints, tendons, bones.
Somatic: structures are highly sensitive to temperature, vibrations, and inflammation. Ex. joint pain, skin pain, tissue pain, etc.
Visceral: structures are highly sensitive to distension, ischemia, and inflammation. Ex. irritable bowel syndrome, bladder disorders, MI, etc.
Neuropathic: Pain causes by a lesion or disease in the somatosensory nervous system. Ex. phantom limb, diabetic neuropathy, spinal cord injury pain
Inflammatory: sensitization and activation of pain pathway. Ex. Rheumatoid Arthritis, appendicitis, inflammatory bowel disease, etc. (*Inflammation underlies most pain processes)
Medication interventions are important but so are non-pharmacological interventions** (oils, warm blanket, massage, etc.)
The nature of the assessment varies with multiple factors (e.g. purpose of the assessment, the setting, patient population, clinician, so no single approach is appropriate for all patients or settings.
Provokes: What relieves it? What aggravates it?
Quality: What does it feel like? Stabbing, burning, crushing, throbbing, nauseating, shooting, twisting, or stretching?
Radiates: Where is it located? Does the pain radiate? Does it feel like it travels/moves around? Did it start elsewhere?
Severity: On a scale of 0-10? Does it interfere with activities? How bad is at its worst? Does it force you to sit down, lie down, slow down? How long does an episode last?
Timing: When did the pain start? How long did it last? How often does it occur: hourly? Daily? Weekly? Monthly? Is it sudden or gradual? What were you doing when you first experienced it? When do you usually experience it: daytime? night? early morning? Are you ever awakened by it? Does it lead to anything else? Is it accompanied by other signs and symptoms? Does it ever occur before, during or after meals?
So because pain is an unpleasant sensory and emotional experience, assessment should also address physical and psychological aspects of pain
The pain standard is to assess pain every 8 hours, re-assess pain 30 minutes after an I.V. medication and an hour after an oral medication
May fluctuate depending on Opioid Naïve and Opioid Tolerant patients.
Opioid Naïve: more sensitive to sedating opioid and benzodiazapine effects
Opioid Tolerant: less sensitive; requires higher dosages to attain effectiveness
The nurse and the patient should be on the same page regarding patients pain goal. A pain rating of a 4 may be acceptable to the nurse but not to the patient.
