CH 10: Pain Assessment- The Fifth Vital Sign

acute pain

short term, self limiting, often predictable trajectory; stops after injury heals

breakthrough pain

pain restarts or escalates b4 next scheduled analgesic dose

chronic (persistent) pain

pain continues for 6 months or longer after initial injury

cutaneous pain

pain originating from skin surface or subcutaneous structures

incident pain

occurs predictably after specific movements

modulation

pain message is inhibited during this last phase of nociception

neuropathic pain

abnormal processing of pain message; burning, shooting in nature

nociception

process whereby noxious stimuli are perceived as pain; central and peripheral nervous systems are intact

nociceptors

specialized nerve endings that detect painful sensations

pain

unpleasant sensory and emotional experience associated w/ actual or potential tissue damage, or described in terms of such damage. Pain is always subjective

perception

conscious awareness of painful sensation

referred pain

pain felt at a particular site but originates from another location

somatic pain

originating from muscle, bone, joints, tendons, or blood vessels

transduction

first phase of nociception whereby the painful stimulus is changed into an action potential

transmission

second phase of nociception whereby the pain impulse moves from the spinal cord to brain

visceral pain

originating from interior organs such as the gallbladder or stomach

Nociceptive pain develops when

nerve fibers in the peripheral and central nervous systems are functioning and intact. It starts outside the nervous system and results from actual or potential tissue damage. Nociception occurs in four phases: transduction, transmission, perception, and

Neuropathic pain does not adhere to typical and predictable phases.

It implies an abnormal processing of the pain message due to an injury of the nerve fibers. It is sustained on a neurochemical level that can only be identified by electromyography and nerve-conduction studies.

pain can be classified by its source

visceral pain, deep somatic pain, cutaneous pain, referred pain

pain can also be classified by its duration

acute pain and persistent (or chronic pain)

neuropathic pain

burning, shooting, and tingling

nociceptive pain is described as

aching if localized and cramping if poorly localized; from somatic sites it is described as throbbing/aching

identify the most reliable indicator of a persons pain

subjective report

recall questions for an initial pain assessment

o Do you have pain, discomfort, or soreness?
o Where is your pain?
o When did it start?
o What does your pain feel like?
o How much pain do you have right now?
o What makes you pain better or worse?
o How does pain limit your function or activities?
o How

Use an overall pain assessment tool, such as the Initial Pain Assessment or the Brief Pain Inventory, to

assess chronic pain or problematic acute pain.

use a pain rating scale to

evaluate pain severity

numeric scale is used for

adults and older children.

Pediatric scales, such as the Oucher Scale and the Faces Pain Rating Scale

are used for young children

Older adults may respond best to

a Descriptor Scale.

initial pain assessment

-clinician ask patient to answer 8 questions concerning location, duration, quality, intensity, and aggravating/relieving factors
-further questions are asked about the manner of expressing pain and the effect of pain that impair ones quality of life

brief pain inventory

ask patients to rate the pain within the past 24 hours using 0-10 scale with respect to its impact on areas such as mood, walking, ability, and sleep

short form McGill pain questionnaire

ask patient to rank a list of descriptions in terms of their intensity and to give an overall intensity rating to their pain

numeric rating scales

ask patient to choose a # that rates level of pain for each painful site, w/ 0 being no pain and highest anchor 10 meaning worst pain ever experienced

descriptor scale

list words that describe different levels of pain intensity, such as no pain, mild pain, moderate pain, and severe pain

child re 2 yrs of age

can report pain and point to its location

rating scales can be introduced

4-5 yrs of age

faces pain scale revised

6 drawing of faces that show pain intensity, from no pain on left (score of 0) to very much pain on right (score of 10)

The physical examination can reveal objective data that support subjective data.

o Assess the patient's joints, muscles, skin, and abdomen to detect injuries or other signs of painful disorders.
o When a person cannot verbally communicate the pain, look for nonverbal behaviors of pain, such as guarding, grimacing, moaning, agitation,