PAIN RECOGNITION AND RELIEF

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PAIN RECOGNITION AND RELIEF

• PAIN MANAGEMENT
• Bessie Burton Sullivan
• Pat Borman, MD

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DEFINITION OF PAIN

• Pain is suffering
• Residents define their pain
• Pain is personal, subjective
• Pain is treatable

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MISCONCEPTIONS ABOUT PAIN

• Pain is part of aging, inevitable
• Acknowledging pain is weak
• Pain always means serious disease or death
• Pain is punishment
• Pain leads to loss of independence

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ROADBLOCKS TO PAIN MANAGEMENT

• No format for regular, complete assessment and
  reassessment
• Misjudging behavioral clues
• Lack of documentation tool
• Myth that pain is normal
• Lack of nursing knowledge

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PAIN ASSESSMENT

• QUESTION Resident and family
• OBSERVE Resident behavior
• EXAMINE Resident
• EVALUATE Function, ADLs
• REASSESS FREQUENTLY TO MONITOR TREATMENTS

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PAIN ASSESSMENTQUESTIONS

• QUESTIONS TO ASK
• Are you in pain hurting, achy, uncomfortable,
  bothered?
• Is any other spot bothering you? (More than one
  site or type of pain)
• Pain Scale Assessment

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PAIN ASSESSMENTQUESTIONS

• DEFINE THE PAIN
• Location, quality, severity, frequency, duration
• Aggravating or alleviating factors
• Amount of dysfuction

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PAIN ASSESSMENT OBSERVATIONS

• OBSERVE BEHAVIORS
• Sad, frown, irritable, low mood
• Moan, groan, cry, sigh, wince
• Rub, protect a part, pointing, touching,
  favoring, fidgeting
• Change in activity, sleep, appetite, mobility,
  gait, resisting care, combative

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PAIN ASSESSMENTEXAMINATION

• EXAMINE FOR SOURCE OF PAIN
• Types of Pain Muscle, Joint, Neurological
• Sources Arthritis, low back pain, gout,
  osteoporosis, stroke, fracture, diabetes,
  headache, shingles,dental, pressure ulcers,
  restraints, other

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PAIN ASSESSMENTEVALUATE FUNCTION

• CHANGES IN FUNCTION CAN BE A SIGN OF PAIN
• Decreased participation, change in gait, less
  active
• Decreased mobility, more, reliance on
  assistance/devices
• Increased incontinence, less grooming

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DOCUMENTING PAIN MANAGEMENT

• Communication amongst team members is critical
• Pain Scales Numeric, Visual
• Resident Education component
• Ongoing Assessment Pre and Post
  treatment

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MEDICATIONS FOR PAIN

• NON-OPIOIDS Acetaminophen
• Aspirin
• NSAIDs
• Tramadol
• Topicals
• capsaicin
• lidocaine

• OPIOIDS
• Morphine
• Hydromorphone
• Codiene
• Hydrocodone
• Oxycodone
• Topicals
• Fentanyl

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ADJUVANTTREATMENTS

• Corticosteroids
• Antidepressents
• TCADs
• Anticonvulsants
• Nuerontin, Tegretol, Clonazepam
• Muscle relaxers

• Education
• Counseling
• Exercise
• PT/OT
• Positioning
• Heat, cold, massage
• Relaxation
• Hypnosis

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DOCUMENT EFFECACY OF TREATMENT

• Pain diagnosis is recorded
• Record each administered dose
• Confirm effectiveness with pain scale, resident
  report, observation
• Use Sedation scale and document any side effects
  of treatment

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MEDICATION SIDE EFFECTS

• Opiates can cause
• Constipation
• Urinary Retention
• Sedation, Delirium
• Impaired cognition
• Decreased respiratory rate Nausea, Itching

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RESIDENT EDUCATION

• Pain can and should be managed
• You define your level of pain and relief from
  medication
• Please report pain as soon as it bothers you
• Tell us any concerns you have about your pain
  relief plan

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PAIN RECOGNITION AND RELIEF

• Recognition is the first step to relieving pain
• Develop a pain vocabulary and ASK, Be observant
  for pain behaviors in your residents
• Educate your residents we can help, you dont
  have to suffer
• Be an advocate for pain relief