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What is Pain? n “Pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.”

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Presentation on theme: "What is Pain? n “Pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.”"— Presentation transcript:

1 What is Pain? n “Pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.” n “Pain is whatever the experiencing person says it is, existing whenever he/she says it does.” IASP, 1979 McCaffery, 1969

2 Common Painful Conditions in Long-Term Care Residents n Degenerative joint disease n Rheumatoid/osteoarthritis n Osteoporosis n Fractures n Muscle pain/stiffness n Neuropathies n Post stroke pain n Skin or pressure ulcers n Immobility

3 What are the consequences? n Affects overall quality of life n Depression n Emotional distress n Decreased socialization n Disturbed sleep and appetite n Reduced mobility and ambulation n Slow rehabilitation n Agitated behavior n Slowed healing n Increased health care utilization n Increased costs

4 Five-step Ladder to Optimal Pain Management Communicating the understanding Legitimizing the pain Believing the person has pain Understanding the pain experience Getting to know the pain Fink, 1996

5 Getting to Know the Pain n Words n Intensity n Location n Duration n Aggravating/Alleviating Factors

6 Intensity n Quantitative measurement scales ä Numeric Rating Scale (NRS) ä Verbal Descriptor Scale (VDS) ä Faces Scales (Wong-Baker, Bieri) ä Pain Thermometer n Questions to ask ä “If 0 is no pain and 10 is the worst possible pain, what is your pain right now, in the past 24 hours (since lunch time yesterday), since you received your pain medicine?” ä “Where do you want your pain to be?”

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8 The Faces Pain Scale Revised (FPS-R) The Bieri Faces Pain Scale

9 Pain Thermometer

10 Reasons Why Residents Don’t Request Pain Medication n Concerned about pain medication ä “I’m afraid of getting hooked.” ä “If used too early, it won’t work later.” ä “I don’t want to get constipated.” n Stoic – “Pain not that bad, I can handle it” n Anticipate staff response – not believed n Not wanting to bother staff n “Pain is a part of aging; just need to bear it.” n Fate/Passivity – nothing helps n Physician won’t order; nurse won’t give n Self-management strategies

11 Common Pain Behaviors in Cognitively Impaired Elderly Persons n Facial Expressions n Verbalizations, Vocalizations n Body Movements n Changes in Interpersonal Interactions n Changes in Activity Patterns/Routines n Mental Status Changes JAGS, 2002; 50:S205-S224 *Observe at rest & movement

12 Pain Assessment Tools for Use in the Cognitively Impaired Nonverbal Resident n Discomfort in Dementia of the Alzheimer’s Type (DS-DAT) n Modified DS-DAT n Checklist of Nonverbal Pain Indicators (CNPI) n Assessment of Discomfort in Dementia Protocol (ADD) n Pain Assessment in Advanced Dementia (PAINAD) n Pain Assessment for the Dementing Elder (PADE) n The Pain Assessment Scale for Seniors with Severe Dementia (PACSLAC) n Nursing Assistant-Administered Instrument to Assess Pain in Demented Individuals (NOPPAIN) Review of pain scales by Dr. Keela Herr & colleagues -


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