:

PAIN ASSESSMENT : THE PRACTICAL POINT

.

1. : diagnosis
2. : selection of treatment
3. : the efficacy of treatment

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7

7 7

7

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7

Is it easy?
G G :


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&

/

7

The pain experience can be

influenced by



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7

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7 7/

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Self report


= Gold standard

th
5

PAIN: the
VITAL SIGN

How to assess pain ?

Essentially it is by asking the
patient about their pain.
Tools can aid the assessment
process.

Pain measurement



 



Principles of Measurement
Tools
- 7777
-
- 77 7 & 7 &
G
- 77 G

Cognitive Impairment 1st step

Mild to Moderate : verbal descriptor scale

Cognitive Impairment 2nd step

Severe

Unable to communicate

The pain level needs to be made by

caregivers, nurse, or other heath care provider
by assessing BEHAVIOR

Bio-Psycho-Social Model
Biological

Pain
Psychological

Social

Good pain management

involves
Assessment of the whole person

Assess the person

Not just only the pain
Organic
Factors

Culture

Past experiences

Patients subjective
report of pain

Attitude, Expectations
=

Coping efforts
Mood
Resources;
Response of family members
Impact of
pain on life

Meaning of the pain in the situation

Definition of Pain
Pain

is an unpleasant sensory or emotional

experience associated with actual or
potential tissue damage or described
in term of such damage
(IASP)

:-  .
 
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What type of Pain?

Duration
- Acute
- Chronic
Categories
- Nociceptive
- Neuropathic
- Psychogenic

Acute Pain

G

, ,
G


Can you have a normal blood Pressure and Pulse
with acute pain?

Chronic Pain

 

(. 3-6 )



: nerve damage
: non-specific back pain

Acute & Chronic pain

Acute pain
- < 3
-
-

- Change of HR, P, RR, BP
-  
-
-  

Chronic pain
- >3
-
-  
- vital signs 
-
1
-
-

- 
 

Nociceptive Pain
Nociceptive pain can be
* Somatic Pain
* Visceral Pain
The location of the pain receptors
forms the basis of this classification.

Somatic- Nociceptive Pain

G 7GG 7
Skin, mucosa, bones, joints and
pleura

- Hot, Stinging, well localised,

nagging dull ache

Visceral Nociceptive Pain

- G

- G 7 7
- 7


- : Generalised aching
- : squeezing
- : dull aching
- ,
- 

Neuropathic Pain

This pain arises from injury or
disease to nerve tissue

Described as : burning, shooting,

stabbing, tingling, etc.

Frequently hypersensitive : to

touch or cold

Examples : trigeminal neuralgia, diabetic
neuropathy, phantom limbs

Mixed

Neuropathic
pain

Mixed
Pain

Nociceptive
Pain

Psychogenic Pain
Definition is
77
77G
? ?

G 7
7
G
7

Key Elements to the pain

assessment process
-Location
-Description
-Intensity
-Duration
-Alleviating factors
-Aggravating factors
-Associated factors

(Location)

77 7
1 7

- G7
- 7 ?
- 7 ?
- 77?

 ?
77
1
( nociceptive or neuropathic pain)

-
-#% ?
-Dull %, Stabbing ?
Burning ? Crushing % ?

77 ?

-G 7G 7 ?
- ?
-7?
-?
-G ?

Intensity of the pain and

its effect on function

At rest and on movement

-
-

77G

7?
7 ?
77
?



 G

7
7


777
G

Behavioral
NIPS : 0-1 yr.
Cheops :1-3 yr.
FLACC (faces, leg, activity,
cries, consolability)

Self - Report
Poker chips (age 3 8 years)
Faces Pain Scale Revised (age 4-9
years)
Numeric scale (age 6/10 years and
up)
VAS (age 10 and up)

Faces Scale ( >3 y )

Initial assessment

-
- 
-  
- 



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- 7 ?
(, 7, )
- 7 G ?

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- 7?

Parents view

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7
7G

Parents actually know

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&

(7)
7
(7)

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#

Pain ? For every clinic visit

7
- 7
- 77
- 77
- 7
-
- 7
( , )

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 7
G
 7
( 7
7 )
 7
 7 G G




7
(individual)

7
G (bias)

...
 ,

7
7 7
 7
77
7

Pain Assessment
in selected group
 Postoperative pain
 Pediatric patients
 ICU patients
 Neurological patients
 Geriatric patients
 Psychological dysfunction patients
 Substance patients

Postoperative pain

 7
- 7 7
- 7
- (unidimension)
 77
-

Pediatric Patients
 (unidimension)


 3-4 7
77

ICU Patients



 7
 15-30 /

Neurological Patients

G
 7


Geriatric Patients

G
 7
 77

Psychological dysfunction patients


 /


7
 7

Psychogenic pain

 G

 / ( )


 



'



' 

American Pain Society : APS 2005

//

Home care call

5th VS

APS 2005
Improve by
Evidence-Base

Assess pain impact

PS < 3-4
Drug efficacy/ S/E