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What are the Ps of pain assessment?

The P’s refer to pain, pallor, pulse, paresthesia, and paralysis. Pain is commonly rated on a 10-point scale and can be disproportionately severe in the case of compartment syndrome.

What are three 3 components of a pain assessment?

Introduction – Pain assessment is crucial if pain management is to be effective. Nurses are in a unique position to assess pain as they have the most contact with the child and their family in hospital. Pain is the most common symptom children experience in hospital.

Acute pain (noiciception) is associated with tissue damage and an inflammatory response, it is self limiting of short duration and does not involve neural tissue. Pain is multidimensional therefore assessment must include the intensity, location, duration and description, the impact on activity and the factors that may influence the child’s perception of pain (bio psychosocial phenomenon) The influences that may alter pain perception and coping strategies include social history/issues, cultural and religious beliefs, past pain experiences and the first pain experience.

In addition family response to their child in pain can have a negative or positive influence.

What is the 5 step hierarchy of pain assessment?

Table 5.2 DisDAT. Most common signs and behaviours (cues) presented by individuals with disabilities when content and when distressed –

Contented cues (signs and behaviours observed in person when content)	Percentage presenting with these cues	Distressed cues (signs and behaviours observed in person when distressed)	Percentage presenting with these cues
Smiles	80	Lifts hands to head	50
Vocalizes without prompting	70	Screams, wails	40
Has relaxed body/face	50	Withdraws	40
Laughs	40	Becomes quiet	30
Responds vocally to social interaction	40	Groans	30
Has bright eyes	40	Face is bright red	30
Makes eye contact	40	Body is rigid	30
Eyes move around	30	Looks tearful, sad	20
Gestures towards social partner (spontaneous and response)	30	Is restless	20
Is affectionate	30	Clenches and grinds teeth	20
Is quiet	30	Grimaces, face is distorted	20
Sits straight/upright	20	Body is slumped	20
Blows raspberries	20	Uses different tone in vocalization	20
Grimaces	10	Face is rigid	10
Grinds teeth	10	Curls into themselves	10
Head is upright	10	Is not smiling	10
Is involved in interactions and environment	10	Makes growling noises	10
Likes close proximity	10	Eyes widen	10
Makes sighs of contentment	10	Increases eye movement	10
Co-operates with interventions	10	Breathes shallowly	10
Taps feet to music	10	Has shortness of breath	10

Both people who know the individuals and those who do not know them are able to identify distress using the DisDAT tool. However, people who know an individual’s specific signs and cues able to identify the distress earlier. (Distress is noted as a change from contented behaviours to behaviours that indicated distress.) Keep in mind that each person typically has his or her own language of distress.

1. The DisDat is available online at http://prc.coh.org/PainNOA/Dis%20DAT_Tool.pdf People with intellectual disabilities and mental illness deserve the same standard of care as all other individuals.
2. This means they should have regular annual checkups with a physician, a dentist, and any other health professional who is regularly involved in their care, such as a physiotherapist or occupational therapist.

Individuals may have one or more medical conditions that require more regular follow-up (for example, diabetes that requires monitoring by a physician every three months). Caregivers should expect and advocate for this level of care to ensure that complications related to disease processes are detected early.

• People with intellectual disabilities may require a longer appointment time and/or may feel more comfortable if a person they trust accompanies them to their appointments (see Chapter 4).
• Unfortunately many people with dual diagnosis receive substandard care, perhaps because a health care professional holds prejudicial beliefs about individuals with intellectual disabilities, or simply because he or she does not know how to care for individuals with intellectual disabilities.

If an individual has experienced diagnostic testing and surgical procedures in the past without adequate pain treatment, or didn’t understand what was happening or what was expected, he or she may be fearful and anxious before health care visits. Similarly, when health care services have not recognized, treated, or managed an individual’s pain well, the caregiver can leave the experience feeling the negative emotional impact (Findlay, Williams, Baum, Scior, 2014).

• The gold standard for good pain assessment is to have the individual self-report symptoms as much as he or she is able before a proxy adds information.
• Caregivers should report regular behaviour, any changes that they have observed, and whether they have seen these responses in the past related to specific health care concerns.

None of this information takes the place of a thorough physical assessment and diagnostic workup by a health care professional. Ideally, clients should see health care professionals who know them well and who have the individual’s health care history.

In emergencies and in situations where the individual is in obvious pain or distress, they may see health care professionals they have never met before. This can be quite frightening and anxiety-provoking for many individuals, especially for those who also have mental health issues (see Chapter 3). Thus, it is important that the individual be accompanied to appointments or to the emergency department by a family member or caregiver who knows the most about the person, who can provide comfort, and who is trusted by the person.

Many people with intellectual disabilities may require some anxiety medication or sedation for complex dental or medical procedures, so they really appreciate having someone with them who cares. Often an individual can be helped by distracting activities, ongoing conversations, a comforting object, or a promise of an enjoyed activity after a health care visit.

In this chapter we have discussed the experience of pain. Health care providers, direct support workers, and all those who care for and about individuals living with intellectual disabilities have an ethical duty to implement pain assessments with both verbal and non-verbal information. Often the main indicators that a person is in distress are behavioural cues and information from others.

The progression or hierarchy of steps to assess pain are 1) obtain a self-report, 2) search for potential causes, 3) observe behaviours, 4) obtain information from others (proxy reporting), and 5) attempt a trial of pain medication. People may experience pain even when they are carrying out normal daily activities, and therefore a guiding principle is to involve those who know the person throughout the process of assessing and treating pain.

• Five tools to assess physical pain have been explained: 1) the Wong-Baker FACES® Pain Rating Scale, 2) the Individualized Numeric Rating Scale, 3) the FLACC Pain Assessment Scale, 4) pictures for identifying distress, and 5) the DisDat.
• We have emphasized how dually diagnosed people require regular checkups that include thorough physical assessments and diagnostic workups.

During complex medical procedures, caregivers can request that health care professionals provide anxiety medications. Caregivers can provide distracting activities or an enjoyable activity after the procedure. Assessing and responding when dually diagnosed people say or show that they are in pain is a critical element in supporting them toward living healthy lives.

What is the best pain assessment tool?

Pain Assessment for Older Adults WHY: There is significant evidence demonstrating that pain is a common problem in older adults (persons 65 years of age and older). In one study, 50% of adults 65 years of age and older said they experienced pain in the previous 30 days.

1. Up to 80% of nursing residents experience pain regularly (National Center for Health Statistics, 2006).
2. Although many older adults suffer from pain there is widespread undertreatment of pain.
3. Reasons for this include concerns related to opioid dependence, the belief that pain is a normal part of aging, and a lack of routine pain assessment.

Persistent pain has been associated with functional impairment, falls, slow rehabilitation, depression, anxiety, decreased socialization, sleep disturbance, as well as increased healthcare utilization and costs. In 2009, the Joint Commission removed the requirement that pain be assessed as “the fifth vital sign” due to, in part, concerns of overtreatment of pain with opioids.

1. However, in 2016, The Joint Commission began a project to both revise its pain assessment and management standards and identified the assessment and management of both acute and chronic pain a priority.
2. BEST TOOL: Identifying and measuring pain begins with a person’s self-report.
3. This can be challenging in a population with disparities in cognition, literacy, and language.

Simply worded questions and tools, that are easily understood, continue to be the most effective. The best choice for assessing pain intensity include: the Iowa Pain Thermometer (IPT), the Numeric Rating Scale (NRS), and the Faces Pain Scale-Revised (FPS-R).

• The most widely used tool, the NRS, asks a person to rate their pain by assigning a numerical value with zero indicating no pain and 10 representing the worst pain imaginable.
• The IPT is a modified Verbal Descriptor Scale (VDS) with seven pain descriptors describing different levels of pain intensity.

The FPS-R asks people to describe their pain according to a facial expression corresponding with their pain. TARGET POPULATION: All three scales are used with older adults in acute and long term care settings and in the community. While there are specific tools designed to capture pain in non-verbal cognitively impaired older adults, studies have shown that the FPS-R and the IPT may be used effectively with cognitively impaired older adults.

1. The choice of a scale may depend on institutional preference or the presence of a particular language or sensory impairment.
2. The most important consideration is the consistent use of the same scale with each individual.
3. VALIDITY AND RELIABILITY: All three scales have demonstrated good internal consistency with Cronbach’s α coefficients of 0.85 to 0.89.

Test-retest reliability for each ranged from 0.57 to 0.83 for the NRS, from 0.52 to 0.83 for the verbal descriptor scale and from 0.44 to 0.94 for the FPS-R. A factor analysis found that all three scales were valid, although the FPS-R was the weakest (Herr, Spratt, Mobily, & Richardson, 2004).

STRENGTHS AND LIMITATIONS: The overall strengths of these scales are their ability to quickly and reliably screen for pain. These scales are intended to assess pain intensity and should not be substituted for a more comprehensive pain assessment that would include obtaining a pain history and a physical exam leading to the etiology of pain.

For cognitively intact older adults all three scales are effective screening tools, with the NRS being the most widely used tool. In one study, the IPT showed the lowest failure rates with little appreciable affects associated with cognitively impaired older adults (Herr, Spratt, Garand, & Li, 2007).

While the research is limited there has been some evidence that these tools are effective when used with a variety of ethnic populations. MORE ON THE TOPIC: Baker, D. The Joint Commission’s Pain Standards: Origins and Evolution. Oakbrook Terrace, IL. The Joint Commission 2017. Centers for Disease Control and Prevention, National Center for Health Statistics.

Health, United States, 2006. With chartbook on trends in the health of Americans. Special features: Pain. Hyattsville, MD. Available at: Cornelius, R.,Herr, K., Gordon, D., Kretzer, K., & Butcher, H. (2017). Acute Pain Management in Older Adults. Journal of Gerontological Nursing, 43(2), 18-27.

Herr, K., Bjoro, K., & Decker, S. (2006). Tools for assessment of pain in nonverbal older adults with dementia: A state-of-the-science review. Journal of Pain and Symptom Management, 31(2), 170-192. Herr, K., Spratt, K., Garand, L., & Li, L. (2007) Evaluation of the Iowa Pain Thermometer and other selected pain intensity scales in younger and older adult cohorts using controlled clinical pain: A preliminary study.

Pain Medicine, 8(7), 585-600. Herr, K., Spratt, K., Mobily, P., & Richardson, G. (2004). Pain intensity assessment in older adults: Use of Experimental Pain to Compare Psychometric Properties and Usability of Selected Scales in Adult and Older Populations.

Clinical Journal of Pain, 20(4), 207-219. Taylor, L., & Herr, K. (2003). Pain intensity assessment: A comparison of selected pain intensity scales for use in cognitively intact and cognitively impaired African American older adults. Pain Management Nursing, 4(2), 87-95. Taylor, L.J., Harris, J., Epps, C., & Herr, K.

(2005). Psychometric evaluation of selected pain intensity scales for use in cognitively impaired and cognitively intact older adults. Rehabilitation Nursing, 30(2), 55-61. Ware, J. Epps, C., Herr, K., & Packard, A. (2006). Evaluation of the revised faces pain scale, verbal descriptor scale, numeric rating scale, and Iowa pain thermometer in older minority adults.

What are the 5 A’s of monitoring chronic pain?

Table 4 – The Ten Principles of Universal Precautions for Patients with Persistent Using Chronic Opioid Therapy *

1. Make a diagnosis with appropriate differential including the biopsychosocial-spiritual status.
2. Psychological assessment including risk of addictive disorders. The assessment of the patient uses the biopsychosocial model with the spiritual factors included.
3. Informed consent (verbal or written/signed). Provide patient education regarding management of pain and side effects.
4. Treatment agreement to establish expectations of both the provider and the patient. Establish a therapeutic relationship promoting trust and honesty. This treatment agreement also includes safe storage of medications in the interest of public safety, i.e. Lock Your Meds®; as well as rationale for potential opioid discontinuation or discharge from medication treatment. See box 7 for Suggested Points for Inclusion in a Treatment Agreement.
5. Pre/post intervention assessment of pain level and function. With the use of the bio-psychosocial-spiritual model, the assessment is included in its entirety.
6. Appropriate trial of opioid therapy and/or adjunctive medications. Promote supportive recovery environment with family and significant other involvement. Integrate non-pharmacologic adjunctive therapies such as biofeedback, relaxation training, physical therapy, cognitive therapy and support groups.
7. Reassessment of pain level and function. With the use of the biopsychosocial-spiritual model, the assessment is included in its entirety. Use of adherence monitoring measures are applied and include urine toxicology, screening tools for alcohol/substance use disorders, pill counts, and overall adherence with treatment plan appointments and medication use.
8. Regularly assess the 5A’s which stand for Analgesia, Activity, Adverse Reactions, Aberrant Behavior and Affect **,
9. Periodically review pain diagnosis and comorbid diagnoses, including addictive disorders and mental health.
10. 10. Documentation.

Every person for whom opioids are prescribed has the potential to abuse their medication ( Webster & Dove, 2007 ). A person’s vulnerability to prescription drug abuse is associated with many variables: the specific drug being prescribed, environmental and genetic factors, other illnesses, use of alcohol and other drugs, and the suffering associated with their persistent pain ( Savage, et al., 2008 ; Webster & Dove, 2007 ).

• Because it is impossible to predict who may abuse substances throughout the continuum of care, clinicians are compelled to respectfully assess every person before a prescription is written for an opioid ( Heit & Lipman, 2009 ).
• A systematic approach using the 10-point assessment of the Universal Precautions has been adapted using the biopsychosocial-spiritual model, and is presented in Table 4,

Risk stratification methods include the use of assessment tools to recognize patients at risk for medication adherence problems, and to evaluate problematic behaviors as they impact perceived risk and treatment planning. To assist in risk stratification there are many assessment tools on how to identify those at risk for SUDs, including opioid abuse or addiction ( Adams, Gatchel, Robinson, Polatin, Gajraj, Deschner, & Noe, 2004 ; Belgrade, Schamber, & Lindgren, 2006 ; Butler, Budman, Fernandez, & Jamison, 2004 ; Compton, et al., 1998 ; Ferrari, Cicero, Bertolini, Leone, Pasciullo, & Sternieri, 2005 ; Friedman, Li, & Mehrotra, 2003 ; Kirsh, 2007 ; Li, Katragadda, Mehrotra, Mosuro, & Friedman, 2001 ; Webster & Webster, 2005 ).

However, in a recent study of 428 health care providers assessing risk factors for opioid abuse, clinicians often misinterpreted initial presentation of aberrant behaviors, failing to appreciate the wide differential diagnosis ( Miller, Heit, Gourlay, Peppin, Hampton, & Miller, 2011 ). If a patient takes more medication than prescribed, is this an indication of abuse, addiction, undertreatment (pseudoaddiction), anxiety, impulse, or confusion? Behaviors are frequently misunderstood and too often premature assumptions misdirect treatment.

There is significant confusion about what it means to be adherent to an opioid regimen, and the screening tools for recognizing the risk of abuse are rarely used although readily available ( Miller, et al., 2011 ; Passik & Kirsh, 2003 ).

What are the ABC’s of pain management?

There is universal acceptance of the ABC’s (Airway, Breathing, Circulation) of BLS (Basic Life Support). We throw RICE at a sprain (Rest, Ice, Compression, Elevation). Charting would be filthy without SOAP notes (Subjective, Objective, Assessment, Plan). Collections of letters such as these dot every specialty.

What is the 11 point pain intensity numerical rating scale?

Abstract – Pain intensity is frequently measured on an 11-point pain intensity numerical rating scale (PI-NRS), where 0=no pain and 10=worst possible pain. However, it is difficult to interpret the clinical importance of changes from baseline on this scale (such as a 1- or 2-point change).

To date, there are no data driven estimates for clinically important differences in pain intensity scales used for chronic pain studies. We have estimated a clinically important difference on this scale by relating it to global assessments of change in multiple studies of chronic pain. Data on 2724 subjects from 10 recently completed placebo-controlled clinical trials of pregabalin in diabetic neuropathy, postherpetic neuralgia, chronic low back pain, fibromyalgia, and osteoarthritis were used.

The studies had similar designs and measurement instruments, including the PI-NRS, collected in a daily diary, and the standard seven-point patient global impression of change (PGIC), collected at the endpoint. The changes in the PI-NRS from baseline to the endpoint were compared to the PGIC for each subject.

• Categories of “much improved” and “very much improved” were used as determinants of a clinically important difference and the relationship to the PI-NRS was explored using graphs, box plots, and sensitivity/specificity analyses.
• A consistent relationship between the change in PI-NRS and the PGIC was demonstrated regardless of study, disease type, age, sex, study result, or treatment group.

On average, a reduction of approximately two points or a reduction of approximately 30% in the PI-NRS represented a clinically important difference. The relationship between percent change and the PGIC was also consistent regardless of baseline pain, while higher baseline scores required larger raw changes to represent a clinically important difference.

What is the 10 pain scale?

Using the Pain Scale If you want your pain to be taken seriously, It is important that you take the pain scale seriously. Because pain is subjective, it is difficult to explain what you’re feeling to another person—even your own doctor. To effectively use the pain scale, familiarize yourself with the levels before your procedure, identifying what key levels are indicative to your pain level.

1. Following a surgery or procedure, typically we tell patients to continue to take medications that allow them to maintain a level of “5 or below.” 0 – Pain Free Mild Pain – Nagging, annoying, but doesn’t really interfere with daily living activities.1 – Pain is very mild, barely noticeable.
2. Most of the time you don’t think about it.2 – Minor pain.

Annoying and may have occasional stronger twinges.3 – Pain is noticeable and distracting, however, you can get used to it and adapt. Moderate Pain – Interferes significantly with daily living activities.4 – Moderate pain. If you are deeply involved in an activity, it can be ignored for a period of time, but is still distracting.5 – Moderately strong pain.

It can’t be ignored for more than a few minutes, but with effort you still can manage to work or participate in some social activities.6 – Moderately strong pain that interferes with normal daily activities. Difficulty concentrating. Severe Pain – Disabling; unable to perform daily living activities.7 – Severe pain that dominates your senses and significantly limits your ability to perform normal daily activities or maintain social relationships.

Interferes with sleep.8 – Intense pain. Physical activity is severely limited. Conversing requires great effort.9 – Excruciating pain. Unable to converse. Crying out and/or moaning uncontrollably.10 – Unspeakable pain. Bedridden and possibly delirious. Very few people will ever experience this level of pain.

What are the basic components of pain?

Pain Processes – Figure 7-1 illustrates the major components of the brain systems involved in processing pain-related information. There are four major processes: transduction, transmission, modulation, and perception. Transduction refers to the processes by which tissue-damaging stimuli activate nerve endings.

Transmission refers to the relay functions by which the message is carried from the site of tissue injury to the brain regions underlying perception. Modulation is a recently discovered neural process that acts specifically to reduce activity in the transmission system. Perception is the subjective awareness produced by sensory signals; it involves the integration of many sensory messages into a coherent and meaningful whole.

Perception is a complex function of several processes, including attention, expectation, and interpretation.

What is the 11 point numeric pain rating scale NPRS?

Numerical pain rating scale – The Numerical Pain Rating Scale (NPRS) is a subjective measure in which individuals rate their pain on an eleven-point numerical scale. The scale is composed of 0 (no pain at all) to 10 (worst imaginable pain). It has been shown that a composite scoring system including best, worse, and current level of pain over the last 24 hours was sufficient to pick up changes in pain intensity with maximal reliability ( Jensen et al 1999 ).