1 The Role of the Nurse Aide in Pain Management Adapted from:The PERT Program 2004 Pain & Palliative Care Research Department Swedish Medical Center, Seattle, Washington Geriatric Aide Curriculum NC Division of Health Service Regulation Module 19

2 Pain Management Objectives 1. Define pain 2. Describe the difference between acute and chronic pain 3. Describe some common side effects of medications used to treat pain 4. Describe elements of pain observation

3 Pain in Long-Term Care: Defining the Problem

4 PAIN: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage… ” -- IASP

5 PAIN: “Anything the patient says it is…” -- Margo McCaffery

6 How common is pain in the nursing home? 71% - 83% of residents in nursing homes have pain – Gagliese & Melzack, 1997

7 Most Common Types of Pain in Long-Term Care Musculoskeletal: osteoarthritis, osteoporosis Nerve related: diabetic neuropathy, pain after shingles, phantom limb pain Constipation Cancer pain

8 Acute and Chronic Pain ACUTE Sudden onset symptom Occurs in response to illness or injury Usually decreases or goes away over time as healing occurs Goal: pain goes away when cause is treated CHRONIC Slow onset, or follows acute Lasts > 3 months Cause sometimes is unknown Sometimes divided into cancer and noncancer Goal: maintain functioning and quality of life

9 Pain is a natural part of growing old. Older people are less sensitive to pain. About Pain in the Older Adult

10 If an older person doesn’t report pain, that person doesn’t have pain. If a person can sleep or be distracted from pain, that person doesn’t really have pain. About Pain in the Older Adult

11 Strong pain medicine, like morphine, can’t be used safely for the older adult because they are too sensitive to dangerous side effects. About Pain in the Older Adult

12 People with dementia and other cognitive impairments don’t feel pain. People with dementia and other cognitive impairments can’t reliably report their pain. About Pain in the Older Adult

13 Meaning of Pain Culture Belief system Coping methods/ Previous experiences Overall physical condition

14 Overview of Pain Medications

15 Categories of Pain Medication Acetaminophen –Also known as Tylenol ® –One of the safest medications for mild to moderate chronic pain Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) –Examples: Motrin ®, Naprosyn ®, Aleve ®

16 Categories of Pain Medication Opioids –Used for more severe pain –Examples: Percocet ®, OxyContin ®, Tylenol #3 ®, Vicodin ®, morphine Side effects –Sleepiness, confusion –Nausea, constipation

17 Categories of Pain Medication Co-analgesics help relieve pain but are use mostly for other illnesses besides pain Examples: antidepressants, antiseizure medication

18 Tolerance Reduced physical response to a medication after many doses. It results in the need for higher doses to relieve pain. TOLERANCE IS NOT ADDICTION Defining the Terms Related to Opioid Use

19 Physical Dependence Occurrence of withdrawal symptoms following a sudden decrease in dose PHYSICAL DEPENDENCE IS NOT ADDICTION Defining the Terms Related to Opioid Use

20 Addiction Loss of control over drug use Drug used for reasons other than pain Continued drug use in spite of drug-related harm to self and others Defining the Terms Related to Opioid Use

21 Pseudo-Addiction Occurs when pain is undertreated May look like addiction, but the behaviors stop when the pain is relieved PSEUDO-ADDICTION IS NOT ADDICTION Defining the Terms Related to Opioid Use

22 Observing and Reporting Pain

23 Common Words for Pain Ache Discomfort Sore Heavy Burning Stiff

24 How Bad is the Pain? (Intensity)

25 Pain Intensity McGill Pain Questionnaire Present Pain Intensity Scale (PPI) 0 - No Pain 1 - Mild 2 - Discomforting 3 - Distressing 4 - Horrible 5 - Excruciating

26 FACES Pain Scale Pain Intensity

27 Pain Intensity

28 Where is the Pain? Pain Intensity

29 How Does the Resident Describe the Pain?

30 Describing Pain Aching Dull Sore Shooting Radiating Burning Stabbing

31 Behavioral/Observational Cues to Pain in Residents with Cognitive Impairment Grimacing or wincing Bracing Guarding Rubbing Changes in activity level

32 Behavioral/Observational Cues to Pain in Residents with Cognitive Impairment Sleeplessness, restlessness Resistance to movement Increased agitation, anger, etc. Withdrawal/depression Decreased appetite

33 Clues about Pain in the Cognitively Impaired Older Adult Words or statements, for example, “ouch,” “that hurts” Protesting or resisting care and transfers Moans Cries

34 What is the Pattern of Pain? Constant? OR Does it come and go?

35 What Makes the Pain Better? Over-the-counter medications Natural remedies Prescription medications Nondrug therapies

36 What Makes the Pain Worse? Movement Being tired Feeling blue Nausea Family problems

37 Side Effects of Pain Medicines NSAIDs: Swelling Stomach upset Opioids: Constipation Sedation Nausea/vomiting

38 When to Observe for Pain During personal care During transfers and ambulation Following activities Following pain management interventions

39 What are the Goals for Pain Therapy? Complete pain relief? Balance between pain relief and medication side effects? Better able to move? Able to function more independently?

40 Nurse Aide Roles in Pain Management Observe for side effects of medications and report to nurse Observe to check the effectiveness of therapies and report to nurse Administer nondrug treatments Support and get help for residents in pain from the nurse

41 CASE STUDY: “Joe” 86 years old History of prostate cancer Pain in back and legs  cancer in the bone Mild dementia Uses walker and standby assist

42 CASE STUDY: “Joe” Nauseated Difficulties standing up from sitting position “I can’t go to work today. I’m too tired.” No grimacing VS stable

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