1. Lisa Stephenson QIPP Lead Pharmacist NEE CCG 26th January 2016
Pain Management
Lisa Stephenson
QIPP Lead Pharmacist
NEE CCG
26th January 2016

2. What is Pain?
Pain is a very individual experience; only the person feeling the pain can describe it properly.
Pain can be:-
Acute or short-term pain
Indication of injury
Chronic or longstanding pain
Longer than 3 months mild or severe
It is not well understood either in humans or animals and since it is complex and cannot be directly measured. For example two people may undergo the same unpleasant experience but each will have a different description of the pain. This makes it difficult to define and treat.
Acute or short-term pain
This can be intense and short-lived and is usually an indication of impending danger (for example touching a sharp object, or something cold or hot) or an indication of an injury. When the danger is removed, or the injury heals, the pain usually goes away.
Chronic or longstanding pain
This lasts for much longer (at least 3 months) and can be mild or severe. When pain lasts for a long time, it can affect every part of a person's life. It can affect their ability to work, their relationships with family and friends, activity levels, sleep and independence. All of this can become overwhelming and can cause a vicious circle of pain and distress.
It is now widely accepted that longstanding pain and disability can only be understood and managed within a biopsychosocial model. Since people's beliefs about pain, disease and/or disability are the largest predictors of pain-associated disability, treatment needs to address the role of biological, psychological and social factors as obstacles to recovery.

3. Signs of Pain Verbal Non – verbal The person affected tells us
Facial Expressions
Vocalizations
Body Movements
Social Interaction
Facial Expressions -Clenched teeth, Wrinkled forehead, Biting lips, Scowling, Closing eyes tightly, Widely opened eyes or mouth
Vocalizations – Crying, Moaning, Gasping, Groaning, Grunting
Body Movements –Restlessness, Protective body movement, Muscle tension, Immobility, Pacing, Rhythmic movement
Social Interaction – Silence, Withdrawal, Reduced attention span, Focus on pain relief measures

4. Dementia & Pain Non – verbal Facial Expressions Vocalizations
Body Movements
Behavioural changes
Emotional changes
Facial expressions When you look at the person’s face, are they telling you they are in pain e.g. frowning, looking frightened? Verbal expressions Is the person making unexplained/different noises e.g. groaning, crying?
Body movements Is the person’s body language telling you they are in pain e.g. pacing, rocking?
Behavioural changes Are there changes in their behaviour e.g. sleeping, eating or not wanting to get out of bed?
Emotional changes Have you noticed any emotional changes e.g. irritability or distress?

5. Non-pharmacological Interventions
Comfort measures
Hot water bottle
Blanket
Pillows for support
Movement and changing position
Some positions may can less pain
Massage
Distraction
Massage provide pain relief and comfort
Distraction may work for some people with acute pain. This involves doing something they enjoy e.g. listening to music, playing board games

6. Pharmacological Treatment
Paracetamol - OTC
Ibuprofen - OTC
Naproxen
Codeine
Morphine orally
Patches

7. Patches Where on the body to apply patches?
Intact skin on your upper arm, outer arm, upper chest, upper back or side of the chest.
Apply to a relatively hairless or nearly hairless skin site. If no suitable hair free sites are available the hairs should be cut off with a pair of scissors. Do not shave them off.
Avoid skin which is red, irritated or has any other blemishes, for instance large scars.
After a hot bath or shower, wait until the skin is completely dry and cool.
The area of skin you choose must be dry and clean. If necessary, wash it with cold or lukewarm water. Do not use soap, alcohol, oil, lotions or other detergents. Do not apply lotion, cream or ointment to the chosen area. This might prevent your patch from sticking properly.
A new patch should then be applied to a different skin site after removal of the previous transdermal patch. Several days should elapse before a new patch is applied to the same area of skin.

8. Warnings associated with opiate patches
All patients should be advised to avoid exposing the patch site to direct external heat sources such as heating pads, hot water bottles, electric blankets, prolonged hot baths while wearing the patch, since there is potential for temperature dependent increases in release of drug from the patch.
Patients with fever should be monitored for opioid side effects.

9. Removal and Disposal of Patches
Breathing difficulties
Increased drowsiness
Confusion
Dizziness
Impaired speech
Patches should be disposed of by folding in half and seal all edges then place in clinical waste
Remove patch immediately and seek medical attention

10. Recap Non-pharmacological and pharmacological treatment may be used
Patches must be applied to hairless area of skin
Avoid hot baths while wearing patch
Remember people with dementia express pain non-verbally

11. Questions