1. Pain Management

2. Alleviating pain is highly dependent on the provider’s ability to identify, measure and interpret the symptoms
Pain management

3. Up to 30% of patients transported by ambulance have moderate to severe pain
Information regarding pain severity is often not documented
If paramedics do not actively seek information to identify the presence of pain this symptom may be missed
Research

4. The initial survey and primary assessment will identify the chief complaint
This should include questions about pain
The region where the pain is felt
Whether the pain radiates and if so the pattern of radiation
The quality of the pain
Factors that provoke or ease the pain
The nature of the pain
Assessment of pain

5. OPQRST Used to guide the assessment of pain O=onset
P=provokes/palliates
Q=quality
R=region/radiates
S=severity
T=Time
OPQRST

6. What was the patient doing when they first noticed the pain
Was the onset abrupt or gradually getting worse
Is the pain constant or sporadic
If it’s sporadic how frequent is it occurring
Onset of the Event

7. Provokes/palliates Does anything exacerbate or relieve the pain
Did the patient take any pain medication prior to your arrival
Provokes/palliates

8. Quality Describe the nature of the pain
Is the pain sharp or dull, cramp-like or diffuse
This will help decide if the pain is visceral or musculoskeletal
Quality

9. Does the pain spread to other parts of the body
radiates

10. Use a reliable and validated pain scale
severity

11. time What was the onset of pain What is the duration of the pain
Have they ever experienced similar pain
time

12. complex Pain is personal and complex
It has both sensory and emotional components
Can be expressed through verbal reports or behavioral cues
complex

13. Factors that can affect pain expression
Age
Gender
Cultural and social norms
Prior pain experiences
The context in which the pain occurs
Perceived control over the pain
Factors that can affect pain expression

14. The Consequences of pain
Acknowledge that each patient is different and expresses pain differently
Avoid using your own expectations of normal pain behavior to validate the patient’s report of pain
Health professional tend to underestimate pain
The Consequences of pain

15. Measuring pain VNRS=The Verbal Numeric Rating Scale
ARS=The Adjective Response Scale
VAS=The Visual Analogue Scale
FLACC=The Facial Expression, Leg Movement, Activity, Cry and Consolability Scale
Wong-Baker FACES pain rating scale
EVENDOL Scale=Evaluation Child Pain Scale
Abby Pain Scale=for older adults with dementia
Measuring pain

16. VNRS=The Verbal numeric rating scale
An 11 point scale acceptable for in the field
The patient chooses a number between zero and ten to represent their pain
Zero indicates no pain and ten indicates the worst pain imaginable
Avoid referencing previous episodes of pain (ex: childbirth = 10) because the intention is to rate the current pain
VNRS=The Verbal numeric rating scale

17. ARS=The Adjective response scale
Uses standard terms to indicate level of pain severity
None-Slight-Moderate-Severe-Agonizing
May not be responsive to significant changes in pain making it more difficult to reassess
Cultural and language barriers could be a problem for this scale
ARS=The Adjective response scale

18. VAS=The Visual Analogue scale
A 100 mm line with key words at both ends
The patient makes a mark on the line
The results are read in millimeters
A slide scale is also available
VAS=The Visual Analogue scale

19. Good for children 2 months to 7 years
Currently recommended for prehospital use
FLACC=the facial expression, leg movement, activity, cry, Consolability scale

20. Wong-baker faces pain rating scale
Good for children 3 and older
Allows patients to visually identify the severity of their current pain level
Ask the patient to choose the face that best describes the pain they are experiencing
Wong-baker faces pain rating scale

21. EVENDOL Scale Child’s pain scale for patients less than 7 years old
Primarily used in the emergency department
Not yet validated for prehospital use
EVENDOL Scale

22. Designed to assess pain in older adults with dementia who cannot verbalize their pain experience
Not commonly used prehospital
If often seen in extended care facilities
Abby pain scale

23. file:///C:/Users/jmartin/Downloads/EMS%20Reference%20- %20The%20Assessment%20of%20Pain%20in%20Paramedic%20Pra ctice%20-% pdf
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