1. What is Pain? n “Pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.” n “Pain is whatever the experiencing person says it is, existing whenever he/she says it does.” IASP, 1979 McCaffery, 1969

2. Common Painful Conditions in Long-Term Care Residents n Degenerative joint disease n Rheumatoid/osteoarthritis n Osteoporosis n Fractures n Muscle pain/stiffness n Neuropathies n Post stroke pain n Skin or pressure ulcers n Immobility

3. What are the consequences? n Affects overall quality of life n Depression n Emotional distress n Decreased socialization n Disturbed sleep and appetite n Reduced mobility and ambulation n Slow rehabilitation n Agitated behavior n Slowed healing n Increased health care utilization n Increased costs

4. Five-step Ladder to Optimal Pain Management Communicating the understanding Legitimizing the pain Believing the person has pain Understanding the pain experience Getting to know the pain Fink, 1996

5. Getting to Know the Pain n Words n Intensity n Location n Duration n Aggravating/Alleviating Factors

6. Intensity n Quantitative measurement scales ä Numeric Rating Scale (NRS) ä Verbal Descriptor Scale (VDS) ä Faces Scales (Wong-Baker, Bieri) ä Pain Thermometer n Questions to ask ä “If 0 is no pain and 10 is the worst possible pain, what is your pain right now, in the past 24 hours (since lunch time yesterday), since you received your pain medicine?” ä “Where do you want your pain to be?”

8. The Faces Pain Scale Revised (FPS-R) The Bieri Faces Pain Scale

9. Pain Thermometer

10. Reasons Why Residents Don’t Request Pain Medication n Concerned about pain medication ä “I’m afraid of getting hooked.” ä “If used too early, it won’t work later.” ä “I don’t want to get constipated.” n Stoic – “Pain not that bad, I can handle it” n Anticipate staff response – not believed n Not wanting to bother staff n “Pain is a part of aging; just need to bear it.” n Fate/Passivity – nothing helps n Physician won’t order; nurse won’t give n Self-management strategies

11. Common Pain Behaviors in Cognitively Impaired Elderly Persons n Facial Expressions n Verbalizations, Vocalizations n Body Movements n Changes in Interpersonal Interactions n Changes in Activity Patterns/Routines n Mental Status Changes JAGS, 2002; 50:S205-S224 *Observe at rest & movement

12. Pain Assessment Tools for Use in the Cognitively Impaired Nonverbal Resident n Discomfort in Dementia of the Alzheimer’s Type (DS-DAT) n Modified DS-DAT n Checklist of Nonverbal Pain Indicators (CNPI) n Assessment of Discomfort in Dementia Protocol (ADD) n Pain Assessment in Advanced Dementia (PAINAD) n Pain Assessment for the Dementing Elder (PADE) n The Pain Assessment Scale for Seniors with Severe Dementia (PACSLAC) n Nursing Assistant-Administered Instrument to Assess Pain in Demented Individuals (NOPPAIN) Review of pain scales by Dr. Keela Herr & colleagues - www.coh.org