1. Pain Management

2. Pain is “ an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” (International Association for the Study of Pain)

3. Pain Is subjective Interferes with the quality of life Must be assessed on a continuing basis May compromise the immune system May hasten death by increasing psychological stress

4. Pain is measured by Pattern Location Quality Intensity

5. Pain can be measured by Pattern: Acute pain comes on suddenly; chronic pain is always there Quality: aching, squeezing, throbbing, burning, tingling, shooting Location: Where does it hurt? Intensity: on scale of 10, with 0 no pain History: When did it start? How long did it last? What brought it on?

6. Aggravating/alleviating factors: What makes it worse or better? Medication history: When did you last take something for the pain? Did it help? Meaning of pain: reactions to pain vary with cultural backgrounds Physical exam: adds to information about other components of pain Reassessment: necessary so needed changes can be made

7. Assessment of pain includes Physical exam To see patient as a whole Psychological and cultural assessment To help explain response to pain Diagnostic work up To find cause of pain

8. Tools for pain evaluation Nurses discovered they could get responses from children by using faces. Original faces ranged from 1- 5 Modified to range 1-10 Adults respond better to horizontal numerical scale

9. Wong-Baker FACES scale

10. Horizontal numerical scale 0 1 2 3 4 5 6 7 8 9 10

11. Interference with pain control Caregivers Healthcare systems Patients

12. Interference by caregivers Improper assessment of pain Concern that the patient might become addicted Concern about unpleasant side effects from narcotics Giving too little medication

13. Interference by healthcare systems Lack of understanding about pain management Not enough places to go for care Concerns about addiction to controlled substances Inadequate reimbursement

14. Interference by patients Concern about perception of being a “good patient.” Afraid to report pain Reluctant to take medicines at all Fear of addiction or of becoming tolerant to pain medicine Side effects of narcotics Cost