1. FOR THE HEALTHCARE PRACTITIONER PAIN ASSESSMENT METHODS

2. WHAT IS PAIN? Subjective feeling triggered by the nervous system May be acute, chronic, or recurrent Often used as a diagnostic tool for healthcare practitioners

3. CHARACTERISTICS OF PAIN Duration Acute, chronic, recurrent? Severity Minor, debilitating? Quality Continuous vs. intermittent Location Localized vs. diffuse Contributing factors What makes the pain better or worse? Etiology What underlying process is causing the pain?

4. HARMFUL EFFECTS OF UNDERMANAGED PAIN Psychological disruptions Depression and anxiety Cardiovascular system Hypercoagulation, tachycardia, hypertension, increased oxygen demand Gastrointestinal (GI) system Decreased gastric emptying and intestinal motility Increased risk of ileus Decreased immune function Risk of infection increases Chronic pain later in life

5. HOW IS PAIN ASSESSED?

6. PAIN ASSESSMENT SCALES Pain is most commonly assessed using pain assessment scales Nurses assess pain most frequently Pain can also be assessed by: Physicians, physical therapist, nursing assistants, etc. Frequently used pain scales FLACC scale Wong-Baker FACES scale Numerical scale

7. FLACC SCALE Used to assess pain in nonverbal children May be nonverbal due to: Age (infants, toddlers) Cognitive impairments Patient given score from zero to ten Score indicates intensity of pain Assessed based on five patient factors Face- No expression, grimacing, clenched jaw? Legs- Relaxed, tense, kicking? Activity- Relaxed, squirming, jerking? Cry- No cry, whimpering, screaming? Consolability- How easily can they be consoled?

8. FLACC SCALE

9. WONG-BAKER FACES SCALE Most commonly used for children ages 3-8 Must have understanding of concept of pain Able to articulate presence and location of pain Unable to assign numerical value to their pain Child points to a picture of a facial expression that best reflects the way they are feeling Faces range from smiling to crying Represent pain leveled from zero to ten

10. WONG-BAKER FACES SCALE

11. NUMERIC PAIN SCALE Patient asked to give three pain ratings: Current pain level Worst pain in last 24 hours Least pain in last 24 hours Provider averages three pain ratings Rate pain on scale of zero to ten Zero represents no pain Ten represents the worst pain imaginable

12. KEYS TO PAIN MANAGEMENT Adequate pain management is key Effectively managing pain builds trust with patient and prevents further health complications Understand principles of pain management Anticipate and prevent pain Adequately assess pain Use multimodal approach to pain management Involve patients in their own pain management

13. REFERENCES Pain Assessment. (n.d.). Pain Assessment. Retrieved June 4, 2014, from http://emedicine.medscape.com/article/1948069- overviewhttp://emedicine.medscape.com/article/1948069- overview Pain assessment: The corner stone to optimal pain management. (n.d.).. Retrieved June 4, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317046/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317046/ Pain: MedlinePlus. (n.d.). U.S National Library of Medicine. Retrieved June 4, 2014, from http://www.nlm.nih.gov/medlineplus/pain.html http://www.nlm.nih.gov/medlineplus/pain.html Wells N, Pasero C, McCaffery M. Improving the Quality of Care through Pain Assessment and Management. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 17. Available from: http://www.ncbi.nlm.nih.gov/books/NBK/2658/

14. REFLECTIVE NOTE This presentation is aimed at the healthcare providers responsible for assessing pain in their daily work. This may include, but is not limited to, nurses, nursing assistants, physical therapists, and physicians. Pain assessment and management is an essential part of patient care. It is very important for healthcare practitioners to understand why pain management is so important, as well as how to adequately assess their patients’ pain. This presentation demonstrates a few of the most commonly used pain assessment tools that can be utilized in daily practice. It also explains to healthcare providers why effective pain assessment and management is key as well as the complications that can ensue if pain is not adequately managed. Readers would most likely encounter this document in places such as new employee orientations and pain management classes offered through their employers. Though it contains information aimed at healthcare practitioners, the wording is, for the most part, simple enough to be understood by people outside the healthcare field. It could also be used to enlighten patients about how their pain will be assessed so they can aid their nurses and physicians in managing their pain. Especially in the pediatric population, it could be an effective tool for parents, who are essential in helping to assess their own children’s pain.