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PAIN RECOGNITION AND RELIEF. PAIN MANAGEMENT Bessie Burton Sullivan Pat Borman, MD . DEFINITION OF PAIN. Pain is suffering Residents define their pain Pain is personal, subjective Pain is treatable. MISCONCEPTIONS ABOUT PAIN. Pain is part of aging, inevitable

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pain recognition and relief

PAIN RECOGNITION AND RELIEF

PAIN MANAGEMENT

Bessie Burton Sullivan

Pat Borman, MD

definition of pain
DEFINITION OF PAIN
  • Pain is suffering
  • Residents define their pain
  • Pain is personal, subjective
  • Pain is treatable
misconceptions about pain
MISCONCEPTIONS ABOUT PAIN
  • Pain is part of aging, inevitable
  • Acknowledging pain is weak
  • Pain always means serious disease or death
  • Pain is punishment
  • Pain leads to loss of independence
roadblocks to pain management
ROADBLOCKS TO PAIN MANAGEMENT
  • No format for regular, complete assessment and reassessment
  • Misjudging behavioral clues
  • Lack of documentation tool
  • Myth that pain is normal
  • Lack of nursing knowledge
pain assessment
PAIN ASSESSMENT
  • QUESTION Resident and family
  • OBSERVE Resident behavior
  • EXAMINE Resident
  • EVALUATE Function, ADLs
  • REASSESS FREQUENTLY TO MONITOR TREATMENTS
pain assessment questions
PAIN ASSESSMENTQUESTIONS

QUESTIONS TO ASK

  • Are you in pain: hurting, achy, uncomfortable, bothered?
  • Is any other spot bothering you? (More than one site or type of pain)
  • Pain Scale Assessment
pain assessment questions7
PAIN ASSESSMENTQUESTIONS

DEFINE THE PAIN

  • Location, quality, severity, frequency, duration
  • Aggravating or alleviating factors
  • Amount of dysfuction
pain assessment observations
PAIN ASSESSMENT OBSERVATIONS

OBSERVE BEHAVIORS

  • Sad, frown, irritable, low mood
  • Moan, groan, cry, sigh, wince
  • Rub, protect a part, pointing, touching, favoring, fidgeting
  • Change in activity, sleep, appetite, mobility, gait, resisting care, combative
pain assessment examination
PAIN ASSESSMENTEXAMINATION

EXAMINE FOR SOURCE OF PAIN

  • Types of Pain: Muscle, Joint, Neurological
  • Sources: Arthritis, low back pain, gout, osteoporosis, stroke, fracture, diabetes, headache, shingles,dental, pressure ulcers, restraints, other
pain assessment evaluate function
PAIN ASSESSMENTEVALUATE FUNCTION

CHANGES IN FUNCTION CAN BE A SIGN OF PAIN

  • Decreased participation, change in gait, less active
  • Decreased mobility, more, reliance on assistance/devices
  • Increased incontinence, less grooming
documenting pain management
DOCUMENTING PAIN MANAGEMENT
  • Communication amongst team members is critical
  • Pain Scales: Numeric, Visual
  • Resident Education component
  • Ongoing Assessment: Pre and Post treatment
medications for pain
NON-OPIOIDS: Acetaminophen

Aspirin

NSAIDs

Tramadol

Topicals:

capsaicin

lidocaine

OPIOIDS:

Morphine

Hydromorphone

Codiene

Hydrocodone

Oxycodone

Topicals:

Fentanyl

MEDICATIONS FOR PAIN
adjuvant treatments
Corticosteroids

Antidepressents

TCADs

Anticonvulsants

Nuerontin, Tegretol, Clonazepam

Muscle relaxers

Education

Counseling

Exercise

PT/OT

Positioning

Heat, cold, massage

Relaxation

Hypnosis

ADJUVANTTREATMENTS
document effecacy of treatment
DOCUMENT EFFECACY OF TREATMENT
  • Pain diagnosis is recorded
  • Record each administered dose
  • Confirm effectiveness with pain scale, resident report, observation
  • Use Sedation scale and document any side effects of treatment
medication side effects
MEDICATION SIDE EFFECTS
  • Opiates can cause:

Constipation

Urinary Retention

Sedation, Delirium

Impaired cognition

Decreased respiratory rate Nausea, Itching

resident education
RESIDENT EDUCATION
  • Pain can and should be managed
  • You define your level of pain and relief from medication
  • Please report pain as soon as it bothers you
  • Tell us any concerns you have about your pain relief plan
pain recognition and relief17
PAIN: RECOGNITION AND RELIEF
  • Recognition is the first step to relieving pain
  • Develop a pain vocabulary and ASK, Be observant for pain behaviors in your residents
  • Educate your residents: we can help, you don’t have to suffer
  • Be an advocate for pain relief