PAIN: RECOGNITION AND RELIEF

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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
   Acknowledging pain is weak
   Pain always means serious
    disease or death
   Pain is punishment
   Pain leads to loss of
    independence
    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

   QUESTION Resident and family
   OBSERVE Resident behavior
   EXAMINE Resident
   EVALUATE Function, ADLs

   REASSESS FREQUENTLY TO
    MONITOR TREATMENTS
      PAIN ASSESSMENT
         QUESTIONS

        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
         QUESTIONS

        DEFINE THE PAIN
   Location, quality, severity,
    frequency, duration
   Aggravating or alleviating
    factors
   Amount of dysfuction
      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

    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

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

   Communication amongst team
    members is critical
   Pain Scales: Numeric, Visual
   Resident Education component
   Ongoing Assessment:
    Pre and Post treatment
MEDICATIONS FOR PAIN

   NON-OPIOIDS:       OPIOIDS:
    Acetaminophen       Morphine
    Aspirin             Hydromorphone
    NSAIDs              Codiene
    Tramadol            Hydrocodone
   Topicals:           Oxycodone
    capsaicin          Topicals:
    lidocaine           Fentanyl
           ADJUVANT
          TREATMENTS
   Corticosteroids      Education
   Antidepressents      Counseling
       TCADs             Exercise
   Anticonvulsants      PT/OT
    Nuerontin,           Positioning
    Tegretol,            Heat, cold,
    Clonazepam            massage
   Muscle relaxers      Relaxation
                         Hypnosis
    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

   Opiates can cause:
      Constipation
      Urinary Retention
      Sedation, Delirium
      Impaired cognition
      Decreased respiratory rate
      Nausea, Itching
    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 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

				
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