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					What is Pain?
   “Pain is an              “Pain is
    unpleasant sensory        whatever the
    and emotional             experiencing
    experience arising        person says it
    from actual or            is, existing
    potential tissue          whenever
    damage or                 he/she says it
    described in              does.”
    terms of such
    damage.”
             IASP, 1979         McCaffery, 1969
Common Painful Conditions in
Long-Term Care Residents
     Degenerative joint disease
     Rheumatoid/osteoarthritis
     Osteoporosis
     Fractures
     Muscle pain/stiffness
     Neuropathies
     Post stroke pain
     Skin or pressure ulcers
     Immobility
What are the consequences?
   Affects overall         Reduced mobility
    quality of life          and ambulation
   Depression              Slow rehabilitation
   Emotional distress      Agitated behavior
   Decreased               Slowed healing
    socialization           Increased health
   Disturbed sleep          care utilization
    and appetite            Increased costs
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
Getting to Know
the Pain

   Words
   Intensity
   Location
   Duration
   Aggravating/Alleviating
    Factors
Intensity
   Quantitative measurement scales
       Numeric Rating Scale (NRS)
       Verbal Descriptor Scale (VDS)
       Faces Scales (Wong-Baker, Bieri)
       Pain Thermometer
   Questions to ask
       “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?”
       “Where do you want your pain to be?”
The Faces Pain Scale Revised (FPS-R)




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

 Facial Expressions
 Verbalizations, Vocalizations
 Body Movements
 Changes in Interpersonal Interactions
 Changes in Activity Patterns/Routines
 Mental Status Changes
 *Observe at rest & movement

                               JAGS, 2002; 50:S205-S224
Pain Assessment Tools for Use in the
Cognitively Impaired Nonverbal Resident
    Discomfort in Dementia of the Alzheimer’s Type
     (DS-DAT)
    Modified DS-DAT
    Checklist of Nonverbal Pain Indicators (CNPI)
    Assessment of Discomfort in Dementia Protocol
     (ADD)
    Pain Assessment in Advanced Dementia (PAINAD)
    Pain Assessment for the Dementing Elder (PADE)
    The Pain Assessment Scale for Seniors with Severe
     Dementia (PACSLAC)
    Nursing Assistant-Administered Instrument to
     Assess Pain in Demented Individuals (NOPPAIN)
Review of pain scales by Dr. Keela Herr & colleagues - www.coh.org

				
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