Transcript Creativity Session

What is Pain?
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“Pain is an
unpleasant sensory
and emotional
experience arising
from actual or
potential tissue
damage or
described in
terms of such
damage.”
IASP, 1979
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“Pain is
whatever the
experiencing
person says it
is, existing
whenever
he/she says it
does.”
McCaffery, 1969
Common Painful Conditions in
Long-Term Care Residents
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Degenerative joint disease
Rheumatoid/osteoarthritis
Osteoporosis
Fractures
Muscle pain/stiffness
Neuropathies
Post stroke pain
Skin or pressure ulcers
Immobility
What are the consequences?
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Affects overall
quality of life
Depression
Emotional distress
Decreased
socialization
Disturbed sleep
and appetite
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Reduced mobility
and ambulation
Slow rehabilitation
Agitated behavior
Slowed healing
Increased health
care utilization
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
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Words
Intensity
Location
Duration
Aggravating/Alleviating
Factors
Intensity
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Quantitative measurement scales
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Numeric Rating Scale (NRS)
Verbal Descriptor Scale (VDS)
Faces Scales (Wong-Baker, Bieri)
Pain Thermometer
Questions to ask
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“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
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Concerned about pain medication
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“I’m afraid of getting hooked.”
“If used too early, it won’t work later.”
“I don’t want to get constipated.”
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Stoic – “Pain not that bad, I can handle it”
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Anticipate staff response – not believed
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Not wanting to bother staff
“Pain is a part of aging; just need to bear it.”
Fate/Passivity – nothing helps
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Physician won’t order; nurse won’t give
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Self-management strategies
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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
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*Observe at rest & movement
JAGS, 2002; 50:S205-S224
Pain Assessment Tools for Use in the
Cognitively Impaired Nonverbal Resident
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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