Transcript document

Chronic Pain in Primary Care:
Assessment Across the Lifespan
Module 2
Stephanie Key, MSN, RN, CPNP-PC
Mary Lou Adams, PhD, RN, FNP-BC, FAAN
Frances Sonstein, MSN, RN, FNP, CNS
Diane Tyler, PhD, RN, FNP-BC, FNP-C, FAAN
Paula Worley, MSN, RN, FNP-BC
The University of Texas at Austin School of Nursing
Consultants:
Yvonne D’Arcy, MSN, RN and JoEllen Wynne, MSN, RN, FNP-BC, FAANP
Objectives:
Discuss factors that affect the assessment
of chronic pain.
 Describe components of the
comprehensive assessment of chronic
pain.
 Identify valid and reliable pain assessment
tools appropriate for primary care.
Goal: provide NPs with a concise overview
of standardized pain assessment methods.
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Factors that affect Pain Assessment
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Personal meaning of pain
◦ Quality of life
◦ Financial burden
◦ Social isolation
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Cultural aspects
◦ Race/ethnicity
◦ Language
Cognition
 Extraneous factors
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Comprehensive Assessment
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History
◦ Present Illness (OLDCARTS)
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Onset
Location
Duration
Characteristics
Aggravating and Alleviating factors
Radiate
Timing
Severity/Intensity
◦ Past medical (co-morbidities)
◦ Any past issues with pain management
Comprehensive Assessment
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Physical Examination
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Vital Signs
General survey
Neurological exam
Musculoskeletal exam
Pain evaluation & descriptors
 Nociceptive
 Sharp & stabbing; Dull, aching & throbbing
 Neuropathic
 Burning, electric & tingling
Comprehensive Assessment
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Psychosocial factors
◦ Impact on lifestyle
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Family dynamics
Social isolation
Sleep
Work productivity
◦ Fear of addiction
◦ Mental health
 Suicide risk
 Depression
Comprehensive Assessment
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Medication review
◦ Current medicines
◦ Past medicines for pain control and effect
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Behavioral measures
◦ Checklist of Nonverbal Pain Indicators(CNPI)
 Vocal complaints: nonverbal (sighs, gasps, groans, moans,
cries)
 Facial grimaces (furrowed brow, clenched teeth,
tightened
lips, distorted expressions, narrowed eyes)
 Bracing (clutching or holding onto something or affected area
during movement)
 Restlessness (constant or intermittent shifting, rocking, hand
motions, inability to sit still)
 Rubbing (massaging of affected area)
 Vocal complaints (words expressing pain or discomfort, cursing
during movement, exclamations of protest)
Feldt, K.S. (2000). The checklist of
nonverbal pain indicators (CNPI). Pain
Management Nursing.3(1): 13-21.
Comprehensive Assessment
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Diagnostic Studies
◦ Individualized to the patient and history
◦ Low back pain national guidelines
 “Diagnostic imaging is indicated for patients with low
back pain only if they have severe progressive
neurologic impairments or signs or symptoms
indicating a serious or specific underlying condition, or
if they are candidates for invasive interventions.
Routine imaging is not associated with clinically
meaningful benefits in other patients and can lead to
Roger Chou, Amir Qaseem, Douglas K.
harms.”
Owens, Paul Shekelle, ; Diagnostic Imaging
for Low Back Pain: Advice for High-Value
Health Care From the American College of
Physicians. Annals of Internal Medicine. 2011
Feb;154(3):181-189.
Pain Assessment Tools

Types of Pain Scales
◦ Uni-dimensional
◦ Multi-dimensional
Tools for Adults
 Tools for Children
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Tools for Adults
Adult faces tool
 Multiple-Language Pain Assessment Scale
 Brief Pain Inventory (BPI)- Short form
 McGill Pain Questionnaire (MPQ)
 Short-form MPQ
 Pain Quality Assessment Scale (PQAS)
 Depression scale
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Tools for Children and Infants
Wong/Baker Faces Rating Scale
 Body Outline Tool
 Neonatal Infant Pain Scale (NIPS)
 Depression scale
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Tool for Dementia Patients
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Pain Assessment in Advanced Dementia
Scale (PAINAD)
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Breathing
Negative vocalizations
Facial expression
Body language
Consolability
Scores range 0-10
Screen for Addiction
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Screening Instrument for Substance Abuse Potential (SISAP)®
◦ a 5-item, clinician-administered test that asks pointed questions concerning
alcohol, marijuana, and cigarette abuse
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Screener and Opioid Assessment for Patients in Pain (SOAPP)®
◦ a self-report questionnaire available in 5-, 14-, and 24-item versions, which
has recently undergone revisions and which is considered less susceptible
to patient deception
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Opioid Risk Tool (ORT) ®
◦ a 5-item, yes-or-no, self-report for measuring and predicting the probability
that a patient taking opioids will display aberrant behaviors
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Current Opioid Misuse Measure (COMM)®
◦ a 40-item patient directed questionnaire that assesses how patient is
currently using their medications
Implications
Assessment is the basis for appropriate
management.
 Assessment is a multifactorial process.
 The patient is part of the team in
managing chronic pain.
 As a health care provider, it is pertinent
to trust your patients and verify the
information.
 Finally document, document, document!
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Website References
http://www.painedu.org/tools.asp
 www.wongbakerfaces.org
 www.emergingsolutionsinpain.com
 http://www.inflexxion.com/COMM
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References
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Bouhassira, D. & Attal, N. (2011). Diagnosis and assessment of neuropathic pain: The
saga of clinical tools. PAIN, 152, S74-S83.
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Feldt, K.S. (2000). The checklist of nonverbal pain indicators (CNPI). Pain
Management Nursing.3(1): 13-21.

Chou, R., Qaseem, A., Owens, D.K., & Shekelle, P. (2011). Diagnostic imaging
for low back pain: Advice for high-value health care from the American College of
Physicians. Annals of Internal Medicine 54(3):181-189.

Loretz, L. (2005). Primary care tools for clinicians. St. Louis, MO: Mosby.
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Herr, K, Bursch, H., Miller, L.L. , & Seafford, K. (2010). Use of pain-behavioral
assessment tools in the nursing home. Journal of Gerontological Nursing, 36, 18-29.
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Narayan, M.C. (2010). Culture’s effects on pain assessment and management.
American Journal of Nursing, 110(4), 38-47.
Post-Test Questions
1.
Pain is highly complex and personal.
a) True
b) False
2.
Which of the following are factors that
affect pain assessment?
a)
b)
c)
d)
Race/ethnicity
Cognition
Language barriers
All of the above
Post-Test Questions
3. What does the “A” stand for in the
acronym OLDCARTS in the history of
present illness?
a)
b)
c)
d)
Adverse reactions
Alcohol use
Aggravating and Alleviating factors
All of the above
Post-Test Questions
4. Listening to a patient’s description of his
pain can provide insight into the type of
pain such as nociceptive or neuropathic.
a)
b)
True
False
Post-Test Questions
5.
There is a lower suicide risk in patients
with chronic pain than in the average
population.
a)
b)
True
False
Post-Test Questions
6.
During an examination of a 82-year old
male who is non-verbal, you observe
that the patient has tightened lips and
clenched teeth when you palpate his
shoulder. This is an example of which
behavior on the Checklist of Nonverbal
Pain Indicators(CNPI)?
a)
b)
c)
d)
Restlessness
Facial grimaces/Winces
Bracing
Rubbing
Post-Test Questions
7. Basic X-ray films should be ordered on all
patients that complain of chronic pain.
a)
b)
True
False
Post-Test Questions
8.
A screening tool that allows the
provider to assess only the intensity of
pain is called a:
a)
b)
c)
d)
Uni-dimensional scale
Multi-dimensional scale
Bi-modal scale
Multi-factorial scale
Post-Test Questions
9.
All of the following chronic pain tools
are reliable and valid to use with adults
except:
a)
b)
c)
d)
Brief Pain Inventory(BPI)-Short form
McGIll Pain Questionnaire(MPQ)
Pain Quality Assessment Scale(PQAS)
Neonatal Infant Pain Scale(NIPS)
Post-Test Questions
10.
Which of the following screening tools for
opioid use measures and predicts the
probability that a patient taking opioids will
display aberrant behaviors?
a)
b)
c)
d)
Current Opioid Misuse Measure(COMM)
Opioid Risk Tool(ORT)
Screening Instrument for Substance Abuse Potential
(SISAP)
Screener and Opioid Assessment for Patients in Pain
(SOAPP)®