Assessment nyeri.ppt

dr. Ken Wirastuti, MKes, Sp.S

Bagian Ilmu Penyakit Saraf

Fakultas Kedokteran-Universitas Islam Sultan Agung

Pain: The Fifth Vital Sign• Pain should be considered the “fifth vital sign”

• Patients should be assessed for pain every time pulse, blood pressure, core temperature, and respiration are measured

• Healthcare professionals should recognize a report of unrelieved pain as a “red flag”

American Pain Society Quality Improvement Committee. JAMA. 1995;1847–1880.

Why is assessment important?

• a reduced experience of pain

• increased comfort

• improved physiological, psychological and physical function

• increased satisfaction with pain management on treatment efficacy

• Pain is not a simple sensation that can be easily assessed and measured.

Basic Characteristics of Assessment Tools

• Highly valid and reliable• Allow for the comparison of the magnitude of

changes in pain (ratio scale)• Be relatively free of bias• Be useful for assessing both experimental

and clinical pain• Allow for comparison with physiological

measures in humans and animals• Be relatively easy to use

The pain assessment involves

• an overall appraisal of the factors that may influence a patients experience and expression of pain (McCaffery and Pasero 1999)

Assessing the Patient With Pain

• Onset and duration• Location/distribution• Quality• Intensity• Aggravating/relieving factors• Associated features or secondary signs/symptoms• Associated factors

– mood/emotional distress– functional activities

• Treatment response

Measuring pain

Pain should be measured using an assessment tool that identifies the quantity and/or quality of one or more of the dimensions of the patients’ experience of pain. This includes the:

• intensity of pain;

• intensity and associated anxiety and behaviour.

Pain assessment tools

The range of pain measurement tools is vast, and includes both uni-dimensional and multi-dimensional methods.

Uni-dimensional tools• measure one dimension of the pain

experience, for example, intensity;• are accurate, simple, quick, easy to use and

understand;• are commonly used for acute pain

assessment;

Multi-dimensional pain assessment tools

• provide information about the qualitative and quantitative aspects of pain;

• may be useful if neuropathic pain is suspected;

• require patients to have good verbal skills and sustained concentration, as they take longer to complete than uni-dimensional tools.

Pain assessment tools

• Uni-dimensional measurement tools (selection):

• Visual analogue scales • Verbal rating scales• Graphic rating scales• Numerical rating scales• Verbal descriptor scales• Body diagrams• Computer graphic scales• Picture scales• Coin scales

• Multi-dimensional pain measurement tools (selection)

• McGill pain questionnaire (short and long)• Brief pain inventory (short and long)• Behavioural pain scales• Pain/comfort journal• Multidimensional pain inventory• Pain information and beliefs questionnaire• Pain and impairment relationship scale• Pain cognition questionnaire• Pain beliefs and perceptions inventory• Coping strategies questionnaire• Pain disability index• Hospital anxiety and depression

questionnaire (HAD scale)• Neuropathic signs and symptoms ( Leeds

assessment of neuropathic symptoms and signs (LANSS) (Bennett, 2001).

• Cognitively impaired/dementia pain scales

The various methods to measure pain

1. Subjective Report2. Spontaneous Behavioural

Responses3. Physiological Measures

Pain Intensity Rating Scales• Pain Faces Scale

00

No No hurthurt

22

Hurts Hurts just a just a

little bitlittle bit

44

Hurts a Hurts a little bit little bit moremore

6

Hurts even more

8

Hurts a whole

lot

1010

Hurts as Hurts as much as much as you can you can imagineimagine

• Brief Pain Inventory

Shade areas of worst painShade areas of worst pain

Put an X on area that hurts mostPut an X on area that hurts most

(Cleeland, 1991; Wong et al, 2001)