What is Pain? n “Pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.”

What is Pain?

“Pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage.”

“Pain is whatever the experiencing person says it is, existing whenever he/she says it does.”

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 quality of life

Depression Emotional distress Decreased

socialization Disturbed sleep

and appetite

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 understandingLegitimizing

the painBelieving theperson has painUnderstanding the

pain experienceGetting 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

JAGS, 2002; 50:S205-S224

*Observe at rest & movement

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