PAIN RECOGNITION AND RELIEF

1. PAIN RECOGNITION AND RELIEF PAIN MANAGEMENT Bessie Burton Sullivan Pat Borman, MD

2. DEFINITION OF PAIN • Pain is suffering • Residents define their pain • Pain is personal, subjective • Pain is treatable

3. MISCONCEPTIONS ABOUT PAIN • Pain is part of aging, inevitable • Acknowledging pain is weak • Pain always means serious disease or death • Pain is punishment • Pain leads to loss of independence

4. ROADBLOCKS TO PAIN MANAGEMENT • No format for regular, complete assessment and reassessment • Misjudging behavioral clues • Lack of documentation tool • Myth that pain is normal • Lack of nursing knowledge

5. PAIN ASSESSMENT • QUESTION Resident and family • OBSERVE Resident behavior • EXAMINE Resident • EVALUATE Function, ADLs • REASSESS FREQUENTLY TO MONITOR TREATMENTS

6. PAIN ASSESSMENTQUESTIONS QUESTIONS TO ASK • Are you in pain: hurting, achy, uncomfortable, bothered? • Is any other spot bothering you? (More than one site or type of pain) • Pain Scale Assessment

7. PAIN ASSESSMENTQUESTIONS DEFINE THE PAIN • Location, quality, severity, frequency, duration • Aggravating or alleviating factors • Amount of dysfuction

8. PAIN ASSESSMENT OBSERVATIONS OBSERVE BEHAVIORS • Sad, frown, irritable, low mood • Moan, groan, cry, sigh, wince • Rub, protect a part, pointing, touching, favoring, fidgeting • Change in activity, sleep, appetite, mobility, gait, resisting care, combative

9. PAIN ASSESSMENTEXAMINATION EXAMINE FOR SOURCE OF PAIN • Types of Pain: Muscle, Joint, Neurological • Sources: Arthritis, low back pain, gout, osteoporosis, stroke, fracture, diabetes, headache, shingles,dental, pressure ulcers, restraints, other

10. PAIN ASSESSMENTEVALUATE FUNCTION CHANGES IN FUNCTION CAN BE A SIGN OF PAIN • Decreased participation, change in gait, less active • Decreased mobility, more, reliance on assistance/devices • Increased incontinence, less grooming

11. DOCUMENTING PAIN MANAGEMENT • Communication amongst team members is critical • Pain Scales: Numeric, Visual • Resident Education component • Ongoing Assessment: Pre and Post treatment

12. NON-OPIOIDS: Acetaminophen Aspirin NSAIDs Tramadol Topicals: capsaicin lidocaine OPIOIDS: Morphine Hydromorphone Codiene Hydrocodone Oxycodone Topicals: Fentanyl MEDICATIONS FOR PAIN

13. Corticosteroids Antidepressents TCADs Anticonvulsants Nuerontin, Tegretol, Clonazepam Muscle relaxers Education Counseling Exercise PT/OT Positioning Heat, cold, massage Relaxation Hypnosis ADJUVANTTREATMENTS

14. DOCUMENT EFFECACY OF TREATMENT • Pain diagnosis is recorded • Record each administered dose • Confirm effectiveness with pain scale, resident report, observation • Use Sedation scale and document any side effects of treatment

15. MEDICATION SIDE EFFECTS • Opiates can cause: Constipation Urinary Retention Sedation, Delirium Impaired cognition Decreased respiratory rate Nausea, Itching

16. RESIDENT EDUCATION • Pain can and should be managed • You define your level of pain and relief from medication • Please report pain as soon as it bothers you • Tell us any concerns you have about your pain relief plan

17. PAIN: RECOGNITION AND RELIEF • Recognition is the first step to relieving pain • Develop a pain vocabulary and ASK, Be observant for pain behaviors in your residents • Educate your residents: we can help, you don’t have to suffer • Be an advocate for pain relief