PAIN  RECOGNITION AND RELIEF PAIN MANAGEMENT Bessie Burton Sullivan Pat Borman, MD
DEFINITION OF PAIN <ul><ul><li>Pain is suffering </li></ul></ul><ul><ul><li>Residents define their pain  </li></ul></ul><u...
MISCONCEPTIONS ABOUT PAIN <ul><li>Pain is  part of aging, inevitable </li></ul><ul><li>Acknowledging pain is weak </li></u...
ROADBLOCKS TO PAIN MANAGEMENT <ul><li>No format for regular, complete assessment and reassessment </li></ul><ul><li>Misjud...
PAIN ASSESSMENT <ul><li>QUESTION Resident and family </li></ul><ul><li>OBSERVE Resident behavior </li></ul><ul><li>EXAMINE...
PAIN ASSESSMENT QUESTIONS <ul><li>QUESTIONS TO ASK </li></ul><ul><li>Are you in pain:  hurting, achy, uncomfortable, bothe...
PAIN ASSESSMENT QUESTIONS <ul><li>DEFINE THE PAIN </li></ul><ul><li>Location, quality, severity, frequency, duration </li>...
PAIN ASSESSMENT  OBSERVATIONS <ul><li>OBSERVE BEHAVIORS </li></ul><ul><li>Sad, frown, irritable, low mood </li></ul><ul><l...
PAIN ASSESSMENT EXAMINATION <ul><li>EXAMINE FOR SOURCE OF PAIN </li></ul><ul><li>Types of Pain:  Muscle, Joint, Neurologic...
PAIN ASSESSMENT EVALUATE FUNCTION <ul><li>CHANGES IN FUNCTION CAN BE  A SIGN OF PAIN </li></ul><ul><li>Decreased participa...
DOCUMENTING PAIN MANAGEMENT <ul><li>Communication amongst team members is critical </li></ul><ul><li>Pain Scales:  Numeric...
MEDICATIONS FOR PAIN <ul><li>NON-OPIOIDS:  Acetaminophen </li></ul><ul><li>Aspirin </li></ul><ul><li>NSAIDs </li></ul><ul>...
ADJUVANT TREATMENTS <ul><li>Corticosteroids </li></ul><ul><li>Antidepressents </li></ul><ul><li>TCADs </li></ul><ul><li>An...
DOCUMENT EFFECACY OF TREATMENT <ul><li>Pain diagnosis is recorded </li></ul><ul><li>Record each administered dose </li></u...
MEDICATION SIDE EFFECTS <ul><li>Opiates can cause: </li></ul><ul><li>Constipation </li></ul><ul><li>Urinary Retention </li...
RESIDENT EDUCATION <ul><li>Pain can and should be managed </li></ul><ul><li>You define your level of pain and relief from ...
PAIN:  RECOGNITION AND RELIEF <ul><li>Recognition is the first step to relieving pain </li></ul><ul><li>Develop a pain voc...
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Pain Relief in the Elderly

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Pain Relief in the Elderly

  1. 1. PAIN RECOGNITION AND RELIEF PAIN MANAGEMENT Bessie Burton Sullivan Pat Borman, MD
  2. 2. DEFINITION OF PAIN <ul><ul><li>Pain is suffering </li></ul></ul><ul><ul><li>Residents define their pain </li></ul></ul><ul><ul><li>Pain is personal, subjective </li></ul></ul><ul><ul><li>Pain is treatable </li></ul></ul>
  3. 3. MISCONCEPTIONS ABOUT PAIN <ul><li>Pain is part of aging, inevitable </li></ul><ul><li>Acknowledging pain is weak </li></ul><ul><li>Pain always means serious disease or death </li></ul><ul><li>Pain is punishment </li></ul><ul><li>Pain leads to loss of independence </li></ul>
  4. 4. ROADBLOCKS TO PAIN MANAGEMENT <ul><li>No format for regular, complete assessment and reassessment </li></ul><ul><li>Misjudging behavioral clues </li></ul><ul><li>Lack of documentation tool </li></ul><ul><li>Myth that pain is normal </li></ul><ul><li>Lack of nursing knowledge </li></ul>
  5. 5. PAIN ASSESSMENT <ul><li>QUESTION Resident and family </li></ul><ul><li>OBSERVE Resident behavior </li></ul><ul><li>EXAMINE Resident </li></ul><ul><li>EVALUATE Function, ADLs </li></ul><ul><li>REASSESS FREQUENTLY TO MONITOR TREATMENTS </li></ul>
  6. 6. PAIN ASSESSMENT QUESTIONS <ul><li>QUESTIONS TO ASK </li></ul><ul><li>Are you in pain: hurting, achy, uncomfortable, bothered? </li></ul><ul><li>Is any other spot bothering you? (More than one site or type of pain) </li></ul><ul><li>Pain Scale Assessment </li></ul>
  7. 7. PAIN ASSESSMENT QUESTIONS <ul><li>DEFINE THE PAIN </li></ul><ul><li>Location, quality, severity, frequency, duration </li></ul><ul><li>Aggravating or alleviating factors </li></ul><ul><li>Amount of dysfuction </li></ul>
  8. 8. PAIN ASSESSMENT OBSERVATIONS <ul><li>OBSERVE BEHAVIORS </li></ul><ul><li>Sad, frown, irritable, low mood </li></ul><ul><li>Moan, groan, cry, sigh, wince </li></ul><ul><li>Rub, protect a part, pointing, touching, favoring, fidgeting </li></ul><ul><li>Change in activity, sleep, appetite, mobility, gait, resisting care, combative </li></ul>
  9. 9. PAIN ASSESSMENT EXAMINATION <ul><li>EXAMINE FOR SOURCE OF PAIN </li></ul><ul><li>Types of Pain: Muscle, Joint, Neurological </li></ul><ul><li>Sources: Arthritis, low back pain, gout, osteoporosis, stroke, fracture, diabetes, headache, shingles,dental, pressure ulcers, restraints, other </li></ul>
  10. 10. PAIN ASSESSMENT EVALUATE FUNCTION <ul><li>CHANGES IN FUNCTION CAN BE A SIGN OF PAIN </li></ul><ul><li>Decreased participation, change in gait, less active </li></ul><ul><li>Decreased mobility, more, reliance on assistance/devices </li></ul><ul><li>Increased incontinence, less grooming </li></ul>
  11. 11. DOCUMENTING PAIN MANAGEMENT <ul><li>Communication amongst team members is critical </li></ul><ul><li>Pain Scales: Numeric, Visual </li></ul><ul><li>Resident Education component </li></ul><ul><li>Ongoing Assessment: Pre and Post treatment </li></ul>
  12. 12. MEDICATIONS FOR PAIN <ul><li>NON-OPIOIDS: Acetaminophen </li></ul><ul><li>Aspirin </li></ul><ul><li>NSAIDs </li></ul><ul><li>Tramadol </li></ul><ul><li>Topicals: </li></ul><ul><li>capsaicin </li></ul><ul><li>lidocaine </li></ul><ul><li>OPIOIDS: </li></ul><ul><li>Morphine </li></ul><ul><li>Hydromorphone </li></ul><ul><li>Codiene </li></ul><ul><li>Hydrocodone </li></ul><ul><li>Oxycodone </li></ul><ul><li>Topicals: </li></ul><ul><li>Fentanyl </li></ul>
  13. 13. ADJUVANT TREATMENTS <ul><li>Corticosteroids </li></ul><ul><li>Antidepressents </li></ul><ul><li>TCADs </li></ul><ul><li>Anticonvulsants </li></ul><ul><li>Nuerontin, Tegretol, Clonazepam </li></ul><ul><li>Muscle relaxers </li></ul><ul><li>Education </li></ul><ul><li>Counseling </li></ul><ul><li>Exercise </li></ul><ul><li>PT/OT </li></ul><ul><li>Positioning </li></ul><ul><li>Heat, cold, massage </li></ul><ul><li>Relaxation </li></ul><ul><li>Hypnosis </li></ul>
  14. 14. DOCUMENT EFFECACY OF TREATMENT <ul><li>Pain diagnosis is recorded </li></ul><ul><li>Record each administered dose </li></ul><ul><li>Confirm effectiveness with pain scale, resident report, observation </li></ul><ul><li>Use Sedation scale and document any side effects of treatment </li></ul>
  15. 15. MEDICATION SIDE EFFECTS <ul><li>Opiates can cause: </li></ul><ul><li>Constipation </li></ul><ul><li>Urinary Retention </li></ul><ul><li>Sedation, Delirium </li></ul><ul><li>Impaired cognition </li></ul><ul><li>Decreased respiratory rate Nausea, Itching </li></ul>
  16. 16. RESIDENT EDUCATION <ul><li>Pain can and should be managed </li></ul><ul><li>You define your level of pain and relief from medication </li></ul><ul><li>Please report pain as soon as it bothers you </li></ul><ul><li>Tell us any concerns you have about your pain relief plan </li></ul>
  17. 17. PAIN: RECOGNITION AND RELIEF <ul><li>Recognition is the first step to relieving pain </li></ul><ul><li>Develop a pain vocabulary and ASK, Be observant for pain behaviors in your residents </li></ul><ul><li>Educate your residents: we can help, you don’t have to suffer </li></ul><ul><li>Be an advocate for pain relief </li></ul>

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