Pain as 5 th vs

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Pain as 5 th vs

  1. 1. PAIN AS 5 TH VITAL SIGN DR LEE OI WAH PENGARAH HCM Powerpoint Templates Page 1
  2. 2. OBJECTIVE:The purpose of module is to train doctors andnurses on pain assessment and painmanagement in order to implement pain as a5th vital sign effectively in OUR hospital Powerpoint Templates Page 2 5th Vital Sign: Doctors’ training module: Intruduction
  3. 3. • All types of pain in all parts of the world are inadequately treated, be it acute or chronic, related to malignant or non-malignant etiologies.• Pain can be relieved in up to 90% of cancer patients, yet fewer than 50% receive adequate treatment• National APS audit, Malaysia showed that 76% of post- laparotomy patients suffered moderate to severe pain in the 1st 24 hours• What about patients in the medical wards or patients who have not had surgery? Powerpoint Templates 5 Vital Sign: Doctors’ training module: Intruduction th Page 3
  4. 4. • New standards in 2001 • Record pain as the 5th vital signJoint Commission on Accreditation of Healthcare Organizations.Jt Comm Perspect. 1999;19(5):6–8.Sklar DP. Ann Emerg Med. 1996;27:412–413. Powerpoint Templates 5 Vital Sign: Doctors’ training module: Intruduction th Page 4
  5. 5. • Pain should be considered the “fifth vital sign” • Patients should be assessed for pain every time pulse, blood pressure, temperature, and respiration are measuredAmerican Pain Society Quality Improvement Committee. JAMA. 1995;1847–1880. Powerpoint Templates 5 Vital Sign: Doctors’ training module: Intruduction th Page 5
  6. 6. • Promote doctor-patient and nurse-patient interaction – Better communication – Better patient satisfaction• Provide better patient care – Individualised carer – Priority to pain assessment – Better awareness of pain  better management of pain  early ambulation  faster recovery, reduced length of stay Powerpoint Templates 5 Vital Sign: Doctors’ training module: Intruduction th Page 6
  7. 7. Definition of pain“An unpleasant sensory and emotionalexperience associated with actual orpotential tissue damage, or described interms of such damage.” Merskey,1964 International Association for the Study of Pain (IASP) Powerpoint Templates 5 Vital Sign: Doctors’ training module: Pain Physiology th Page 7
  8. 8. Powerpoint Templates Page 8
  9. 9. Spectrum of Pain Healing ACUTE NO PAIN PAIN Insidious onset CHRONIC PAIN post-surgical syndromes / cancer ACUTE CHRONIC PAIN PAIN Powerpoint Templates Page 95th Vital Sign: Doctors’ training module: Pain Physiology Courtesy of Prof Ramani Vijayan, MASP
  10. 10. Pain Pathway PAIN Sensory cortex (Anatomy) PAG / RAS Thalamus Descending inhibitory Ascending ST fibres tracts Free nerve endings Spinal cord Dorsal horn Afferent nerve – ( A / c) Powerpoint Templates Page 105th Vital Sign: Doctors’ training module: Pain Physiology Courtesy of Prof Ramani Vijayan, MASP
  11. 11. TYPES OF PAINPhysiologicalPathological or clinical Powerpoint Templates Page 11
  12. 12. EFFECTS OF SEVERE UNRELIEVED PAIN Physiological Psychological Economic Powerpoint Templates Page 14
  13. 13. PHYSIOLOGICAL EFFECTS OF PAINNo System Effects1. CNS ↑ sympathetic activity, hyperalgesia,chronic pain2. Endocrine ↑ stress hormone, catabolic state,hyperglycaemia, immunesupression3. CVS ↑HR,↑BP, myocardial ischaemia4. Respiratory Inability of cough and deep breath, lung collapse and lung infection5. GIT ↓parasympathetic activity, ileus, nausea and vomitting6. Genitourinary Urinary retention7. Muskuloskeletal Delayed ambulation, DVT Powerpoint Templates Page 15
  14. 14. PSYCHOLOGICAL EFFECTS OFPAIN Anxiety Agitation  poor sleep  uncooperative patient  depression Powerpoint Templates 5 Vital Sign: Doctors’ training module: Pain Physiology th Page 16
  15. 15. ECONOMIC EFFECTS OFPAIN Delayed ambulation and feeding Increased postoperative complications Delayed recovery Prolonged hospital stay Increased cost Powerpoint Templates 5 Vital Sign: Doctors’ training module: Pain Physiology th Page 17
  16. 16. Conclusion• Acute pain should be aggressively treated for the following reasons: – Patient comfort – Prevent adverse physiological and psychological consequences of unrelieved pain – Reduce risk of developing chronic pain Powerpoint Templates 5 Vital Sign: Doctors’ training module: Pain Physiology th Page 18
  17. 17. FACTORS AFFECTING PAIN• Perception of Pain• Socio Cultural Factors• Age• Gender• Meaning of Pain• Anxiety• Past experience with Pain Powerpoint Templates Page 19
  18. 18. Physician Barriers to Mgmt• Inadequate knowledge of pain management• Poor assessment of pain• Concern about regulation of controlled substances• Fear of patient addiction or misuse• Concern about side effects, tolerance Powerpoint Templates Page 20
  19. 19. Patient Barriers to Mgmt. – Older adults often expect pain with age – Use other words than “pain’ (aching, hurting, throbbing, “a misery”) – Fear need for diagnostic tests or medications that have side effects – For some, pain is a metaphor for serious disease or death – For others, pain and suffering represent atonement for past actions Powerpoint Templates Page 21
  20. 20. Barriers in LTC setting• Different response (may not show typical sx)• Cognitive and communication barriers• Cultural and social barriers• Co-existing illnesses and multiple meds• Staff training and access to appropriate tools• Practitioner limitations• System barriers Powerpoint Templates Page 22
  21. 21. Powerpoint Templates Page 23

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