2. 1) To increase awareness of the different factors
that affect a person’s pain experience, and to
learn some practical pain management
techniques
2) To discuss the elements of suffering
3) To identify common symptoms/side effects
experienced by people who are dying, and to
discuss symptom management methods
4) To learn relaxation techniques
5) To identify common symptom and functional
assessment tools
Goals
3. What is Pain?
• A physical sensation relayed to the brain
through the nervous system.
• Subjective. Difficult to determine exact cause.
• Two people experiencing the same pain will
react differently.
• Pain is what the person says it is.
• Acute pain is different from chronic pain.
I. The Experience of Pain and Pain
Management
4. Brainstorm:
• What signs tell you someone is in pain?
• What influences how a person
perceives pain and responds to pain?
• What is the difference
between acute pain and
chronic pain?
Exercise: Understanding Pain
5. • Past experience
• Cultural background
• Gender
• “Meaning” of pain
• Life experiences
• Other symptoms
• Anxiety
• Rest and sleep
Factors Affecting Pain
6. A person may experience:
• Acute pain
• Chronic or persistent pain
• Breakthrough pain
• Referred
• Radiating
Pain at End of Life
7. • To recognize pain, home support workers should:
• Observe the person carefully for signs of pain
• Ask some simple questions to determine the type of pain
and how to relieve it:
• Are you experiencing pain?
• When did it start?
• Where do you feel it? Is it
sharp/dull/shooting/stabbing etc.?
• What is the intensity (0-10)?
• What makes it better or worse?
• Any other symptoms (dizziness, nausea, etc.)?
• What can I do to help?
• Use the pain chart to document and describe the pain.
Recognizing Pain
8. • Persons nearing end of life should receive
ongoing pain assessments:
• Usually by nurses and physicians, but support
workers should have the knowledge and tools to
assess pain
• Symptoms to be rated include: “guarding”, tiredness,
drowsiness, nausea, appetite, breathing, depression,
anxiety, well-being
• Characterize by location, intensity, etiology, and other
factors
Assessing Pain
9. Visual Analog Scale (VAS) for Pain
A VAS is usually a horizontal line, 100 mm in length,
anchored by word descriptors at each end.
The patient marks on the line the point that they feel
represents their perception of their current pain.
The VAS score is determined by measuring in millimetres
from the left hand end of the line to the point that the patient
marks.
Pain Assessment Tools
10. Wong-Baker FACES Pain Rating Scale
This scale is often used with children.
The person is asked to choose the face that best describes
how he or she is feeling.
Pain Assessment Tools
11. Edmonton Symptom Assessment System – revised
The ESAS-r can be
used to assess a
number of symptoms
Pain Assessment Tools
12. Pain – grimacing, guarding
Tiredness – more time spent resting
Drowsiness – less alert
Nausea – retching, vomiting
Loss of appetite – less intake
Shortness of breath – increased effort to breathe
Depression – tearfulness, flat affect, social withdrawal, less
concentration, disturbed sleep
Anxiety – agitation, restlessness, increased heart rate
Signs of Different Symptoms
14. Case Study
Mrs. V. is a 70 year old female recently diagnosed with
Stage 4 breast cancer. She requires assistance with
meal preparation and personal care. During your visit
today, Mrs. V. is quieter than usual. She looks very
unhappy but tells you everything is fine. You notice
her grimacing during her shower whenever you move
her right arm. You ask if she is in pain and she tells
you just a little.
1. How would you manage this situation?
2. How can you help Mrs. V. with her pain?
Exercise: Alleviating Pain II
16. Myth 1
Pain medication –
particularly opioids –
will cause addiction.
Reality
People do not become
dependent when pain
medication is used for
pain control.
Myth 2
People will become
tolerant of pain
medications so they
will no longer help.
Reality
People who are dying
can get pain relief by
taking narcotics every
four hours for up to a
year without having to
increase the dosage.
Myths about Pain Management
17. Myth 3
Pain medications often
cause hallucinations.
Reality
Only about 1% of people
experience hallucinations.
Hallucinations may occur
when a person is first put
on opioids or when the
dosage is increased. This
side effect typically lasts
24 to 72 hours, and then
disappears.
Myths about Pain Management
18. • Ensure client has received medication at the appropriate
time.
• Ensure client has good body alignment.
• Use appropriate turning, lifting and moving techniques.
• Use touch to provide comfort.
• Provide a calm, quiet environment.
• Avoid sudden movements.
• Provide soft music if desired.
• Ensure body temperature is not too warm or cold.
Measures to Promote Comfort
and Relieve Pan
19. “Suffering” includes:
• Physical pain and other symptoms
• Psychological pain
• Social issues such as changed roles, family
issues, isolation and financial worries
• Spiritual/existential aspects of life, including
beliefs and fears.
II. Understanding Suffering
20. Support workers can help by:
• Providing a committed presence
• Affirming the person’s value
• Being compassionate
• Demonstrating acts of kindness
• Asking questions:
• What are you most proud of?
• What things did you do that were most important to you?
• What part of you is strongest now?
• What takes your mind away from illness and gives you
comfort?
• Is there anything in the way you are treated that is
undermining your sense of dignity?
Reducing Suffering
21. III. Symptoms and Symptom
Management
Possible Symptoms
Include:
• Anorexia – loss of
appetite
• Weakness
• Thirst
• Fever
• Jaundice
• Nausea/vomiting
• Constipation
• Insomnia
• Hiccups
• Skin irritation
• Incontinence
• Fatigue
22. Support Worker’s Role in Symptom
Management
• Follow the care plan
• Use a tool like the ESAS-r to assess
intensity of symptoms
• Create a comfortable physical environment
• Help with details that can increase comfort
• Encourage relaxation techniques
23. The Palliative Performance Scale version 2 (PPSv2) is used
to describe a client’s functional status. The PPS is done by
doctors and nurses. However, the support worker should
know the general meaning of the PPS scores on five
observable parameters:
1) Degree of ambulation
2) Ability to do activities and evidence of disease
3) Ability to do self-care
4) Intake
5) Level of consciousness
Understanding the Client’s Needs
25. • Ambulation: How is the client’s mobility? Is he/she fully
mobile or is the ability to walk decreasing?
• Activity level: How active is the client? Is the client able
to do his/her normal hobby, job or work?
• Self care: Is the client independent with self-care? How
much help does he/she need? Is this declining?
• Intake: How much is the client eating or drinking? Is it
normal or reduced?
• Consciousness level: Is the client lucid or fully alert?
Does the client have confusion? Is he/she drowsy? Has
the client’s consciousness level declined?
What does the PPS Score Mean?
26. Do you have a better understanding of pain and
how to help clients manage pain?
Do you have a better understanding of suffering?
Are you better able to recognize symptoms
experienced by people nearing end of life?
Do you have a better understanding of the support
worker’s role in symptom management?
Learning Outcomes
