Pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

is often regarded as the fifth

vital sign Vital signs (also known as vitals) are a group of the four to six most crucial medical signs that indicate the status of the body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a p ...

in regard to

healthcare Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...

because it is accepted now in healthcare that

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

, like other vital signs, is an objective sensation rather than subjective. As a result

nurse Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health c ...

s are trained and expected to assess pain.

Regulation

Pain assessment and re-assessment after administration of

analgesic An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It ...

s or

pain management Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals pr ...

is regulated in healthcare facilities by

accreditation Accreditation is the independent, third-party evaluation of a conformity assessment body (such as certification body, inspection body or laboratory) against recognised standards, conveying formal demonstration of its impartiality and competence to ...

bodies, like the Joint Commission. The Joint Commission began setting standards for pain assessment in 2001 stating that the route of analgesic administration dictates the times for pain reassessment, as different routes require different amounts of time for the

medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...

to have a therapeutic effect. Oral: 45–69 minutes.

Intramuscular Intramuscular injection, often abbreviated IM, is the injection of a substance into a muscle. In medicine, it is one of several methods for parenteral administration of medications. Intramuscular injection may be preferred because muscles have l ...

: 30 minutes.

Intravascular The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away f ...

: 15 minutes.

Types of assessment

Most pain assessments are done in the form of a scale. The scale is explained to the

patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health c ...

, who then chooses a score. A rating is taken before administering any medication and after the specified time frame to rate the

efficacy Efficacy is the ability to perform a task to a satisfactory or expected degree. The word comes from the same roots as ''effectiveness'', and it has often been used synonymously, although in pharmacology a pragmatic clinical trial#Efficacy versu ...

of treatment.

Number scale

Patients rate pain on a scale from 0-10, 0 being no pain and 10 being the worst pain imaginable.

Faces scale

A scale with corresponding faces depicting various levels of pain is shown to the patient and they select one.

Special considerations

Patients who cannot verbalize/comprehend

pain scale A pain scale measures a patient's pain intensity or other features. Pain scales are a common communication tool in medical contexts, and are used in a variety of medical settings. Pain scales are a necessity to assist with better assessment of pai ...

s are assessed with different types of scales.

FLACC

Used for neonates/infants: The scores are added together to achieve a 0-10 pain score.

Physiological measurement of pain

fMRI brain scanning has been used to measure pain, giving good correlations with self-reported pain.

Long-term pain

Hedonic adaptation The hedonic treadmill, also known as hedonic adaptation, is the observed tendency of humans to quickly return to a relatively stable level of happiness despite major positive or negative events or life changes. According to this theory, as a perso ...

means that actual long-term suffering due to physical illness is often much lower than expected.

Legal awards for pain and suffering

One area where assessments of

pain and suffering Pain and suffering is the legal term for the physical and emotional stress caused from an injury (see also pain and suffering). Some damages that might come under this category would be: aches, temporary and permanent limitations on activity, p ...

are required to be made effectively is in legal awards. In the Western world these are typically discretionary awards made by juries and are regarded as difficult to predict, variable and subjective, for instance in the US, UK,

Australia Australia, officially the Commonwealth of Australia, is a Sovereign state, sovereign country comprising the mainland of the Australia (continent), Australian continent, the island of Tasmania, and numerous List of islands of Australia, sma ...

and New Zealand.http://www.ejcl.org/133/art133-2.pdf

Addiction

Many patients who use drugs and are on

opioid Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid us ...

benzodiazepine Benzodiazepines (BZD, BDZ, BZs), sometimes called "benzos", are a class of depressant drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are prescribed to treat conditions such as anxiety disorders, ...

stimulant Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and inv ...

barbiturate Barbiturates are a class of depressant drugs that are chemically derived from barbituric acid. They are effective when used medically as anxiolytics, hypnotics, and anticonvulsants, but have physical and psychological addiction potential as we ...

s, and

sedative-hypnotic A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are CNS depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but th ...

s have the potential to become addicted. Many people with

chronic illness A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the course of the disease lasts for more than three mo ...

es,

injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, o ...

, and history of

mental illness A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...

are prescribed these drugs. As a nurse it is difficult to assess whether the pain is real or whether the patient is seeking the

narcotic The term narcotic (, from ancient Greek ναρκῶ ''narkō'', "to make numb") originally referred medically to any psychoactive compound with numbing or paralyzing properties. In the United States, it has since become associated with opiates ...

. Adult patients display pain and emotions differently. Many patients become dependent physically and mentally on these drugs. 1.name 2.age 3.sex 4.occupation 5.address 6.chief complaint of patient 7.history of patient:- present illness history past illness history medical history family history personal history 8.pain site of pain nature of pain quantity of pain on v.a.s scale type of pain 9.examination active movement passive movement 10.observation gait posture r.o.m palpation aggravating factor relieving factor tenderness 11.treatment

Nurse Pain assessment

*Does the patient show nonverbal signs of pain such as crying or grimacing? *Does the patient watch the clock and ask for the

pain medication An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It i ...

sedative A sedative or tranquilliser is a substance that induces sedation by reducing irritability or excitement. They are CNS depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but t ...

at the exact time it's due? *Does the patient continually ask for the medication? *Does the patient continually ask the

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

to increase pain medication? *What is the dose of the medication and how often does the patient ask for it? *How long has the patient been taking the drug? *Does the patient have a change in mood and behavior if they don't receive the medication at the exact time? *Have a conversation with the patient. Do they want the medication because they are in pain or because they can't sleep? *Do they want the medication because they are anxious? *What is going on in the patient's life? *What are their social circumstances? *Is the nursing staff performing three non-drug interventions before administering a sedative, hypnotic, or anti anxiety medication? *How many different medications is the patient on? *Is the patient gradually asking for less medication as time goes on or are they asking for more?

Assessment findings

If the patient is continually asking for the physician to increase their pain medication or increase the frequency, they need further evaluation by both a nurse and a physician. There is a good possibility the patient is in pain. There is also a possibility that they are becoming addicted to prescribed medication. The patient's history must be taken into account as well. Medical conditions such as

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

and

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involv ...

are chronic conditions and can be very painful. In long-term care facilities, three non-drug interventions need to be attempted before administering anti-anxiety or anti-psychotic medications. These interventions can consist of giving the patient food, drinks, one on one care,

back rub Massage is the manipulation of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In Eu ...

, changing the patient's position in bed, adjusting the temperature, and redirecting the patient's mental focus. Many times these interventions work, but many times the medication may still need to be administered. The patient's history and diagnosis are helpful in deciding whether or not the patient is developing a substance abuse problem. A patient having social or relationship problems may need to meet with a crisis counselor. During every shift that a nurse is on duty, they must do an assessment of the patient. If they suspect the patient is becoming addicted, they must notify the physician.

References

{{reflist Pain