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Winter 2010 Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign Chapter 10
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Chapter 10
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
What is Pain?
Highly complex & subjective experience originating in CNS or PNS or both
Nociceptors detect painful stimuli in skin, connective, tissue, muscle and throacic, abdominal & pelvic viscera → CNS
Stimuli sent to CNS via: Aδ fibres
Myelinated & larger in diameter Transmit pain quickly Described as localized, short-term and sharp, shooting
C fibres Nonmyelinated & smaller in diameter Transmit pain more slowly Described as diffuse, dull, aching, throbbing, persitent
after initial injury
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Neuroanatomical Pathway
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Nociception
Describes how noxious stimuli are percived as pain
4 phases: Transduction Transmission Perception modulation
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Nociception
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Sources of Pain Pain is based on its origin
1. Nociceptive d/t tissue injuryResolves as tissue healing occursLocalized Described as aching or throbbing
Somatic: superficial or cutaneous (ie. Skin surface & subcutaneous layer) or deep (ie from tendons, joints, muscles or bone)Visceral: originates from internal organs
2. Neuropathic◦ Initiated or caused by a primary lesion or dysfunction of the nervous system
◦ d/t injury to PNS, CNS or both◦ Described as burning, shooting
3. Referred◦ Pain felt at a particular site but originates from another location◦ May originate from visceral or somatic structures
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
© Pat Thomas, 2006.
Common Sites of Referred Pain
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Types of Pain by Duration
Acute pain Short term Self-limiting Follows a predictable trajectory Dissipates after injury heals
Persistent pain Continues for 6 months or longer Types are malignant (cancer-related) and
nonmalignant Does not stop when injury heals
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Pain assessment questions Pain assessment tools
Winter 2010
Questions to ask: Where is your pain? When did your pain
start? What does your pain
feel like? How much pain do you
have now? What makes the pain
better or worse?
How does pain limit your function/activities?
How do you behave when you are in pain? How would others know you are in pain?
What does pain mean to you?
Why do you think you are having pain?
Subjective Data
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Initial pain assessment Brief pain inventory Short-Form McGill Pain
Questionnaire Pain rating scales
Numeric rating scales Descriptor scale Wong Baker scale
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
From McCaffery, M. & Pasero, From McCaffery, M. & Pasero, C. (1999). C. (1999). Pain: Clinical Pain: Clinical manual,manual, 2 2ndnd ed. St. Louis: ed. St. Louis: Mosby.Mosby.
Brief Pain Inventory
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Joints—note Size/contour/circumference AROM/PROM
Muscles/skin—inspect Color/swelling Masses/deformity Sensation changes
Objective Data Collection
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Objective Data Collection Cont’d
Abdomen—inspect and palpate Contour/symmetry Guarding/organ size
Pain behaviour—inspect Nonverbal cues Acute pain behaviour Persistent pain behaviour
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Acute Pain Behaviours Guarding Grimacing Vocalizations such as moaning Agitation, restlessness Stillness Diaphoresis Change in vital signs
Objective Data Collection Cont’d
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Persistent (Chronic) Pain Behaviours Bracing Rubbing Diminished activity Sighing Change in appetite Being with other people Movement Exercise Prayer Sleeping
Objective Data Collection Cont’d
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Assessing pain is very challenging in the unconscious. Critical Care Observation Tool (CPOT)
Neonates: NPASS PIPP
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
A. Somatic
B. Visceral
C. Cutaneous
D. Persistent
Winter 2010
Chapter 10: Chapter 10: Pain Assessment: The Fifth Vital Sign
A. Patients with persistent pain have trouble sleeping.
B. Patients with persistent pain show elevated blood pressures.
C. Patients with persistent pain need less medication.
D. Patients with persistent pain may show few or no outward signs of pain.
