Chapter 10The Fifth Vital Sign: PainUniversal Definition of PainSlide 4Review A & P terminologyNerve vs. Muscle PainNeuropathic PainSources (or Types) of PainSlide 9Acute vs. Chronic PainSlide 11Developmental DifferencesSlide 13Gender DifferencesSlide 15Pain: Subjective DataCRIES Pain Assessment ToolWong-Baker Scale: Young ChildrenPain Intensity Scale: AdultsPQRST:PQRST Method of Pain AssessmentPQRSTU cont’d.PQRSTU cont’dOther Questions:Possible Physical Findings of PainChanges seen in Acute PainChanges seen in Chronic PainAssessing Pain in People with DementiaPain Assessment in Patients with DementiaDocumentation of PainCultural ConsiderationsSlide 32Sample chartingChapter 10Chapter 10Pain Assessment: Pain Assessment: The Fifth Vital SignThe Fifth Vital SignThe Fifth Vital Sign: PainThe Fifth Vital Sign: PainWhat is pain?What is pain?Universal Definition of PainUniversal Definition of Pain•Pain is whatever the experiencing Pain is whatever the experiencing person says it is, existing whenever he person says it is, existing whenever he says it does.says it does.McCaffery, 1968McCaffery, 1968Pain is nearly always Pain is nearly always subjective*subjective* Diagnosis of pain cannot be based Diagnosis of pain cannot be based exclusively on physical exclusively on physical examination findings.examination findings.*There are a few objective signs*There are a few objective signsReview A & P terminologyReview A & P terminologyNeuroanatomic PathwayNeuroanatomic PathwayNociceptionNociceptionFour phases ofFour phases of nociception:nociception:•TransductionTransduction•TransmissionTransmission•PerceptionPerception•ModulationModulationNerve vs. Muscle PainNerve vs. Muscle PainNeuropathic PainNeuropathic PainAtypicalAtypicalDifficult to assess and treatDifficult to assess and treatOften perceived after healingOften perceived after healingOften seen with cancerous tumors Often seen with cancerous tumors patients with tumorspatients with tumorsTreated differentlyTreated differentlySources (or Types) of PainSources (or Types) of PainGrouping by origin:Grouping by origin:•VisceralVisceral•Somatic painSomatic pain•Cutaneous painCutaneous pain•Referred painReferred pain•Phantom painPhantom pain•NeuralgiaNeuralgiaSources (or Types) of PainSources (or Types) of PainGrouping by origin:Grouping by origin:•VisceralVisceral•Somatic painSomatic pain•Cutaneous painCutaneous pain•Referred painReferred pain•Phantom painPhantom pain•NeuralgiaNeuralgia•MyalgiaMyalgiaAcute vs. Chronic PainAcute vs. Chronic PainAcuteAcute•Short-term and self-limitingShort-term and self-limiting•Intensity: mild to severeIntensity: mild to severeChronic (more than 6 months)Chronic (more than 6 months)•Malignant (cancer-caused)Malignant (cancer-caused)Tissue necrosisTissue necrosisStretching of an organ by a growing tumorStretching of an organ by a growing tumorFluctuates with the course of the diseaseFluctuates with the course of the disease•Non-malignantNon-malignantOften associated with musculoskeletal conditionsOften associated with musculoskeletal conditions•Ex: arthritis, low back pain, or fibromyalgiaEx: arthritis, low back pain, or fibromyalgiaAcute vs. Chronic PainAcute vs. Chronic Pain•Pain is divided into acute or chronic Pain is divided into acute or chronic categoriescategoriesAcute pain is short term and self-limiting, Acute pain is short term and self-limiting, often follows a predictable trajectory, and often follows a predictable trajectory, and dissipates after an injury healsdissipates after an injury healsExamples of acute pain include surgery, Examples of acute pain include surgery, trauma, and kidney stonestrauma, and kidney stonesAcute pain serves a self-protective purpose; Acute pain serves a self-protective purpose; acute pain warns individual of actual or acute pain warns individual of actual or potential tissue damagepotential tissue damageDevelopmental DifferencesDevelopmental DifferencesInfantsInfantsAging adultsAging adultsInfants (cont.)Infants have same capacity for pain as adults (cont.)New research indicates that repetitive and poorly controlled pain in infants (daily heel sticks, venipunctures) can result in lifelong adverse consequences such as neurodevelopmental problems, poor weight gain, learning disabilities, psychiatric disorders, and alcoholismGender DifferencesGender DifferencesMen:Men:•Usually more stoic about painUsually more stoic about painWomen: Women: •Express pain more freelyExpress pain more freely•Hormonal changes have strong influence on Hormonal changes have strong influence on pain sensitivitypain sensitivity•2-3 X more likely to have migraines 2-3 X more likely to have migraines •More sensitive to pain during premenstrual More sensitive to pain during premenstrual periodperiod•6 X more likely to have fibromyaligia6 X more likely to have fibromyaligiaGender DifferencesGender Differences•With recent findings from Human With recent findings from Human Genome Project, genetic differences Genome Project, genetic differences between both sexes may account for between both sexes may account for differences in pain perceptiondifferences in pain perceptionA pain gene exists, which helps to explain A pain gene exists, which helps to explain why some people feel more/less pain why some people feel more/less pain even with same stimuluseven with same stimulusEfforts are being made to tailor Efforts are being made to tailor pharmacological agents to improve pain pharmacological agents to improve pain treatment based on genetic sequencingtreatment based on genetic sequencingSlide 10-Slide 10-1515Pain: Subjective Data Pain: Subjective Data Most reliable indicator of painMost reliable indicator of painPain assessment toolsPain assessment tools•Numeric scalesNumeric scales•Descriptor ScaleDescriptor ScaleInfants and ChildrenInfants and Children•Dependent on behavioral and physiologic cuesDependent on behavioral and physiologic cues•By age 2: can report and point to locationBy age 2: can report and point to location•By 4 or 5: rating scales can be usedBy 4 or 5: rating scales can be usedWong-Baker ScaleWong-Baker ScaleCRIES Pain Assessment ToolCRIES Pain Assessment ToolUsed in preterm Used in preterm and term neonatesand term neonatesWong-Baker Scale: Wong-Baker Scale: Young ChildrenYoung