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Pain Assessment

Sep 3, 2024

Pain Assessment Lecture

Introduction to Pain

  • Pain originates from the Central Nervous System (CNS) and/or Peripheral Nervous System (PNS).
  • It is a subjective experience involving specialized nerve endings called nociceptors.
  • Nociceptors are found in the skin, joints, connective tissues, muscles, and visceral organs.

Phases of Nociceptors

  1. Transduction Phase
    • Noxious stimulus (e.g., injury, burn, tumor) occurs in periphery.
    • Neurotransmitters carry pain impulse across nerve fibers.
  2. Transmission Phase
    • Pain impulses move from spinal cord to brain.
  3. Perception Phase
    • Conscious awareness of pain sensation.
  4. Modulation Phase
    • Inhibition of pain message via neurotransmitters (e.g., serotonin, norepinephrine).

Types of Pain

  • Nociceptive Pain
    • Predictable phases; limited to injury.
  • Neuropathic Pain
    • Abnormal impulses; difficult to assess.
    • Chronic conditions: diabetes, shingles, HIV, etc.

Sources and Types of Pain

  • Visceral Pain
    • Originates in internal organs.
    • Described as dull, deep, squeezing, or cramping.
  • Somatic Pain
    • Originates from muscles, bones, joints.
    • Described as aching or throbbing.
  • Cutaneous Pain
    • From skin or subcutaneous tissue.
    • Described as sharp or burning.
  • Referred Pain
    • Felt at a site different from origin.

Pain Duration

  • Acute Pain
    • Short-term; follows a predictable trajectory.
    • Examples: surgery, trauma.
  • Chronic Pain
    • Lasts 6+ months; can be persistent or intermittent.
    • Types: Malignant (e.g., tumor) and Non-malignant (e.g., arthritis).

Pain in Aging Adults

  • Pain is not a normal aging process.
  • Common conditions: osteoarthritis, osteoporosis, diabetic neuropathy.
  • Challenges in dementia: nonverbal cues important.

Subjective vs. Objective Data

  • Subjective Data: Patient's verbal communication (PQRST method).
  • Objective Data: Observations and vital signs.

Pain Assessment Tools

  • Numeric Pain Intensity Scale: Rates pain from 0 (no pain) to 10 (worst pain).
  • Faces Scale: Often used for pediatric patients.

Nonverbal Behaviors of Pain

  • Acute Pain Behaviors: Guarding, grimacing, vocalizations, restlessness.
  • Chronic Pain Behaviors: Minimal indication of pain, possible bracing, or rubbing.

Recommended Readings

  • Check Jarvis textbooks, page 169, Table 11.1 for PQRST.
  • Page 178, Table 11.3 for summary of different types of pain.

This concludes the summary of the lecture on pain assessment. Further discussions will occur in class and lab.

Full transcript