Assessment
Assessment of chronic pain first begins with understanding what chronic pain is. Chronic pain is any pain with or without obvious injury that lasts longer than the expected healing period. Like many chronic diseases, it has periods of remission, an absence of symptoms, and exacerbation, an increase in the severity of the symptoms. A recent study suggested that chronic pain affects about 80% of elders in nursing homes. (Pateinakis, 2013) Proper treatment of chronic pain begins with gathering subjective and objective data about the client’s pain. Before meeting with the client determine rather or not the client is capable of communicating about his or her pain. If the client is aphasic or severely demented, it may be necessary to ask family members and/or caregivers to be present during the interview to help answer questions. Even if the patient is able to communicate effectively, they may be more comfortable with loved ones nearby. Review any comorbidities that may be affecting the pain or even causing the pain. Also, note all medications the client is currently taking including herbal supplements and over the counter drugs, to prevent polypharmacy or even identify polypharmacy that is occurring already.
Next, begin a focused interview. COLDSPA can be used effectively to gather all the specific information about the pain itself. Character is the description of the sign or symptom. Onset is when it began. Location is where is it and if it is localized pain or
Chronic pain is often defined as pain lasting more than 12 weeks. It may arise from initial injury, such as a back sprain, or there may be an ongoing issue such as illness. The assignment given consisted of finding a person who suffers from chronic pain to explore the ideas of illness classification, the experience of pain and explanatory models. The interview process was executed on September 17, 2016 via face time lasting approximately 45 minutes in length. She gave me her oral consent for this interview. I explained that this information would be used for a chronic pain paper. (American Chronic Pain Association) The subject is a 53 year old, Caucasian, upper middle class female currently in treatment for melanoma cancer. Currently, no disease
No evidence exists to suggest that older individuals perceive pain to a lesser degree or that sensitivity is diminished. Although pain is a common experience among individuals 65 years of age and older, it is not a normal process of aging. Pain indicates pathology or injury. Pain should never be considered something to tolerate or accept in one's later years.
When pain lasts three to six months or more, it is considered chronic pain. According to the American Geriatrics Association, more than 50 percent of seniors living at home and up to 80 percent of those in care facilities suffer from chronic pain. As a result, a great number of these seniors are not able to function properly during the day or sleep well at night. Some of the most frequent causes of chronic pain in seniors are arthritis, glaucoma, poor circulation, and nerve damage.
According to The World Health Organisation (1999), defined pain as an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain is traditionally described as acute or chronic pain. The prevalence of chronic pain (CP) is higher than of acute of pain, as it affects 7.8 million people of all ages in the UK (Chronic Pain Policy Coalition., 2006). The current leading cause of mortality that is accounting for 60% of all deaths is due to chronic diseases and is also a problem as causes an increasing burden on the health care service (World Health Organisation., 2007). CP can affect a person’s quality of life if managed poorly, statistics shows that 25% of people lose their job and 22% leads to depression. (Chronic Pain Policy Coalition.,
Assessing pain is a very important first step. Having the correct assessment techniques and tools is very important to diagnosing and treating the pain. Acute pain is typically a symptom of something else, so correct assessment will lead the care provider to the underlying issue, D’Amico and Barbarito (2016) identify many tools used for the assessment of pain, discussed later in the paper. Treatment of acute pain should be handled differently than other types of pain due to acute pain being a short-term process of healing. The
The proper way to ensure that this is not a constant problem is to make sure that initial pain assessments as well as re-assessments are done in a timely manner. It seems as though the initial pain assessment was completed using the pain scale but the re-assessment was not complete and documented in the proper amount of time. In order to ensure proper documentation of the re-assessment once the first pain assessment has been completed and an intervention has properly been administered, the first action step will be to make sure that the reassessment is complete within one hour of pain intervention. With electronic mars it is easy to build in a recheck into the system to alert the nurse that a reassessment is needed once the pain medication has been administered to the patient. When a pain intervention is done, a flag will come up to remind the nurse taking care of the patient that a reassessment is due. This will also resolve the issue on the tracer audit of how does the nurse know the intervention worked. Another issue on the audit was if no pain intervention was done what was the reason for it not being done.
Pain is a complex and multidimensional phenomenon that is subjective and unique to each individual. Pain is difficult to describe and often hard to measure; however, most healthcare professionals agree that pain is whatever the patient describes it to be. Pain is one of the most frequently used nursing diagnosis and is the most common problem for which patients in the clinical setting seek help (Cheng, Foster, & Huang, 2003). Unrelieved pain can have a profound impact on the lives of both the patient and his or her family members. The subjective nature of pain makes pain difficult to assess; therefore, many patients do not receive adequate relief. The Joint Commission on Accreditation of Healthcare Organizations
People with advanced dementia are unable to communicate pain levels and the Pain assessment in Advanced Dementia (PAINAD) scale can assist in determining pain levels in individuals with cognitive impairment.
In conclusion it can be seen that early and regular pain assessment on par with other vital parameters along with appropriate treatment by all healthcare providers will lead to improved patient outcomes and satisfaction. This can be achieved by education, use of departmental guidelines and protocols,regular audit of practice and feedback to the professional involved.
Chronic pain describes pain that persists over long periods of time. It handicaps the normal lifestyle and quality of one’s life (http://www.asri.edu/neuro/brochure/pain1.htm).
panel on pain assessment in older persons,13 have corroborated these conclusions.14 In particular, these authors highlight the need for more evaluation of observational pain measures, including validation against the criterion standard of self-report in intact and impaired populations. Almost all research on measuring pain in persons with dementia has focused exclusively on
He also recommended at some point when her physical therapist feels she is ready to join the adapted therapeutic yoga program that meets weekly. They have found that yoga, mindful breathing along with a Tia Chi program help with pain control. Ms. Bambricks private health insurance has given approval for an extended number of physical therapy session so that is decreasing her stress and worry regarding that. Her being able to attend physical therapy consistently has helped to improve the range of motion of her cervical spine and upper body strength. She continues to use a walker for the right drop foot and the left ankle weakness. The numbness she has to the left side of her body continues, along with the right wrist pain and weakness. The attendant care and transportation services have made a great impact on her attendance to her therapy and medical appointments. Our next appointment will be with Neurologist Dr. Hakim on 5/24/18. We will address the coldness to her hand and foot along with the numbness in her
“Chronic pain is even worse to live with than lung, cardiac or liver disease. Bad chronic pain is connected with the worst quality of life. People don’t realize that it is a disease on its own, not just a symptom.” (qtd in MacCallum par 1) Chronic pain is pain that lasts for longer than six months. It can affect different parts of your body and nervous system. (Blahd par. 1) Sometimes the pain is so severe that it is debilitating. That is where pain medication comes into play.
‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage’ (International association for the study of pain 2014). Pain can be made up of complex and subjective experiences. The experience of pain is highly personal and private, and can not be directly observed or measured from one person to the next (Mac Lellan 2006). According to the agency for health care policy and research 1992, an individuals self-report of pain is the most reliable indicator of its presence. This is also supported by Mc Caffery’s definition in 1972, when he said ‘Pain is whatever the experiencing patient says it is, existing whenever he says it does’.
Chronic pain is defined as a pain that doesn’t go away for a long time. The pain can last for weeks, more than 3 months, years, and might make someone feel hopeless. Chronic pain does not relief with regular pain medication. It is important to address chronic pain because is physically and psychologically stressful. Its persistent discomfort can lead to irritation and frustration with the person’s self and with other people. Pain affects not only mental health but interfere also with someone’s sleep pattern.