pain as 5 th vs

Powerpoint Templates


PAIN AS 5 TH VITAL SIGN

DR LEE OI WAH

PENGARAH HCM

http://www.powerpointstyles.com/



The purpose of module is to train doctors and

nurses on pain assessment and pain

management in order to implement pain as a

5th vital sign effectively in OUR hospital

OBJECTIVE:

5th Vital Sign: Doctors’ training module: Intruduction



• All types of pain in all parts of the world are inadequately

treated, be it acute or chronic, related to malignant or

non-malignant etiologies.

• Pain can be relieved in up to 90% of cancer patients, yet

fewer than 50% receive adequate treatment

• National APS audit, Malaysia showed that 76% of post-

laparotomy patients suffered moderate to severe pain in the

1st 24 hours

• What about patients in the medical wards or patients who

have not had surgery?




• New standards in 2001

• Record pain as the 5th vital sign

Joint Commission on Accreditation of Healthcare Organizations. Jt Comm Perspect. 1999;19(5):6–8. Sklar DP. Ann Emerg Med. 1996;27:412–413.




• Pain should be considered

the “fifth vital sign”

• Patients should be assessed

for pain every time pulse,

blood pressure, temperature,

and respiration are measured

American Pain Society Quality Improvement Committee. JAMA. 1995;1847–1880. 5th Vital Sign: Doctors’ training module: Intruduction



• Promote doctor-patient and nurse-patient

interaction

– Better communication

– Better patient satisfaction

• Provide better patient care

– Individualised carer

– Priority to pain assessment

– Better awareness of pain

better management of pain

early ambulation

faster recovery, reduced length of stay




Definition of pain

“An unpleasant sensory and emotional

experience associated with actual or

potential tissue damage, or described in

terms of such damage.”

Merskey,1964

International Association for

the Study of Pain (IASP)

5th Vital Sign: Doctors’ training module: Pain Physiology



Spectrum of Pain

ACUTE

PAIN

CHRONIC

PAIN

ACUTE

PAIN

Healing

NO PAIN

CHRONIC

PAIN

Insidious onset

post-surgical syndromes /

cancer

5th Vital Sign: Doctors’ training module: Pain Physiology Courtesy of Prof Ramani Vijayan, MASP



Pain Pathway

(Anatomy)

Free nerve endings

Afferent nerve – ( A / c)

Spinal cord

Sensory cortex

Thalamus

Descending

inhibitory

fibres

Dorsal horn

PAG / RAS

Ascending ST

tracts

Courtesy of Prof Ramani Vijayan, MASP 5th Vital Sign: Doctors’ training module: Pain Physiology

PAIN



TYPES OF PAIN

Physiological

Pathological or clinical


Powerpoint Templates Page 14

EFFECTS OF SEVERE

UNRELIEVED PAIN

Physiological

Psychological

Economic



PHYSIOLOGICAL EFFECTS OF PAIN

No System Effects

1. CNS ↑ sympathetic activity,

hyperalgesia,chronic pain

2. Endocrine ↑ stress hormone, catabolic

state,hyperglycaemia,

immunesupression

3. CVS ↑HR,↑BP, myocardial ischaemia

4. Respiratory Inability of cough and deep breath, lung

collapse and lung infection

5. GIT ↓parasympathetic activity, ileus, nausea

and vomitting

6. Genitourinary Urinary retention

7. Muskuloskeletal Delayed ambulation, DVT



Anxiety

Agitation

poor sleep

uncooperative patient

depression

PSYCHOLOGICAL EFFECTS OF

PAIN




ECONOMIC EFFECTS OF

PAIN

Delayed ambulation and feeding

Increased postoperative complications

Delayed recovery

Prolonged hospital stay

Increased cost




Conclusion

• Acute pain should be aggressively treated

for the following reasons:

– Patient comfort

– Prevent adverse physiological and

psychological consequences of unrelieved

pain

– Reduce risk of developing chronic pain




FACTORS AFFECTING PAIN

• Perception of Pain

• Socio Cultural Factors

• Age

• Gender

• Meaning of Pain

• Anxiety

• Past experience with Pain



Physician Barriers to Mgmt

• Inadequate knowledge of pain

management

• Poor assessment of pain

• Concern about regulation of controlled

substances

• Fear of patient addiction or misuse

• Concern about side effects, tolerance


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Patient Barriers to Mgmt.

– Older adults often expect pain with age

– Use other words than “pain’ (aching, hurting,

throbbing, “a misery”)

– Fear need for diagnostic tests or medications

that have side effects

– For some, pain is a metaphor for serious

disease or death

– For others, pain and suffering represent

atonement for past actions




Barriers in LTC setting

• Different response (may not show typical sx)

• Cognitive and communication barriers

• Cultural and social barriers

• Co-existing illnesses and multiple meds

• Staff training and access to appropriate tools

• Practitioner limitations

• System barriers



pain as 5 th vs

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