the basics of good pain control: understanding and assessment
DESCRIPTION
The Basics of Good Pain Control: Understanding and Assessment. Dr. Leah Steinberg. On Monday you go to work:. Meet Mr. Peters 52 yr old patient with lung cancer Holding his chest “It feels like I ’ m being squeezed and it is burning” “I can’t sleep…” His wife is crying at his side…. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/1.jpg)
The Basics of Good Pain Control: Understanding and Assessment
Dr. Leah Steinberg
![Page 2: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/2.jpg)
![Page 3: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/3.jpg)
On Monday you go to work:
• Meet Mr. Peters• 52 yr old patient with lung cancer• Holding his chest• “It feels like I’m being squeezed and
it is burning” • “I can’t sleep…”• His wife is crying at his side…
![Page 4: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/4.jpg)
Your Learning Objectives:
1. Appreciate the prevalence of pain in patients with advanced cancer and other medical illnesses;
2. Describe the basic mechanism of pain;3. Define the elements of a complete pain
assessment;
![Page 5: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/5.jpg)
How common are symptoms?
Pain 84%Fatigue 69%Weakness 66%Anorexia 65%
Dyspnea 50%Nausea 36%Delirium 21%
Walsh et al, Supportive Care Cancer 2006 N= 922 patients with advanced cancer
![Page 6: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/6.jpg)
What about non-malignant illness?Congestive Heart FailureEmphysema (COPD)ALSRenal failureAdvanced liver disease
• PAIN
• FATIGUE
• ANOREXIA
• DYSPNEA
![Page 7: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/7.jpg)
Objective 2: What is pain?
• An unpleasant sensation – a feeling• Created by stimulation of receptors
on nerve endings -- nociceptors
![Page 8: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/8.jpg)
![Page 9: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/9.jpg)
Mechanism of pain transmission:
• Cancer damages tissue
• Releases neurotransmitters
• Pain signal
• We now know:
• Cancer itself releases inflammatory mediators
• Inflammatory mediators trigger pain receptors
• Don’t always “see” damage on imaging; size doesn’t matter
![Page 10: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/10.jpg)
Types of pain simplified:
Nociceptive pain
Intact nervous system
Visceral - describe?
Somatic – describe?
Neuropathic pain
Damaged nervous system
Describe?If it sounds
weird…
![Page 11: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/11.jpg)
Back to Mr. Peters:
Sitting in front of you, looking for help…
What have we learned so far?
![Page 12: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/12.jpg)
We now know:
• Common• His disease is causing pain signals• But before we know what to do for
him, we need a good assessment
![Page 13: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/13.jpg)
Objective 3: How do we assess pain?• Thoughts?
![Page 14: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/14.jpg)
How do we assess pain?
Physical Domain+
Psychosocial Domain
TOTAL PAIN
![Page 15: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/15.jpg)
Physical Domain: find etiology
• Location of pain• Timing of pain• Nature (quality): ache, dull, burning, skin• Radiation of pain• Aggrevating/Relieving factors• Severity (use a pain rating scale)• Treatment so far and effect
![Page 16: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/16.jpg)
Past/current medical status
• May assist or complicate assessment:
Assist: Location of cancer: pain syndromes, neuropathic
Complicate: Delirium, dementia, infection, renal function, chronic pain
![Page 17: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/17.jpg)
Mr. Peters: Physical Domain
Now you can start asking some questions!
![Page 18: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/18.jpg)
Physical Domain: Another example• Mrs. C. presented with pain from locally
advanced breast cancer --• Her physical domain assessment:• Sharp, burning, chest wall pain• Started 4 days ago• Worse with movement of arm, dressings• Redness increased• PMH: LABC x 4 yrs, no other illnesses
![Page 19: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/19.jpg)
Mrs. C: What is her pain from?
• What is our going on in this case?
![Page 20: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/20.jpg)
How do we assess pain?
Physical Domain+
Psychosocial Domain
TOTAL PAIN
![Page 21: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/21.jpg)
Psychosocial Domain
• Understanding of disease• Fears, ideas, expectations• History of
depression/anxiety• Fears of opioid use• Family support/awareness• Cultural/religious factors
Affects how your patient perceives and expresses his pain
![Page 22: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/22.jpg)
Mr. Peters: Psychosocial domainNow you can ask more questions!
![Page 23: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/23.jpg)
Psychosocial Domain: Another example• 90 yr old female with bony metastatic
disease to manubrium (lung ca)• Clearly bone (somatic) pain• Clearly uncomfortable• Always said pain was acceptable, never
wanted pain medication – family quite upset
• Assessment revealed fear of sedation and confusion – therefore under expressed pain
![Page 24: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/24.jpg)
Why it is important? Or, how I understand TOTAL PAIN
NOCICEPTION
PERCEPTION
EXPRESSION
Pain receptors and neurotransmission; this is where opioids work
Thalamus and cortex
Psychosocial Domain
![Page 25: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/25.jpg)
Total Pain
• Our patients express pain• Opioids work and they work well• But, remember, it is EXPRESSION of
PAIN• If you are having trouble with
managing pain with opioids, think about the other inputs…
![Page 26: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/26.jpg)
Complete Assessment
• Physical understanding:– Gives you likely etiology and medical
complications
• Psychosocial understanding:– Gives you understanding of how your
treatments will likely work and what other components you need to add to have effect
![Page 27: The Basics of Good Pain Control: Understanding and Assessment](https://reader035.vdocument.in/reader035/viewer/2022062323/56816665550346895dd9f927/html5/thumbnails/27.jpg)
Summary
Prevalence of painMechanisms of pain First (and hardest) step in treatment:
A good pain assessmentOnce you have that, you know the
path to treatment