Pain assessment

The Patient Receiving a Narcotic Analgesicfor Pain ASSESSMENT... 

Pain is the most common symptom prompting patients to seek medical attention and is reported by more than 80% of individuals who visit their primary care provider.1 Despite the frequency of pain symptoms, individuals often do not obtain satisfactory relief of pain. This has led to recent initiatives in health care to make pain the fifth vital sign, thus making pain assessment equally important as obtaining a patient s temperature, pulse, blood pressure, and respiratory rate. 

Pain, particularly acute pain, may be accompanied by physiologic signs and symptoms, and there are no reliable objective markers for pain. Many tools have been designed for assessing the severity of pain including rating scales and multidimensional pain assessment tools. 

Multidimensional assessment tools obtain information about the pain and impact on quality of life, but are often more time-consuming to complete. Examples of these types of tools include the Initial Pain Assessment Tool, Brief Pain Inventory, McGill Pain Questionnaire, the Neuropathic Pain Scale, and the Oswestry Disability Index.29-33... 

Children Pain interviews may be conducted with children as young as 3 or 4 years of age however, communication may be limited by vocabulary.34 Terms familiar to children such as hurt, owie, or boo boo may be used to describe pain. The VAS is best used with children older than 7 years of age. Other scales based on numbers of objects (e.g., poker chips), increasing color intensity, or faces of pain may be helpful for children between 4 and 7 years of age. In children younger than 3 to 4 years of age, behavioral or physiologic measures, such as pulse or respiratory rate, may be more appropriate. Pain assessment in newborns and infants relies on behavioral observation for such clues as vocalizations (crying and fussing), facial expressions,... 

Pain assessment Patient rates pain as 8 on a scale of 1 to 10. 

Joint Commission on Accreditation of Healthcare Organizations. Pain Assessment and Management an Organizational Approach. Oakbrook Terrace, IL JCAHO,2000 1-6. 

Improved pain control using detailed pain assessment every 2 to 4 hours during initial titration and then daily thereafter... 

With chronic pain, monitoring tools such as the Brief Pain Inventory, Initial Pain Assessment Inventory, or McGill Pain Questionnaire may be useful. Quality of life must also be assessed on a regular basis in all patients. 

Scott CS, Riggs KW, Ling EW, Fitzgerald CE, Hill ML, Grunau RV et al. Morphine pharmacokinetics and pain assessment in premature newborns. J Pediatr 1999 135(4) 423-9. 

Pain assessment in children and adolescents is a subject unto itself, and one that any clinician working with a child in pain must be familiar with (Franck et ah, 2000). Treatment of pain in children and adolescents must include cognitive-behavioral interventions such as preparation and rehearsal, hypnosis, guided imagery, breathing exercises, muscle relaxation, and distraction consideration of other complementary interventions such as acupuncture or biofeedback is common (Powers, 1999 Chen et ah, 2000 Rusy and Weisman, 2000). 

Franck, L.S., Greenberg, C.S., and Stevens, B. (2000) Pain assessment in infants and children. Pediatr Clin North Am 47 487-512. 

Pain severity assessment Pain assessment on admission Pain reassessment after analgesic dose... 

Perform an integumentary assessment, including a burn assessment Perform a pain assessment Perform a trauma assessment from head to toe Perform a mental status assessment, including a Glasgow Coma Scale... 

The Joint Commission on Accreditation of Healthcare Organizations requires that all patients receive a pain assessment and appropriate pain-relief measures. Various pain scales are available to measure pain in preverbal and verbal children nurses should administer... 

The choice of pain assessment scale will depend on the environment in which pain will be assessed, the patient s ability to comprehend the scale, and how detailed the assessment needs to be. Most pharmacists will find a simple verbal scale of 0 to 10, with 0 = no pain and 10 = worst pain imaginable useful. 

A component of the new JCAHO standard is documentation of pain assessment and intensity in all patients. In addition, the interventions that are performed based on the pain assessment, such as administration of a pain medication, need to be documented along with the reassessment of the effect of these interventions. Pharmacists can play a key role in developing standardized assessment forms that include recommendations for pain medications based on the results. 

Pharmacists should be involved in all steps of pain management. This includes the initial development of pain management policies and procedures development of standardized pain assessment and documentation forms development of standardized treatment orders, including recommendations to manage adverse effects education of staff on the implementation of the new pain management standards and quality assurance efforts to evaluate the policies and procedures. 

Patients should be evaluated in a refined way. Tools like TNSc are to be applied. Population should be clearly stratified at baseline for preexisting and/or coexistent risk factors for neuropathy development. Precise actual cumulative dose data should be analysed. Sample size should consider the real amount of patients that have developed neurological signs/ symptoms. Moreover, patient reported outcome measures (PRO) and pain assessment should be considered. 

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