Pain in Gerontology
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Chapter13Pain.pptxGerontologic nursing
Chapter 13: Pain
Pain
When all body systems are working together well pain should not be felt
Pain is the fifth vital sign
Pain is under recognized, highly prevalent and undertreated in older adults
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage the
Whatever the experiencing person says it is, existing whenever they say it does
Highly subjective personal experience
Pain
Many different causes and kinds of pain
Can be caused by
Injury
Illness
Sickness
Disease
Surgery
Pain
Conditions often associated with pain in elders:
Degenerative joint disease
Rheumatoid arthritis
Fibromyalgia
Post stroke syndromes
Low back disorders
Peripheral vascular disease
Amputations
Headaches
Pressure ulcers
Contractures
Pain
Untreated pain can become an intolerable burden and may lead to depression, decreased socialization & functional abilities & insomnia
Pain
Acute
Rapid onset
Relatively short duration
Sign of a new health problem requiring diagnosis and analgesia
Chronic
Persistent pain
continues after healing
Not amenable to a cure
Pain
Box 13.1 on page 214: Pathophysiologic Classification of Chronic Pain
Nociceptive (bone pain, dull, aching)
Visceral (cramping, squeezing) or somatic
Tissue inflammation
Mechanical deformation
Ongoing injury
Neuropathic (sharp, burning)
Pathophysiologic process involving the peripheral or central nervous system
Do not respond to analgesic therapy
Pain
Stereotyping older persons as having less pain because of their age contributes to less frequent pain assessment and less appropriate and effective treatment
Older adults commonly report less pain because:
Do not want to be complainers
Fear having to undergo more test and medical treatment
Fear losing their independence
Pain
Consequences of persistent pain are numerous
Depression
Anxiety
Decreased socialization
Sleep disturbance
Decreased or impaired ambulation, gait disturbance
Falls
Prolonged recovery periods
Increased health care use and cost
Incontinence
Constipation
Pain
Goals for pain management
Listening to the older adult and paying close attention
Relief from pain
Control of chronic disease conditions causing pain
Maintenance of mobility and functional status
Promotion of self care and maximum independence
Improved quality of life
Barriers to Effective Pain Management in Older Adults
Underreporting of pain
Inadequate access to diagnostic services
Nurse’s lack of knowledge regarding adequate pain assessment techniques
Barriers to Effective Pain Management in Older Adults
Fear of addiction
Unable to report feelings of pain due to cognitive or sensory impairment
Concerns regarding side effects of medications
Acknowledging pain will lead to a loss of independence
Pain is a punishment for past actions
Religious or cultural beliefs
Pain
Table 13.1 on page 217
Pain assessment in advanced demenias (PAINAD)
PAINAD
Breathing
Negative vocalization
Facial expression
Body language
Consolability
Pain
O = onset
L = location (there may be multiple sites)
D = duration (how long does the pain last, constant, intermittent)
C = characteristics (neuropathic (sharp, shooting, burning), nociceptive (bone pain, dull, aching), visceral (cramping, squeezing))
A = aggravating factors (moving, walking, sitting, turning, chewing, breathing)
R = relieving factors (what makes the pain better, worse)
T = treatment (medications, non-pharmacological interventions, cold, heat, massage, distraction)
Pain
Pain
Family member or caregiver can report recent changes that may indicate pain
6 main types of pain behaviors and indicators
Facial expression (frowning, frightened face & grimacing)
Verbalization/vocalization (sighing, chanting, groaning, crying & moaning)
Body movements (tense posture, bracing, rubbing, rocking, pacing & guarding)
Changes in interpersonal interactions (aggressiveness & combativeness or withdrawal)
Changes in activity patterns or routines (appetite & sleep changes)
Mental status changes (crying & increased confusion)
Pain Interview Questions
Pain history
Distinguish acute from chronic pain
Location
Frequency
Intensity
Alleviating & aggravating factors
Associated symptoms
Response to previous & current analgesic therapy
Meaning of pain
Pain medication ordered or given to you
Words to Describe Pain
| Aching Dull Sharp Bloating Numbing Shooting Burning Pressure Soreness Pressing | Cramping Stabbing Comes and goes Pulling Throbbing Constant Radiating Tightness Cutting Searing |
Pain Assessment
Begins when the nurse accepts the person’s report of pain and takes that report seriously
Assessment
Medical history (thorough)
Physical exam
Pain history
Daily pain diary (Figure 13 – 2 on page 221)
History of trauma
Medication history
Previous pain experience
Lab values
Pain Assessment
Table 13.2 on page 218
Assessment of pain in older adults
Box 13.2 on page 219
Self assessment questions to help nurses determine their cultural normal concerning pain
Box 13.3 on page 219
Explanatory model interview for pain assessment
Pain Assessment
Assist health care professionals in objectively and accurately measuring a patient’s report of pain and any relief or change in that pain
Pain is not an isolated phenomenon
It is an experience that influences all dimensions of an individual’s quality of life
Pain assessment of older adults also includes an evaluation for depression
Non-opioid Analgesics
Analgesics are used as a first line approach to pain management
Examples:
Acetaminophen (Tylenol)
Mild to moderate musculoskeletal pain
Ibuprofen (Motrin, Advil)
Mild to moderate arthritic pain and other inflammatory disorders
Naproxen (Naprosyn, Aleve)
Block pain by inhibiting pain reception at the local level
Pain Assessment
As the administrators of drugs, nurses paly a major role in ensuring that older adults have their pain treated in a safe, effective and efficient way
Nurse’s must be knowledgeable about the physiologic changes of aging that may alter drug absorption, metabolism and excretion in the older adult
Nonopioid Analgesics
Acetaminophen
Ibuprofen
Naproxen
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for treating mild to moderate arthritic pain and other inflammatory disorders
Opioid Analgesics
Prescribed for patients with mild to moderate pain that is poorly tolerated or cannot be adequately managed with a non-opioid analgesic
Start low and go slow
Table 13.4 on page 225
Opioids to avoid in pain management of older adults
Moderate to severe pain may be relieved with:
Hydrocodone
Oxycodone
Hydromorphone
Methadone
Fentanyl
Side Effects
Common side effects of opioids
Nausea
Vomiting
Constipation
Urinary retention
Older adults are more sensitive to sedation and respiratory depression
Adjuvant Medications
Medications without intrinsic analgesic properties are helpful in treating certain types of chronic pain
Adjuvant medications include:
Anticonvulsants
Gabapentin (Neurontin)
Antidepressants
Some sedatives
Complementary & Alternative Medicine
Fall into two subgroups
Natural products
Herbal and botanicals
Vitamins and minerals
Mind and body practices
Acupuncture
Massage therapy
Meditation
Movement therapies
Relaxation techniques
T’ai Chi
Yoga
Complementary & Alternative Medicine
Heat and cold
Visualization or imagery
Vivid picture in one’s mind
Progressive relaxation
Distraction
Music therapy, pet therapy, puzzles, movies, laughter
Exercise
Peripheral nerve stimulation
TENS
Acupuncture
Hypnosis
Education
Planning pain relief
