Pain Assessment:

The Fifth Vital Sign

Chapter 10

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 10: Pain Assessment: The Fifth Vital Sign

Structure and Function

Neuroanatomic pathway

Nociception

Neuropathic pain

Sources of pain

Types of pain

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Neuroanatomic Pathway

Nociceptors

Interneurons

Anterolateral spinothalamic tract

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Neuroanatomic Pathway (cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Nociception

Transduction

Transmission

Perception

Modulation

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 10-5

Chapter 10: Pain Assessment: The Fifth Vital Sign

Nociception (cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 10-6

Chapter 10: Pain Assessment: The Fifth Vital Sign

Neuropathic Pain

Abnormal processing of pain message

Most difficult type of pain to assess and treat

Neurochemical level

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Sources of Pain

Visceral pain

Deep somatic pain

Cutaneous pain

Referred pain

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Common Sites for Referred Pain

Pat Thomas, 2006.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Types of Pain

Acute pain

Short term

Self-limiting

Follows a predictable trajectory

Dissipates after injury heals

Chronic pain

Continues for 6 months or longer

Types are malignant (cancer related) and

nonmalignant

Does not stop when injury heals

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Subjective DataHealth History

Pain assessment questions

Pain assessment tools

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Pain Assessment Questions

Questions to ask:

How does pain limit

your function/activities?

How do you behave

when you are in pain?
How would others
know you are in pain?

How much pain do you

have now?

What makes the pain

better or worse?

What does pain mean

to you?

Why do you think you

are having pain?

Where is your pain?

When did your pain

start?

What does your pain

feel like?

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 10-12

Chapter 10: Pain Assessment: The Fifth Vital Sign

Pain Assessment Tools

Initial pain assessment

Brief pain inventory

Pain rating scales

Numeric rating scales

Descriptor scale

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 10-13

Chapter 10: Pain Assessment: The Fifth Vital Sign

Initial Pain Assessment

From McCaffery M, Pasero C:

Pain: Clinical manual, ed 2, St.
Louis, 1999, Mosby.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 10-14

Chapter 10: Pain Assessment: The Fifth Vital Sign

Brief Pain Inventory

From McCaffery M, Pasero C:

Pain: Clinical manual, ed 2, St.
Louis, 1999, Mosby.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Objective DataPhysical Exam

Jointsnote

Size/contour/circumference

AROM/PROM

Muscles/skininspect

Color/swelling

Masses/deformity

Sensation changes

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Objective DataPhysical Exam

(cont.)

Abdomeninspect and palpate

Contour/symmetry

Guarding/organ size

Pain behaviorinspect

Nonverbal cues

Acute pain behavior

Chronic pain behavior

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Acute Pain Behaviors

Guarding

Grimacing

Vocalizations such as moaning

Agitation, restlessness

Stillness

Diaphoresis

Change in vital signs

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Chronic Pain Behaviors

Bracing
Rubbing
Diminished activity
Sighing
Change in appetite
Being with other people
Movement
Exercise
Prayer
Sleeping
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Sample Charting

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Abnormal Findings

Reflexive sympathetic dystrophy

Follows trauma to the nerve

Most commonly appears in 40- to 60-year-old men

and women

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

Which type of pain would cholecystitis

(gallbladder disease) cause?
A.

Somatic

B.

Visceral

C.

Cutaneous

D.

Chronic

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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Chapter 10: Pain Assessment: The Fifth Vital Sign

What anticipated finding regarding

patients with chronic pain should guide
a nurses care planning?
A.

B.

C.
D.

Patients with chronic pain have trouble

sleeping.
Patients with chronic pain show elevated blood
pressures.
Patients with chronic pain need less medication.
Patients with chronic pain may show few or no
outward signs of pain.

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

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