Pain

Question 1

Types of pain

Answer 1

Nociceptive pain: caused by injury or inflammation
- processes: transduction, transmission, perception, modulation
- generally reversible through analgesics and opioids
- ex. fractures, burns, tumours, obstructions

Neuropathic pain: caused by injury or malfunction within the CNS or PNS
- can occur without immediate tissue damage or inflammation
- associated with disease process (diabetic neuropathy, inflammation around nerves
- does not respond to analgesics or opioids

Question 2

Definition of pain

Answer 2

• biopsychosocial phenomenon with multiple dimensions, including sensory, cognitive, emotional, developmental, behavioural, spiritual and cultural influences
• 5th vital sign
• always subjective

Question 3

Pain assessment for non-verbal patients and those with dementia

Answer 3

• basic needs assessment (sensory aids, alleviating discomfort,
• ADD protocol
• universal pain assessment (‘Faces’ scale)
• PAINAD

Question 4

Regular pain assessment

Answer 4

• rating pain systematically: 0-10 scale
• comprehensive pain assessment tools (body mapping of pain, pain diary, interview with patient and family)
• LOTTAARRPP
• QOL indicators
• ADL and activity level indicators

Question 5

Non-pharmacologic options

Question 6

What is the ADD protocol?

Answer 6

Assessment of Discomfort in Dementia
- rubbing or holding a body part
- grimacing
- restless body movements
- moaning
- tense muscles
- agitation
- combativeness and anger
- crying
- sleeplessness
- decreased appetite
- exiting behavior and withdrawal
- changes in respiration

Question 6

What is the ADD protocol?

Answer 6

Assessment of Discomfort in Dementia
- rubbing or holding a body part
- grimacing
- restless body movements
- moaning
- tense muscles
- agitation
- combativeness and anger
- crying
- sleeplessness
- decreased appetite
- exiting behavior and withdrawal
- changes in respiration

Question 7

What is PAINAD?

Answer 7

Pain Assessment in Advanced Dementia Scale
- breathing
- negative vocalization
- facial expressions
- body language
- consolability

Question 8

Non-pharmacological interventions

Answer 8

• pain clinics
• music therapy
• pet therapy
• biofeedback

Question 8

Non-pharmacological interventions

Answer 8

• pain clinics
• music therapy
• pet therapy
• biofeedback
• TENS (transcutaneous nerve stimulation, usually by PT)
• Body movement therapy
• reposition
• games and visits
• gardening
• favourite foods
• therapeutic touch
• counselling
• art therapy
• prayer and meditation
• swimming
• stretching
• heat or icing
• herbal formulations
• acupuncture