VON Durham Hospice Services
Monthly Palliative Care Education Newsletter
February 2022
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"How people die lives in the memories of those who live on"
- DAME CICELY SAUNDERS
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Pain Assessment and Tools
Written by Brenda Derdaele RN, CHPCN (C)
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Click red text for additional resources |
WHAT IS PAIN?
Pain is an unpleasant and emotional experience associated with the actual or potential tissue, or described in terms of such damage.
IASP; Canadian Pain Coalition
Pain is whatever the person says it is, exists whenever the person says it does.
McCaffery and Pasero
Pain is bio-psychosocial event.
Thai and Fainsinger
2012a).
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Dame Cicely Saunders coined the term ââtotal painââ and suggested that pain can be understood as having physical, psychological, social, emotional, and spiritual components.
The combination of these elements is believed to result in a ââtotal painââ experience that is individualized and specific to each patient's particular situation.
Understanding that people experience ââtotal painââ is critical for health care professionals. The physical, psychological, social, and spiritual dimensions/causes may contribute to the patient's pain experience. Without a complete and thorough assessment of these dimensions, an accurate picture of the patient's situation cannot be obtained.
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Nociceptive Pain - Arises from stimulation of pain receptors within tissue, which has been damaged or involved in an inflammatory process.
Nociceptive pain may be divided into:
a) Somatic pain - generally well-localized pain that results from the activation of peripheral nociceptors without injury to the peripheral nerve or central nervous system, characterized by sharp, hot or stinging pain which is usually localized to the area of injury.
b) Visceral pain - results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera. It is felt as a poorly localized aching or cramping sensation and is often referred to cutaneous sites.
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Neuropathic Pain - caused by a lesion or disease of the somatosensory nervous system. Neuropathic pain is divided into âperipheralâ (originating in the peripheral nervous system) and âcentralâ (originating in the brain or spinal cord). Neuropathic pain is often described as âburning, tingling, electrical, stabbing or pins and needlesâ
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Mixed Pain - produced by a combination of pathology that involves elements of both nociceptive pain and neuropathic pain.
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Click red text for additional resources
SCREENING
- Routinely screen all patients for pain.
- Pain terminology typically used by the patients to describe the pain such as the use of the word âacheâ, âhurtâ and/or âdiscomfortâ should be assessed and the term used in the ongoing assessment.
- Screening should occur at first contact and be repeated as indicated depending on the personâs condition, setting, care goals, etc.
- Pain assessment should be considered the 5th vital sign.
Remember..... Pain is subjective - "Pain is what the patient says it is".
Edmonton Symptom Assessment Scale
ESASr - is a valid and reliable symptom screening tool which can be used to identify a patientâs pain level on a scale from 0-10. In many patients the ESASr pain scores may suggest the following: 1-3 = Mild Pain, 4-6 = Moderate Pain, and 7-10 = Severe Pain. ESASr scores should not be considered in isolation.
ASSESSMENT
Adapted Pain Assessment Acronym: OPQURTSUV (adapted from Fraser Health)
Onset
- When did it begin? Is it new? How long does it last? How often does it occur?
Palliating/Provoking
- What/who brings it on? What/who makes it better? What/who makes it worse?
Quality
- What does it feel like? Can you describe?
Region/Radiation
- Where is it? Does it spread anywhere?
Severity
- What is the intensity of the pain? Right now? At best? At worst? On average?
Treatment
- What medications or treatments are you currently using? What medications have you tried in the past for this, and how did they work? Do you/did you have any side effects for the medications/treatments?
Understanding/Impact on you
- What do you believes is causing this symptom? How is this symptom affecting you/your level of functioning and/or your family?
Values
- What is your goal for this symptom? What is your comfort goal or acceptable level for this symptom? Are there any other views or feelings about this symptom that are important to you and your family?
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ADDITIONAL AREAS FOR ASSSESSMENT
- Physical assessment - looking for pain on palpation/movement, warm to touch, discoloration, deformity
- Medication review - pain medications, opioids, breakthrough doses, adjuvants
PALLIATIVE PERFORMANCE SCALE (PPS)
- assess functional status, assistance required with care, eating, mental status
- to assist with pain assessments in the severely cognitive impaired patient
- can be used if the patient is able to point at the face that best describes their pain and are cognitively able to understand the question being asked
- Assess for psychosocial or spiritual distress, coping deficits etc.
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REPORTING
Inform MRP of :
- Increased use of breakthrough doses - 3 BT over 24hr x 2-3 days or BT doses with little relief
- If need for SQ medications or pain pump - if patient at risk of loosing ability to swallow medications or oral medications are not controlling pain, pain crisis
REPORTING TOOL
- Assists with gathering information required to report to MRP
- Ability to be used as a communication tool for team members
- Contact MRP by telephone from patients home
DOCUMENTATION
RE-EVALUATION
- Follow up with patient within 24, 48 and 72 hours of starting new pain medication or changes in dose, to ensure medication is managing pain
- Assess for any other symptoms, such as nausea, drowsiness, constipation
- If patient is taking opioids, ensure bowel regime has been initiated
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- Provide education to patient and family
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Palliative Pain and Symptom Management Consultant (Durham Region)
Brenda Derdaele RN, CHPCN(C)
416-807-1403
Please contact for healthcare provider educational opportunities, through education sessions (in-person/virtual), guidance, coaching, mentorship and consultation.
Services are free of charge.
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References and Resources
(click links below)
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UPCOMING EDUCATIONAL OPPORTUNITIES
Feb. 9/2022 - Lunch and Learn
Symptom Management and Use of Symptom Response Kit
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Webinar Education Sessions Available
Understanding Palliative Emergencies - https://bit.ly/3rrLZiN
Pain Assessment and Tools - https://bit.ly/3oiuUWe
To receive Certificate of Completion please visit:
https://www.surveymonkey.com/r/PVRYXFJ
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Want more information regarding other Palliative Care topics? Just ask! |
Please help VON Durham Hospice Services support our Palliative Community, through Volunteer Support, Patient and Caregiver support groups, Hospice Nurse Navigation, Supportive Care Counselling, Grief and Bereavement one to one support and group support. Click below to access referral form. |
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