Pain is defined as an unpleasant sensory or emotional experience associated with tissue damage.
To successfully relieve pain, accurate, continuous pain assessment and reassessment is necessary.
Percentage of patients in various stages of palliative care that have ineffectively treated pain
- 25% of newly diagnosed cancer patients
- 60% of patients undergoing cancer treatments
- 75% of patients in end stage disease
- tissue damage
- a disease process of short duration
- a surgical procedure
- Chronic malignant
- Chronic non-malignant
- sympathetically maintained
- may be related to primary or metastasis in 2/3 of patients
- may be resulting from treatment: surgery, chemo, radiation, procedures or causes such as side effects or infection
- Chronic pain may accompany a disease process such as HIV, arthritis, degenerative joint disease, osteoporosis, COPD, heart failure, neurological disorders (MS), fibromyalgia, CF, diabetes.
- a detailed history
- an assessment of pain intensity
- characteristics of the pain
- the effects of pain on function
- a history of previous substance abuse
- a physical examination with pertinent neurological examination – particularly if nerve pain is suspected
- a psychosocial and cultural work-up as they may pertain to the pain
- ATTN: Special attention should be paid to discrepancies between patients’ verbal description of pain and their behavior and appearance. (this may reveal emotional components or drug seeking behaviors)
- Focus of the assessment should be to areas of pain as well as areas of referred pain
- In the frail or terminal patient assessments should be performed only if the findings will potentially change or facilitate the treatment plan.
- The burden or discomfort of any diagnostic test must be weighed against the potential benefit of the information obtained
- ongoing and subsequent evaluations are necessary to determine the effectiveness of pain management and identify new areas of pain.