Huerta Exam 1: Pain Evaluation and Management

pain definition

unpleasant sensory or emotional experience associated with actual or potential tissue damage

is pain objective or subjective

subjective

even though pain is a subjective experience, we can

get an objective measurement of that subjective experience

pain is multifaceted, as such, what are some variables that affect our experience with pain?

Individual variables such as mood, attention, prior pain experiences, and familial and cultural factors are known to affect one's experience of pain

2 categories of pain

1) acute

2) chronic

typically caused by tissue irritation or damage due to injury, disease, disability or medical procedures

a) acute pain

b) chronic pain

acute

acute pain

Acute pain and its associated physiologic, psychological, and behavioral responses are typically caused by tissue irritation or damage related to injury, disease, disability, or medical or rehabilitative procedures

has a well defined onset

a) acute pain

b) chronic pain

acute

serves as a biological alarm system

a) acute pain

b) chronic pain

acute --> directs attention to damaged structures

usually responses to medication and tx of underlying cause

a) acute pain

b) chronic pain

acute

acute pain can develop into:

chronic pain

endures beyond post of identification of underlying pathological condition:

a) acute pain

b) chronic pain

chronic

- serves no purpose, no alarm

does not appear to serve a biological purpose (no alarm)

a) acute pain

b) chronic pain

chronic

chronic pain tends to produce changes in:

personality

lifestyle (sedentary vs active)

functional ability

mood (irritability)

examples of pain syndromes

1) low back pain syndrome

2) Complex regional pain syndrome (CRPS)

3) myofascial pain

4) fibromyalgia

5) cancer pain

6) disability related pain (cp, sci, ms)

The most common causes of LBP are

injury (eg, lifting) and stress, resulting in musculoskeletal and neurologic disorders (eg, muscle spasm and sciatica).

may also result from infections, degenerative diseases (eg, osteoarthritis), rheumatoid arthritis, spinal stenosis, tumors, and congenital disorders.

When in pain, clients may restrict occupational engagement due to:

a fear that the etiology of pain, the interventions, and the restricted social consequences can be harmful.

characterized as a continuous, severe burning pain that results from trauma, postsurgical inflammation, infection, or laceration to an extremity, causing a cycle of vasospasm and vasodilation

CRPS - complex regional pain syndrome

Complex Regional Pain Syndrome (CRPS)

• Continuous, severe, "burning" pain

• Out of proportion to severity of injury

• Sometimes referred to as "shoulder/hand syndrome"

OT treatment for CRPS

Occupational therapy (OT) treatment strives to normalize sensation, reduce edema, and increase mobility, strength, and endurance while decreasing guarding and restoring routine activities.

a large group of muscle disorders defined by the presence of trigger points (ie, localized areas of deep muscle tenderness)

myofacial pain

Myofascial pain is perceived as a continual dull ache often located in the

head, neck, shoulder, and low back areas.

Pressure on the trigger point elicits pain to a well-defined distal area

widespread musculoskeletal pain in the muscles, ligaments, and tendons.

fibromyalgia

Fibromyalgia

generalized body pain

cancer pain may result from

tumor progression

interventions (eg, surgery, chemotherapy, and radiation)

infection, or muscle aches when clients decrease their activity

when evaluating pain, what should we identify?

1) factors that contribute to pain and aggravate it (time of day, movements, positions)

2) occupational role dysfunction

3) decreased occupational performance

4) diminished quality of life (mood, emotions, physical well-being, participation in life)

Referral for an OT evaluation is made when

pain interferes with the client's occupational performance.

the evaluation of pain consists of assessing:

◻ Pain onset

◻ Location(s)

◻ Frequency

◻ Intensity

◻ Duration

◻ Exacerbating factors

◻ Relieving factors

how do we measure pain intensity?

numerical rating scale (NRS)

or

visual analog scale (VAS)

most frequent scale used

NRS

Numerical Rating Scale (NRS)

a pain scale in which a pt rates their pain on a line scale from 0 to 10

1-4 = minimal impact

5-6 = moderate impact

7-10 = severe impact

visual analog scale

◻ 0 - 10 scale presented with descriptors

◻ Sometimes presented with "emoticons"

◻ Clients tend to prefer NRS, but useful for:

----Difficulty with abstract quantification of pain

---Pediatric clients

pediatric clients tend to prefer what pain scale?

VAS

the elder population tend to prefer what pain scale?

VAS

overall, clients tend to prefer what scale?

NRS over VAS

observable pain behaviors include:

◻ "Guarding"

◻ Bracing

◻ Posturing

◻ Limping

◻ Rubbing

◻ Facial grimacing

what scale is an example of a standardized rating scale that is a reliable, valid, and easy method for documenting observable behaviors?

The University of Alabama Pain Behavior Scale

pain intervention:

1) medication management

2) activity tolerance (graded)

3) body mechanics and postural training

4) energy conservation, pacing and joint protection

5) splinting

6) AE

7) relaxation

8) PAMS

PAMs for pain

-cold packs

-estim