Instruments for evaluating pain SOCRATES
● Hyperalgesia (amplified pain response to stimulation that would normally evoke only mild pain). ● Pain insensitivity, which is also known as congenital analgesia and is one or more rare conditions in which a person cannot feel (and has never felt) physical pain. ● A sensory examination that could include response to light touch, light pressure, pinpricks, cold, or vibrations. (Clark & Galati, 2015) PQRST P What provokes symptoms? What improves or worsens the condition? What were you doing when it started? Do position changes or activities make it worse? Q Quality and Quantity of symptoms: Is it dull, sharp, constant, intermittent, throbbing, pulsating, aching, tearing, or stabbing? R Radiation or Region of symptoms: Does the pain travel, or is it only in one location? Has it always been in the same area, or did it start somewhere else? S Severity of symptoms or rating on a pain scale. Does it affect activities of daily living, such as walking, sitting, eating, or sleeping? T Time or how long have they had the symptoms? Is it worse after eating, changes in weather, or time of day? Other tools, such as the Brief Pain Inventory form, provide an assessment of pain and gauge treatment (AAFP, 2021).
It is critical to gain as much information as possible about the specific complaint of pain to properly determine a course of treatment. The SOCRATES acronym is a useful tool that can be used to remember key points to be collected when assessing a complaint of pain: ● S ite: Where exactly is the pain? ● O nset: When did it start? Was it constant/intermittent? Was it gradual/sudden? ● C haracter: What is the pain like? Sharp? Burning? Tight? ● R adiation: Does the pain radiate/move anywhere? ● A ssociations: Is there anything else associated with the pain, such as sweating or vomiting? ● T ime course: Does it follow any time pattern? How long does it last? ● E xacerbating/relieving factors: Does anything make it better or worse? ● S everity: How severe is the pain? Consider using a 1–10 scale. (Swift, 2019) The physical examination conducted as part of the initial patient screening contains all the elements common to contemporary practice. A few areas should be emphasized because of the unique nature of opioid prescriptions (Clark & Galati, 2015). Here are topics to consider: ● A rigorous evaluation of the patient’s nervous system. ● An assessment of allodynia (pain from the stimulation that would not normally evoke pain, such as light touch).
OPIOIDS FOR CHRONIC NONCANCER PAIN IN ADULTS
An estimated 100 million adults in the United States are affected by chronic pain and are commonly diagnosed with chronic low back pain, joint pain/arthritis, or headaches (Smith & Hillner, 2019). Chronic pain often has no cure; treatment will not provide complete resolution. Treatment interventions for chronic pain should focus on the long- term management of physical, psychological, and social symptoms to improve pain management and quality of life and decrease suffering. Thus, a multidisciplinary, multimodality approach is the most effective method to manage adults’ chronic noncancer pain (Smith & Hillner, 2019). Assessment of adults for chronic opioid therapy A comprehensive assessment of the patient, caregiver(s), and family member(s) is necessary to determine an appropriate chronic pain management regimen. The goal is to determine the nature of the pain and how the pain affects the function and quality of life, assess prior treatment approaches, and detect other conditions that could influence the decision to utilize opioid analgesics (AAFP, 2021). The assessment should include: ● Nature and intensity of pain. ● Past and current treatment regimens and responses, including adverse effects or reactions. ● How pain impacts physical and psychological function. ● How pain influences sleep, mood, work, relationships, leisure, and substance use. ● Identification of concurrent conditions that may increase the risk for adverse events (e.g., obesity, renal disease, sleep apnea, COPD). ● Review of current medications; identify interacting drugs and other CNS depressants.
Self-Assessment Quiz Question #4 Are integrative nursing therapies and complementary therapies the same?
a. Yes. b. No.
● Social support, housing, employment, or recent military deployment. ● Patient and family history of mental health disorders (e.g., bipolar, attention deficit disorder (ADD) / attention deficit hyperactivity disorder (ADHD), depression, posttraumatic stress disorder). ● Patient and family history of substance use, addiction, or dependence. ● Determination of any history of physical, emotional, or sexual abuse and risk factors for substance abuse disorder; validated screening tools for substance abuse disorder help determine a patient’s risk level. ● Review of PDMP results. ● Monitoring of PDMP regularly throughout chronic pain management follow-up to determine if the patient obtains other controlled substance prescriptions from other providers.
Page 62
EliteLearning.com/Dental
Powered by FlippingBook