Therapy Zain admitted to having had poor adherence to medication over the past 6 months. His current medications plans: ● Pregabalin. ● Meclizine. ● Buprenorphine/Naloxone. ● Metoprolol. ● Hydrochlorothiazide. ● Supplements include melatonin, cholecalciferol, and levomefolic acid. Supplementary therapy plans The care team agreed that addressing Zain’s sedentary lifestyle could potentially improve his chances of a fast recovery. To this end, the team explored relaxation, yoga, and outdoor virtual reality experiences to primarily improve his movement range. Over the next 7 months of therapy, he is expected to walk an average of 8 thousand steps per day with a stepwise increase in daily target steps over the next 3 months. Case study summary Zain’s case highlighted how numeric scales may facilitate quantitative progress monitoring in pain therapy. In parts, it also highlighted how pain care teams should conduct a comprehensive assessment of lifestyle, pain complications report, and supplementary care plans (non-drug care) in cases resulting from severe pain impairments.
Self-Assessment Quiz Question #11 Which of the following is considered Zain’s biggest risk factor for his pain condition? a. Poor sleep habits. b. Zero history of illicit drug use.
c. Zain’s ”bull-them-all” runs. d. Zain’s use of Supplements.
Self-Assessment Quiz Question #12 Which of the following was Zain’s primary diagnosis?
a. Lung cancer. b. Nerve pains. c. Obesity. d. Fibromyalgia.
Self-Assessment Quiz Question #13 In this case, study, which of the following is true about the use of Lidocaine patches? a. It is indicated for the cure of fibromyalgia.
b. It affected sustained pain relief. c. It is unnecessary in this scenario. d. It is contraindicated in athletes.
Self-Assessment Quiz Question #14 As used in this case study, which of the following is true about Pregabalin? a. It is indicated for the cure of skeletal degeneration.
b. It is indicated for neuropathic pain. c. It is unnecessary in this scenario. d. It is contraindicated in athletes.
Self-Assessment Quiz Question #15 As used in this case study, which of the following is true about the supplement melatonin? a. It is contraindicated in athletes with fibromyalgia. b. It enhances the effect of Lidocaine. c. It is prescribed to correct Zain’s insomnia. d. It is unnecessary in this scenario.
CONSIDERATIONS IN PAIN ASSESSMENT AND MEASUREMENT
Assessment of pain can be a simple task when dealing with acute pain and pain as a symptom of trauma or disease. Assessment of the location and intensity of the pain often suffices in clinical practice. However, other important aspects of acute pain, in addition to pain intensity at rest, need to be defined and measured when clinical trials of acute pain treatment are planned. If not, meaningless data and false conclusions may result. Assessment of long-lasting pain and the effect of treatment is more challenging, both in patients suffering pain from nonmalignant causes and in patients with cancer pain. Numerous instruments have been developed for diverse types and subtypes of chronic pain conditions to assess qualitative aspects of chronic pain and its impact on function. The extensive list of published instruments indicates that pain assessment continues to be a challenge. Because pain is such a subjective, personal, and private experience, assessing pain in patients with whom we cannot communicate well is difficult, most of all in patients suffering from cognitive impairment and dementia. The
visual analog scale (VAS) and numeric rating scale (NRS) are most commonly used to assess the present intensity of acute pain. They are reliable, valid, sensitive to change, and easy to administer for the measurement of the severity of pain. The NRS, using an 11-point scale (0—’no pain’ to 10—’worst pain’, or ‘pain as bad as it could be”), is often preferred due to its administration simplicity and reliability. VAS is considered the ‘gold standard technique and is used particularly in pain-related research. It consists of a 100 mm unmarked line with standardized wording: ‘no pain’ on the left of the line, and ‘worst pain imaginable’ on the right—the patient then places a mark on the line corresponding to their level of pain. A disadvantage of this scale is that it does not give an instant rating as a measurement is needed and application of the scale requires explanation to the patient when the level of understanding may be decreased in the early post- anesthetic period. A categorical verbal rating scale (VRS) uses words to describe the magnitude of pain, for example, none, mild, moderate, and severe. VRS is a quick, simple tool with a high validity as an indicator of pain intensity;
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Book Code: PYCA2725
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