idiopathic arthritis with intra-articular steroids (Shah, Cappiello, & Suresh, 2016). Nonpharmacological treatment and interventions for pediatric clients who experience pain include those that they are able to complete on their own and those provided by others. Strategies that the child could complete independently include cognitive behavioral (distraction, imagery, thought stopping) and physical (sleeping, positioning, rubbing) techniques (Sng et al., 2017). Caregivers may provide cognitive behavioral (positive reinforcement, breathing, distraction), physical (massage, positioning), assistance with activities of daily living (Sng et al., 2017). Exercise, strengthening, sensory desensitization can be used with success when combined with other psychological and pharmacological interventions (Rodriguez-Lopez, Fernandez- Baena, Barroso, & Yáñez-Santos, 2015). Although emotional support and personal belongings did not reduce pain for children, both were found to improve a child’s ability to manage the pain (Sng et al., 2017). An older adult with pain often experiences more severe disability and impaired quality of life than does a younger person (Fitzcharles, Lussier, & Shir, 2010). The older adult frequently has comorbid diseases, a slower rate of tissue healing, more rapid muscle deconditioning, and reduced mobility (Ferrell et al., 2009; Fitzcharles et al., 2010).
Older adults may also have certain beliefs and challenges that affect pain assessment and management. They have had longer to develop their beliefs about pain and how to cope with it. An older adult may believe that “pain is something to be endured, strong analgesics lead to addiction, complaining about pain is a sign of personal weakness, and pain is an inevitable part of aging” (Catananti & Gambassi, 2010, p. 140). An older adult may also have short-term memory loss, necessitating repetition to reinforce teaching and the use of written aids to be studied at his or her leisure. Older adults excrete drugs more slowly and are more likely to have increased sensitivity to drugs and their side effects (Fitzcharles et al., 2010). Comorbid disease and polypharmacy are common and can put an older client at risk for “drug– disease” and “drug–drug” interactions (Fitzcharles et al., 2010). Older adults can have difficulty keeping track of medication times and dosages. Health professionals can help clients create an organization system for medications and an accurate list of medications to improve communication with healthcare providers. Often, older clients may be seeing a variety of specialists who are not always aware of what the other healthcare providers have prescribed. An attentive practitioner can sometimes help mitigate polypharmacy for these clients.
PAIN ASSESSMENT
Unfortunately, there is no laboratory test for pain, and accurate pain assessment is difficult. The most important facets of pain management are serial assessments and the use of good communication skills. Remember that pain is whatever and whenever the client says it is. The attitude of the health professional goes a long way in allowing clients to fully and honestly talk about their pain. Pain scales Many scales are available to help clients describe and locate their pain. Several are 0 to 10 ranking scales, with 0 being no pain, 1 being the least amount of pain, and 10 being unbearable
The first step in assessing pain is to obtain a description from the client of what his or her pain is and what it does. A pain assessment includes a numeric pain rating (0 = no pain, 10 = worst pain), pain characteristics, duration, location(s), pattern, and what makes the pain better or worse.
pain (Figure 2). Even children who are seven or eight years old should have little difficulty using these numeric scales.
Figure 2: Numeric Rating Scale
Note . From Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients. Academic Emergency Medicine, 17( 1), 50-54. doi:10.1111/j.1553-2712.2009.00620.x.
The Wong-Baker FACES Pain Rating Scale (Figure 3) is a series of images showing a range of facial expressions, from a happy smile to a grimace with tears. This scale may be used with
children to rate pain severity and has been validated outside the emergency department, mostly for chronic pain (Garra et al., 2010).
Figure 3: Wong-Baker FACES Pain Rating Scale
The Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Pain Assessment Scale (Figure 4) measures distress through observation of infants, children, and adults by objectively
assessing facial expression, body movements, or behavior on a standard scale.
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