ASSESSMENT AND TREATMENT...Page 2...( easier to read )

From: Helen Dynda (olddad66@runestone.net)
Sun Jul 23 15:05:09 2000


PAIN: ASSESSMENT AND TREATMENT >Page 2

ASSESSING PAIN - It is very important in the assessment of pain that attention is paid to the following issues:

a.) Location of pain: is it in a single place or multiple locations on the body? The location and pattern of distribution of the pain can lend clues as to the cause.

b.) Nature of pain: is the pain intermittent - that is, does it come and go depending on something that the patient does, a certain movement or body position, etc.? Or is it constant - as a result of continuous stimulation of pain receptors by something?

c.) Duration of pain: is the pain acute - that is, related to an injury (such as a cut from a knife) and associated with normal pain responses? Is the pain chronic - lasting for months due to an ongoing condition or not necessarily related to an obvious event?

d.) Intensity of the pain - often measured on a scale of one to ten. Consider not only the absolute intensity but also whether the pain seems appropriate for the stimulating event. An extreme response suggests that neuropathic and psychosocial issues may be involved.

e.) Quality of pain - is it sharp? Does it burn? Does it feel like an electrical shock? Does it follow a certain path in the body (like sciatica)?

f.) Other factors - is the patient reporting other symptoms such as depression, sleep disturbances, changes in appetite, etc?

BASIC PRINCIPLES OF TREATMENT It may seem obvious but it is important that an attempt is made to identify the cause of the pain - often treating or removing the cause is an effective means of treating the pain. This is not always possible - a cause may not be apparent or the cause may be known but not treatable.

Treatment of the pain should be guided by the classification of the pain:

For pain that is nociceptive, meaning it follows the normal physiological pattern of noxious stimuli activating free nerve endings, "traditional" pain medications are utilized. These include the non-steroidal anti-inflammatory agents (like ibuprofen) and/or opioid medications. Examples of nociceptive pain include injuries (broken bones, etc.) and the pain following surgery.

More on treatment of nociceptive pain:

Management of Chronic Non-Malignant Pain

For pain that is neuropathic in origin (suggested by features such as abnormal duration, electrical or burning sensation, etc.) the addition of agents such as those mentioned earlier is often helpful. Phantom Limb Pain, discussed previously on this site, is an example of a neuropathic pain syndrom.

More details on neuropathic pain:

Hospital Practice article: Neuropathic Pain

University of Iowa Pain Medicine Center article

Pharmacologic Management of Neuropathic Pain

Brain Briefings: Neuropathic Pain

Pain that involves psychological factors should be considered anytime a situation cannot be clearly explained by a known injury, disease, medical condition, etc. Patients may both a physiological and psychological mechanism to their pain and require both medication-based and psychological treatment. These patients are the ones that often require a multi-specialty, multiple practitioner treatment plan.

More information on psychological issues and pain:

Pain: Psychological Paradigms and Practice - an article from Forensic Psychologist

Psychological Pain Management from Psychology Information Online

CONCLUSION

In the evaluation of pain, close attention to the many aspects defining the pain can lead to a succesful identification of the pain as nociceptive or neuropathic. In addition, it is important to evaluate whether a psychological and emotional component exists. The proper classification of the nature of the pain will direct proper treatment with the right types of medication and/or behavioral therapy. When these basic treatment modalities fail, additional and more involved treatment may be required - ranging from nerve blocks to multi-specialty, multi-practitioner treatment plans.

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