[BLANK_AUDIO] We're here today in the simulation lab. We're going to talk about the topic of pain assessment. So it's a very important topic and we'll just get started. What is your guises experience with accessing a patient's pain? >> Usually just like in the clinical setting. It's a scale of zero to ten. Zero being no pain, ten being the worst pain the patient has ever experienced. >> [INAUDIBLE] you do pain assessment before you give medication and after to assess the effectiveness of medication. >> Good. >> And sometimes it can be hard because pain is very subjective, so it sometimes can be confusing how we really do it. >> Right, so you guys have hit on a lot of important points. We'll talk some today about some of the different pain scales, whether it be a verbal 0 to 10 scale like you mentioned. We'll talk about when it's important to assess pain. And also some of the challenges that people will have. So, it's the same in my own experience, it's been a bit of a challenge sometimes. Because pain is a very individual experience. It's very subjective, meaning it's different from person to person. So what looks painful to me might not be painful to somebody else, or it might be more painful. You know, something that doesn't seem painful to me may be very painful for somebody else. So I'm going to just start by telling you guys some of the things that a healthcare provider. We'll ask somebody who comes in with a new complaint of pain. So, some of the most important things that we're going to talk about, in addition to maybe a pain rating which really has to do with intensity, would be pain onset and duration, so when did the pain start and how long has it lasted the intensity, as you mentioned. Also the frequency how often the pain occurs. You'll also want to find out the location of the pain so where in the body the pain is occurring. In addition to location. You also need to know about the quality of the pain. Is it a burning pain, an aching pain, a sharp pain. Sometimes pain is associated with other symptoms. So symptoms of nausea or shortness of breath can sometimes accompany pain and it's also important to try and find out what somebody has already done to treat their pain. So anything that we, that they, that the patient can tell us about what alleviates their pain. Is very helpful to know. And also there's certain things that might cause the pain. So, does a certain movement or a certain activity cause the pain to start? So those are all things that we need to know about the pain itself, and also pain may have an impact on other activities in the person life, person's life. So are they able to walk the same distance that they used to be able to walk. Are they able to sleep. How does it affect their mood, so we need to think about the impact of the pain. So, do you guys have any questions so far about that? Okay. So we'll move on, and we'll talk a little bit about rating pain. As you mentioned the first thing that we're going to, one of the first things we're going to, we might start with, is asking somebody to rate their pain a zero to ten scale and you described it correctly. You're starting with zero which would be nothing and ten which would be the worst pain imaginable. What's your experience using verbal skills with patients? Have they always been able to use that? Or has there ever been a time where someone had difficulty using that to describe their experience? >> A lot of times they say like 15 on a scale of zero to ten so it's hard to tell if that's exaggerated or if it's a true, like it's ten pain that they're experiencing. >> Okay. >> Also sometimes they were like, i'm a four, or a six, or maybe an eight. [LAUGH] And then you're like, okay. So, sometimes it's hard for them to really think about, where their pain is on that, like, scale. >> Yeah. What have you done in that situation? because that's a great example. >> Usually just ask them to clarify ask them again. >> Yeah. >> Or just ask them where the like questions about it. So like where is your pain? How is it, like when did it start? And once I get those more like clarifying factors, sometimes they can come up with a more concrete number. >> Some of the other things that we can do especially, maybe with children or even adults who just have a hard time verbally expressing what they're feeling, or they feel like they need to go beyond the ten to have us believe that they're truly in this intense pain. Is to use a picture scale so, we'll talk about a couple examples of that today. The first one that I'll mention is, we're only going to talk about two, but there are several, out there that are available, so. But the first one that we'll talk about here, is called, Veteran and Defense Pain Scale. So this was pretty recently developed, and it was developed for adults and it has several pictures of faces with either a smiley face or, a serious face, or a very sad distressed face. And then underneath those different pictures it will give a number. That corresponds with the pain as well as the brief descriptions of you know how bad the pain is. [BLANK_AUDIO] So a scale like that for somebody who is struggling to pick between say a four, a six or an eight would really help them to narrow down. And where there pain is at. So, in those situations, [INAUDIBLE] it might be good to use something like that. Along with that particular scale, there are questions that assess some of those other factors we talked about, like how does it affect sleep. So, there's also a scale that's very commonly used in kids called the Wong-Baker FACES scale, are you guys familiar with this at all? So this scale, is another pictorial scale. And the good thing about this one and the reason it's so great for children is that it's a lot simpler than the last one that I showed you. So, you still have the pictures of the faces and you have the numbers. And then the word descriptions are much more basic and simple. So this is even good for use in children as young as three years old. And you'll see it says something like hurts a little bit, hurts even more and along with the healthcare provider explaining this to the child, they should be able to come up with the rating. So this type of scale is good for children, even older children. Just really depending on that person's ability. So a three year old could use this. You could use it in a 13, 15, 16 year old. Just really depending on. How comfortable the person is describing their pain. But really when it comes to picking a scale, you want to pick the developmentally and like, cognitively appropriate scale. So what do I mean by that? Some 13 year olds might need a scale like this if they've never had a pain experience before. If they're never been asked to use a verbal pain scale. If there's a 13 year old who has some sort of condition that causes chronic pain and they've been in the hospital multiple times and they've used this multiple times now they might have basically memorized what it means, what each number means and be able to do this a pain reading verbally without having to be actually be shown a scale. And it could be the same for adults, some adults, as I think you said from your experience. They might not be able to, to rate it verbally but a picture scale might help them, so. You just need to think about the individual, their own abilities, and if your, if somebody is struggling maybe just try a different technique to help them. So we can really get a good understanding. [COUGH] And the same goes for when somebody says 15 really you know ten is the worst imaginable, so what their really trying to say is the worst imaginable they just feel like maybe people don't belive them when they say ten for some reason so whatever that reason may be maybe because they don't look on their face like they have pain, and that actually. Reminds me of something important [COUGH]. When you use these picture scales you don't want to, you don't want the person to assume their face has to look like this. because it's not about what their face looks like, it's about what they feel like. So if they feel like picture eight, but their face looks like picture four, they're going to pick you know the picture that's associated with number eight. [COUGH] Do you guys have any questions? Okay. Let's do a quick review, I guess, and then we'll be done. So, when we are thinking about pain and assessing pain there is those certain factors that I mentioned. So, intensity, location, the duration and onset the quality of the pain, any factors that might precipitate or come before the pain more cause the pain, any factors that might be associated with the pain, so any additional symptoms like shortness of breath, and any relieving factors, so what treatments relieve the pain,. As well as what did, impact does the pain have. Those are all the things that we want to assess. And then, I guess we should touch a little bit more on when to assess the pain. We want to assess pain not only when someone first complains of it, but as you mentioned, Rachel, also as soon as we've given them treatment and kind of following up after that treatment, to make sure that what we've done has actually been effective and that they're getting the relief that they need. This week we've talked about the neural pathways that are involved in the pain experience. We've just had a demonstration of how to thoroughly and properly assess pain in the health care setting and next, we'll be interviewing pain experts where we talk about the clinical and therapeutic importance of pain treatment and management as well as some of the social and cultural factors that influence the pain experience. [BLANK_AUDIO]
