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INTRODUCTION

It is important to realize the difference between nociception and pain. Nociception is when a noxious stimulus depolarizes sensory nerves, which provide the brain with information about tissue injury. Nociception is neither necessary nor sufficient for pain. Pain is a subjective experience; the consequence of filtering, modulating, and distorting nociception through an individual’s affective and cognitive processes.

Pain Management Essentials

Tailoring multimodal approaches (both pharmacologic and non pharmacologic) to the needs, desires, and circumstances of the patient, as opposed to using a single modality to its “limit,” provides better analgesia with the lowest incidence of side effects.1,2 Use a collaborative plan that includes patient input. Pain management does not end on discharge, coordinate with the outpatient provider.

ASSESSMENT

Ask the patient what analgesics have either worked or not in the past, as well as the exact doses of any analgesics they were taking prior to admission. The “OPQRST” mnemonic acronym helps ensure a comprehensive pain assessment (Table 42-1).3

TABLE 42-1A Mnemonic Acronym for Pain Assessment

The most common tools for assessing pain severity are single dimension scales; for example, the verbal numeric scale where patients state a number between 0 (“no pain”) and 10 (“worst pain imaginable”).1 There are observer-based, behavioral scales for specific patient-populations (e.g., pre verbal children, sedated ICU patients, cognitively impaired, and dementia patients).

Single-dimensional scales are quick and easy; however, one major disadvantage is they assign a single value to a complex, multidimensional experience and providers base management decisions on this value. The goals for analgesia should be based on function, not an arbitrary numeric pain value. Therefore, determine the impact of pain on the patient’s ability to do the things they need to recover (e.g., coughing, deep breathing, getting out of bed, and ambulating). Using a functional pain scale with subjective and objective components can help with this. The most important part of the assessment is having the patient describe the quality of the pain using adjectives. This provides information on the “mechanism” of the pain and guides the choice of analgesics (Table 42-2).1

TABLE 42-2Pain Quality Assessment to Determine ...

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