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KEY CONCEPTS

KEY CONCEPTS

  • Image not available. A comprehensive pain symptom analysis should be performed on each individual reporting pain to determine the type of pain condition.

  • Image not available. A patient's self-report of pain is the most reliable indicator of the intensity and presence of pain.

  • Image not available. Appropriateness of self-care options to treat pain must be determined after careful review of red flag indicators.

  • Image not available. The topical route of administration is preferred to oral analgesics whenever feasible.

  • Image not available. Goals focused on quality of life and function in addition to traditional pain scores are preferred.

PATIENT CARE PROCESS

Patient Care Process for Pain Self-Care

Image not available.

Collect

  • Pain Symptom Analysis (ie, PQRSTU, see Table e9-3)

  • Patient characteristics (eg, age, sex, allergies, pregnancy)

  • Past medical history including cardiopulmonary, renal or hepatic disease, psychiatric and sleep disorders

  • Social history (eg, tobacco/ethanol/illicit drug use), dietary habits, occupation

  • Current medications including over-the-counter (OTC) aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, herbal products, and dietary supplements

  • Objective data

    • Physical exam: Blood pressure (BP), heart rate (HR), respiratory rate (RR), height, weight, diaphoresis, pallor, and visual inspection of the area of pain if possible (Note: Changes in vital signs are NOT diagnostic for pain and may not be present in patients with chronic pain.)

    • There are no labs specific for pain assessment. Lab result abnormalities should be evaluated in light of a patient's chronic conditions (ie, elevated uric acid as an indicator of gout)

  • Pain can be categorized based on patient description and medical history

Assess

  • Presence of risk factors that require medical referral (See Table e9-2)

  • Classifications of pain

    • Nociceptive (visceral vs somatic)

    • Neuropathic

  • Duration of pain (acute vs chronic)

  • Ability and willingness to adopt lifestyle modifications (eg, sleep hygiene, exercise) and mind-body techniques (eg, biofeedback, relaxation) as part of a comprehensive approach to pain

  • Ability/willingness to use/pay for treatment options including medications, physical therapy, transcutaneous electrical nerve stimulation (TENS), injectable epidurals

  • Emotional status (eg, presence of anxiety, depression, sleep disorder)

Plan*

  • For many pain conditions, use a multimodal approach incorporating nonpharmacologic therapy if appropriate (Chapter 77 "Pain Management," section on Nonpharmacologic Therapy)

  • Drug therapy regimen including dose, route, frequency, and duration (see Chapter 77, Table 77-5)

  • Referrals to other providers when appropriate (eg, primary care, rheumatologist, orthopedics, behavioral health, gynecologist, gastroenterologist, dentist)

Implement*

  • Provide patient education regarding all elements of the treatment plan (eg, purpose of multimodal treatment including lifestyle and dietary modification, medication administration, adherence)

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up (eg, improved mobility, pain score, prevention of chronic use of OTC pain medications)

Follow-up: Monitor and Evaluate

  • Self-monitoring for resolution of pain symptoms, frequency and duration of pain, when to seek emergency medical attention

  • Improvement of pain symptoms (eg, mobility, pain score, participation in daily activities)

  • Monitoring parameters related to efficacy (eg, mobility, pain score, missed days of activity such as work, or social events)

  • Presence of adverse effects (eg, gastrointestinal issues [ulcers/bleeding], rash)

  • Patient adherence to treatment ...

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