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Pain

Unit 6 Lesson 2

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Define pain and the factors that influence it
Explain the difference between acute and chronic pain
Describe the difference between objective and subjective pain
Explain the pain aid scale

Student Learning Outcomes

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Definitions of Pain

Traditional Definition

"Whatever the patient says it is, experienced whenever they say they are experiencing it."

Revised Definition (2020)

"An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."

Sandquist-Reuter, 2023

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Pain

Pain is subjective and personal
Influenced by

Body's functional ability
Brain's perception
Cultural beliefs and norms

Pain can affect psychological well-being and social interactions
Communication barriers do not eliminate the presence of pain

Sandquist-Reuter, 2023

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Factors Influencing Pain

Biological Factors

Nociception, brain function, illness, age, hormones, inflammation
Genetic sensitivity, past or present injuries

Psychological Factors

Mood, affect, stress, coping mechanisms
Trauma, fear, anxiety, developmental stages

Sandquist-Reuter, 2023

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Factors Influencing Pain continued…

Social Factors

Cultural values, economic background, environment
Social support systems, spirituality, ethnicity, education

Example

Osteoarthritis and its management through topical medications, ice, or heat

Sandquist-Reuter, 2023

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Critical Thinking Question

A 70-year-old client with osteoarthritis reports increased joint pain during their physical therapy sessions. They mention that their pain worsens in cold weather and when they are stressed about family. What factors might be influencing the client’s pain, and how can the nursing aide assist the client in managing these influences?

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Acute vs. Chronic Pain

Acute Pain

Short-term, usually from a specific cause (e.g., injury, surgery)
Physiological responses

Increased pulse
Respiration
Blood pressure
Diaphoresis (sweating)

Sandquist-Reuter, 2023

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Acute vs. Chronic Pain continued…

Chronic Pain

Lasts longer than six months, persistent
Can arise without a clear cause or remain post-injury
Common causes

Osteoarthritis
Fibromyalgia
Spinal conditions

Does not usually alter vital signs

Sandquist-Reuter, 2023

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Acute vs. Chronic Pain continued…

Physical and Emotional Effects

Physical

Muscle tension
Movement limitation
Energy loss

Emotional

Depression
Anger
Anxiety
Fear of reinjury

Sandquist-Reuter, 2023

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Acute vs. Chronic Pain continued…

Impact

Limits regular work, leisure activities, and overall quality of life

Sandquist-Reuter, 2023

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Critical Thinking Question

A client recovering from knee surgery reports pain around the surgical site. Which statement best describes this type of pain?

A. Lasts for six months or longer without improvement

B. Begins suddenly after injury or surgery and lessens as healing occurs

C. Has no effect on vital signs such as heart rate or blood pressure

D. Is rarely relieved by prescribed pain medications or comfort measures

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Objective and Subjective Signs of Pain

Subjective Signs

Client’s verbal expressions
Example: "My knees ache."

Objective Signs

Observable changes

Vital signs
Nonverbal cues (grimacing, guarding)

Sandquist-Reuter, 2023

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Objective and Subjective Signs of Pain

Nonverbal Indicators

Facial expressions
Body movements (rocking, rubbing, moaning)

Importance

Essential to identify signs in non-communicative clients (e.g., dementia)

Tools

Use scales like PAINAD to assess pain in clients who cannot verbalize it

Sandquist-Reuter, 2023

Contact info: info@nursesinternational.org

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Critical Thinking Question

The nurse’s aide notices a resident with dementia grimacing and holding their abdomen. They are unable to verbalize their discomfort. What is the most appropriate action for the nurse’s aide to take?

A. Wait until the resident verbalizes their pain

B. Report and document the nonverbal signs of pain

C. Assume the resident is not experiencing pain since they cannot describe it

D. Provide medication without consulting a nurse

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Pain Assessment Tools

PAINAD Scale

Designed for clients with communication challenges
Assesses:

Breathing independent of vocalization
Negative vocalizations
Facial expressions
Body language
Comfortability with consoling

Sandquist-Reuter, 2023

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Pain Assessment Tools continued…

Scoring System

Each item scored from 0 to 2, total indicates severity of pain

Purpose

Ensures effective pain management
Aids in improving client comfort and quality of life

Sandquist-Reuter, 2023

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Item	0	1	2
Breathing independent of vocalization	Normal	Occasional labored breathing. Short period of hyperventilation.	Noisy labored breathing. Long period of hyperventilation. Cheyne-Stokes respirations.
Negative vocalization	None	Occasional moan or groan. Low-level speech with a negative or disapproving quality.	Repeated trouble calling out. Loud moaning or groaning. Crying.
Facial Expression	Smiling or inexpressive	Sad. Frightened. Frowning.	Facial grimacing.
Body language	Relaxed	Tense. Distressed pacing. Fidgeting.	Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out.
Consoling	No need to console	Distracted or reassured by voice or touch.	Unable to console, distract, or reassure.

PAINAD Scale

Sandquist-Reuter, 2023

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Critical Thinking Question

A resident in a long-term care facility is unable to communicate due to advanced dementia. The nurse’s aide is using the PAINAD scale to assess their pain. The nurse’s aide observes tense body language and occasional moaning.

How should the nurse’s aide score these observations, and what steps should be taken next?

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References

Sandquist-Reuter, M. (2023). Nursing Assistant. WisTech Open. https://wtcs.pressbooks.pub/nurseassist/

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