Assessment and treatment

© Mosby, used with permission from Hockenberry M.J., Wilson D., 2009. Wong’s essentials of pediatric nursing (8th ed.). St. Louis, MO: Mosby

Key concept 4 - Assessment of pain

Pain is multi-dimensional so to assess pain properly we need to assess the multiple dimensions (physical, emotional and cognitive).

• Pain is commonly assessed by a 0 to 10 verbal rating scale where 0 = No pain and 10 = Worst imaginable pain
• Pain is a subjective experience – so if someone says "I have pain" then they have pain!

Read

Bailey, B., Daoust, R., Doyon-Trottier, E., Dauphin-Pierre, S., & Gravel, J. (2010). Validation and properties of the verbal numeric scale in children with acute pain. Pain, 149(2), 216-221. doi:10.1016/j.pain.2009.12.008

Chibnall, J. T., & Tait, R. C. (2001). Pain assessment in cognitively impaired and unimpaired older adults: a comparison of four scales. Pain, 92(1-2), 173-186. doi:DOI: 10.1016/S0304-3959(00)00485-1

Hadjistavropoulos, T., Herr, K., Turk, D. C., Fine, P. G., Dworkin, R. H., Helme, R. M., . . . Williams, J. (2007). An Interdisciplinary Expert Consensus Statement on Assessment of Pain in Older Persons. Clinical Journal of Pain, 23 Supplement(1), S1-S43

Key concept 5 - Treatment of pain

Treatment of pain generally consists of removing the nociceptive stimulus or blocking the nociceptive transmission.

• Treatments for pain can include giving it a bit of a rub (see Gate-Control Theory), medication that interferes with nociceptive transmission or surgery to remove a volume-occupying lesion.
• Consider making the person feel safe - remove things that are threatening and make the person feel less vulnerable. This might involve modifying how the brain is processing input from receptors.
• With this in mind, treatments such as cognitive behavioural therapy and graded motor therapy can be used, especially where a person’s pain experience seems to be influenced by central mechanisms more than peripheral ones.

Read

Bjordal, J. M., Johnson, M. I., Lopes-Martins, R. A., Bogen, B., Chow, R., & Ljunggren, A. E. (2007). Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskeletal Disorders, 8, 51. doi:10.1186/1471-2474-8-51

Burian, M., & Geisslinger, G. (2005). COX-dependent mechanisms involved in the antinociceptive action of NSAIDs at central and peripheral sites. Pharmacology & Therapeutics, 107(2), 139-154. doi:10.1016/j.pharmthera.2005.02.004

Moseley, G. L., & Flor, H. (2012). Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabilitation & Neural Repair, 26(6), 646-652. doi:10.1177/1545968311433209

Vlaeyen, J. W., & Morley, S. (2005). Cognitive-behavioral treatments for chronic pain: what works for whom? The Clinical Journal of Pain, 21(1), 1-8.

Pain and Movement Reasoning Model by Des O'Shaughnessy and Lester Jones is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

Easy-to-access resources include those published on hospital websites and websites of professional groups, however these are often context-specific and are usually presented with disclaimers.