PAIN ASSESSMENT TOL Winnipeg Health Region疼痛评估工具温尼伯卫生区.pptVIP

Framework continued Changes in interpersonal interactions Changes in activity patterns or routines Mental status changes Physical Exam Overall impression/appearance Facial expression Body position and movement Areas of redness, swelling, warmth Palpation, tenderness Focused assessment: eg. chest pain CCHSA Accreditation standards A new Required Organizational Practice for 2009 will be: “Develop and implement an organizational policy and protocol to identify and treat cognitively impaired residents requiring effective pain management” Management Non- Pharmacologic Pharmacologic Non-Pharmacologic Wide range of potential interventions Provision for other needs Reassurance, contact Massage, heat, ice Physiotherapy modalities Pain Pills Pharmacologic management includes four general drug groups: Acetaminophen NSAIDs Opioids Neuropathic pain meds (antidepressants, anticonvulsants) Pain Med-Cognition Quandary All pain pills but acetaminophen can adversely affect cognition, especially in high-risk people such as those with dementia, frailty Pain can impair cognition Chronic pain causes depression, which impairs cognition Pain Meds and Cognition Opiates - sedation, delirium NSAIDs - delirium Anticonvulsants - sedation, cognitive effects Tricyclics - anticholinergic effect and sedation So what to do? Difficult area to study, few studies Dementia further complicates assessment of benefit Pain Meds for Agitation People with severe dementia may not be able to report pain ‘Agitation’ (BPSD - Behavioral and Psychiatric Symptoms of Dementia) is common in dementia Some BPSD may be triggered by unreported pain Empiric Analgesia 2 small placebo-controlled cross-over trials of pain meds for BPSD Opiates - 10 mg BID of oxycodone SR or 20 mg daily of morphine SR vs placebo in 25 patients Some reduction in BPSD among those over age 85 with little observed sedation Empiric Analgesia Acetaminophen 1 g TID vs placebo in 25 patients Small improvements in some observed interaction