Pain assessment and pain management in special populations

[Flonightingal]

What if your patient cannot tell you they are in pain. As NP Laura points out, they may be deaf, or have Alzheimer's/Dementia, maybe even intubated/trached...how then can you assess their pain and adequately control it? There are so many things to consider when fulfilling your role as a nursing professional. This discussion might prove to be very useful to nursing students and veteran practitioners, alike. Let me know your thoughts...

[lmccrn62, MSN, RN]

There are ways to assess pain these populations. ASPMN has a position statement on this topic. Assessment tools are a adjunct to your assessment.

[mluvsgnc]

I am in PDN and my pt. is non-verbal (deaf, half blind, trach tube, etc.) and I have learned his pain cues over time. I suppose this might be an advantage to working with one pt. for 8 hours at a time and learning to understand what they are.

If you don't have that luxury, perhaps you could ask family members about specific behaviors that the person might exhibit when they aren't feeling well. Also, the first time I had an idea that my pt. was in pain was his HR- it was way above baseline. This was my first clue. I also assessed his respirations, which were more rapid and shallow than normal. Then there are the more obvious clues, such as facial grimacing, crying, change in affect, and in my pt.'s case, aggressiveness.

[dudette10, MSN, RN]

There are dementia scales, FLACC scales (mainly for infants), and others to help objectively support pain assessment for those who cannot respond to questions. As a PP noted, if a family member gives care at home, I usually ask them what are the patients indicators for pain in addition to using the scales for pain assessment. If you Google pain assessment, some of the scales should pop up.

[classicdame, MSN, EdD]

do a google search and you will find MANY pain scales, and some are specific to dementia patients or non-verbal (as on respirator) patients.

[Here.I.Stand, BSN, RN]

If ours are unable to verbalize pain for any reason--intubated, altered LOC, mandibular fixators etc--we chart that they are unable to verbalize; then chart their non-verbal and physiological sx of pain, intervention, and sx of comfort.

For example, can they communicate pain? Adult-no. Non-verbal sx of pain: guarding, grimacing, muscle tension. Physiological sx: increased BP, increased HR. Interventions: meds, repositioning. Sx of comfort: calm, no grimace, no guarding, no muscle tension.

We have two pain tools on our EHR. If they can communicate, we fill out the other one that has the 1-10 number, quality, location, onset, radiation, factors that worsen/relieve, post-intervention effectiveness etc. If they're non-verbal, we just enter "non-verbal" on this one.