Download Pain Management

HealthStream Regulatory Script
[Pain Management]
Version: [May 2005]
Lesson 1:
Lesson 2:
Lesson 3:
Lesson 4:
Lesson 5:
Introduction
What is Pain?
Benefits of Pain Management
Assessing Pain
Treating Pain
Lesson 1: Introduction
1001
Introduction
Welcome to the introductory lesson on pain management.
IMAGE: 1001.GIF
Pain management is good medicine in several ways:
• Ethically: Clinicians have an ethical obligation to relieve
pain and suffering.
• Clinically: Good pain management can promote clinical
healing. This means shorter hospital stays and fewer
readmissions.
• From a regulatory standpoint: Regulatory standards
require clinicians to assess and treat pain.
As your partner, HealthStream strives to provide its customers with excellence in
regulatory learning solutions. As new guidelines are continually issued by regulatory
agencies, we work to update courses, as needed, in a timely manner. Since
responsibility for complying with new guidelines remains with your organization,
HealthStream encourages you to routinely check all relevant regulatory agencies
directly for the latest updates for clinical/organizational guidelines.
Point 1 of 4
2
1002
Course Rationale
This course will teach you how to treat pain in your patients.
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You will learn:
• The definition of pain
• The benefits of treating pain
• Best practices and guidelines for assessing pain
• Best practices and guidelines for treating pain
Point 2 of 4
1003
Course Goals
After completing this course, you should be able to:
•
•
•
•
•
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Define pain.
Recognize different types of pain.
List the benefits of treating pain.
Identify the parts of a pain assessment.
Recognize best practices for treating pain.
Point 3 of 4
1004
Course Outline
This introductory lesson gives the course rationale, goals, and
outline.
FLASH ANIMATION:1004.SWF/FLA
Lesson 2 presents background information on pain. This includes
definitions of pain and types of pain.
Lesson 3 describes the benefits of treating pain.
Lesson 4 presents best practices and guidelines for assessing
pain.
Finally, lesson 5 discusses the treatment of pain. This includes
treatment options and monitoring.
oint 4 of 4
Lesson 2: What Is Pain?
2001
Introduction
Welcome to the lesson on defining pain and types of pain.
FLASH ANIMATION:2001.SWF/FLA
Point 1 of 11
2002
Objectives
After completing this lesson, you should be able to:
• Identify definitions of pain.
• List features of pain.
• Recognize types of pain.
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Point 2 of 11
2003
Definition of Pain (1)
One definition of pain is:
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An unpleasant sensory or emotional experience associated with
actual or potential tissue damage
This definition points out:
• Pain is unpleasant.
• Pain can be felt by the senses or the emotions.
• Pain has to do with physical injury. This is the biological
function of pain: to warn the body of injury.
Point 3 of 11
2004
Definition of Pain (2)
Another definition of pain is:
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An unpleasant sensation occurring in varying degrees of severity,
as a consequence of injury, disease, or emotional disorder
This definition points out:
• Pain is unpleasant.
• Pain can be more or less severe.
• Pain can have physical or emotional causes. Therefore,
pain does not always have to do with physical injury. This
differs from the previous definition.
Point 4 of 11
2005
Definition of Pain (3)
A final definition of pain is:
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Whatever the person says it is, occurring whenever the person
says it does
This definition points out:
• Pain is subjective [glossary].
• When assessing pain, the clinician should ask the patient,
whenever possible.
Point 5 of 11
2006
Types of Pain
Types of pain may be grouped by:
• Duration (acute or chronic) [glossary]
• Cause (physiological or psychological) [glossary]
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Let’s take a closer look.
Point 6 of 11
2007
Duration: Acute
Acute pain lasts a short time. This is usually less than a month.
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Acute pain has to do with disease or injury. Therefore, this type of
pain serves its biological function: to warn of injury to the body.
Acute pain causes a physiological stress response [glossary].
This means that “fight-or-flight” symptoms are often seen with
acute pain. These symptoms include:
• Sweating
• Dilation of the pupils
• Increased heart rate
• Increased blood pressure
• Increased respiratory rate
• Anxiety
Point 7 of 11
2008
Duration: Chronic
Pain is chronic if it lasts more than three to six months.
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This type of pain remains long after an injury or disease.
Therefore, chronic pain does not serve a biological function.
Other symptoms are often seen with chronic pain. These include:
• Physical exhaustion
• Loss of strength
• Progressive disability
• Sleep problems
• Decreased appetite or loss of taste for food
• Weight loss
• Constipation
• Decreased sex drive
• Depression
Point 8 of 11
2009
Cause
When classified by cause, pain includes:
• Somatogenic pain: pain with a physiological cause
• Psychogenic pain: pain with a psychological cause
• Idiopathic pain: pain with no apparent cause
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When diagnosing the cause of pain, clinicians start with possible
physiological causes. If a cause is found, the pain is somatogenic.
If all possible physiological causes are ruled out, clinicians look for
psychological causes. If a cause is found, the pain is psychogenic.
If all possible physiological and psychological causes are ruled
out, the pain is idiopathic.
Point 9 of 11
2010
Review
Pain is:
a.
b.
c.
d.
Objective
Subjective
Never biologically useful
Easily measured and quantified
MULTIPLE CHOICE INTERACTION
Correct: B
Feedback for a: Incorrect. The correct answer is B. Pain is
not objective. Pain is highly subjective.
Feedback for b: Correct.
Feedback for c: Incorrect. Pain serves an important
biological function: to warn of injury to the body. The
correct answer is B. Pain is highly subjective.
Feedback for d: Incorrect. Pain can be quite difficult to
measure and quantify. This is because pain is so
subjective. The correct answer is B.
Point 10 of 11
2011
Summary
You have completed the lesson on definitions and types of pain.
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Remember:
• Pain has many definitions.
• Pain is unpleasant.
• Pain can be sensory or emotional.
• The function of pain is to warn of injury to the body.
• Pain can be more or less severe.
• Pain is subjective.
• Acute pain lasts a short time. Symptoms of the physiological
stress response are often seen with acute pain.
• Chronic pain lasts more than three to six months. Many other
symptoms are often seen with chronic pain.
• Pain can be somatogenic, psychogenic, or idiopathic.
Point 11 of 11
Lesson 3: Benefits of Pain Management
3001
Introduction
Welcome to the lesson on the benefits of treating pain.
FLASH ANIMATION: 3001.SWF/FLA
Point 1 of 9
3002
Objectives
After completing this lesson, you should be able to:
•
•
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List the benefits of treating pain.
Recognize JCAHO standards for assessing and treating pain.
Point 2 of 9
3003
Benefits of Pain Management
Treating pain:
• Is ethical
• Promotes patient health and quality of life
• Meets regulatory standards
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Let’s take a closer look at each of these features.
Point 3 of 9
3004
Ethics
Medical professionals have an ethical duty to act in the best
interests of their patients.
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This includes relieving pain.
Point 4 of 9
3005
Patient Health and Quality of Life
Remember: Pain activates the physiological stress response (“fight
or flight”).
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This can be helpful. “Fight-or-flight” can help a person escape from
the cause of pain. This removes the person from danger and
prevents further injury.
But when pain continues for a long period, “fight or flight”
continues, too. This is not helpful. Problems can develop. These
include:
• High blood pressure
• Confusion
• Abnormal hormone levels
• Metabolic abnormalities
• Constipation
• Lowered immunity
• Anxiety and fear
• Hopelessness
• Sleeplessness
• Suicidal thoughts
Point 5 of 9
3006
Patient Health and Quality of Life (2)
In short, prolonged pain is not just unpleasant. It is also harmful to
the body.
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Therefore, treating pain does not just relieve suffering. It also
promotes overall patient health and wellbeing.
This can lead to:
• Shorter hospital stays
• Fewer readmissions
• Better quality of life
Point 6 of 9
3007
Regulatory Standards
Regulatory agencies recognize the importance of treating pain.
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According to JCAHO, pain management is a patient right.
JCAHO requires its hospitals to:
• Assess each patient for pain.
• Regularly reassess for pain.
• Treat pain (or refer the patient for treatment).
• Educate patients about pain.
Guidelines for assessment, treatment, and patient education are
presented in the next two lessons.
Point 7 of 9
3008
Review
Chronic pain is:
a. Biologically useful
b. Physically harmful
c. Psychologically unimportant
d. All of these
e. None of these
MULTIPLE CHOICE INTERACTION
Correct: B
Feedback for A: Incorrect. Chronic pain remains long after
the triggering injury or disuse. Therefore, it does not serve
a biological function. The correct answer is B. Prolonged
pain is physically harmful. This is due to prolonged
activation of the physiological stress response.
Feedback for B: Correct. Prolonged pain is physically
harmful. This is due to prolonged activation of the
physiological stress response.
Feedback for C: Incorrect. Chronic pain can lead to
psychological problems such as anxiety, fear,
hopelessness, and suicidal thinking. The correct answer is
B. Prolonged pain is physically harmful. This is due to
prolonged activation of the physiological stress response.
Feedback for D: Incorrect. The correct answer is B.
Prolonged pain is physically harmful. This is due to
prolonged activation of the physiological stress response.
Feedback for E: Incorrect. The correct answer is B.
Prolonged pain is physically harmful. This is due to
prolonged activation of the physiological stress response.
Point 8 of 9
3009
Summary
You have completed the lesson on the benefits of treating pain.
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Remember:
• Medical professionals have an ethical duty to relieve pain and
suffering.
• Prolonged pain can be harmful to the body. Treating pain can
promote overall patient health and wellbeing.
• According to JCAHO, pain management is a patient right.
• JCAHO standards requires hospitals to assess for pain, treat
pain, and educate patients about pain.
Point 9 of 9
Lesson 4: Assessing Pain
4001
Introduction
Welcome to the lesson on assessing pain.
FLASH ANIMATION: 4001.SWF/FLA
Point 1 of 23
4002
Objectives
After completing this lesson, you should be able to:
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•
List the parts of a baseline pain assessment, including the
function and goal of each part.
• Recognize opportunities for patient education during the pain
assessment.
• Identify pain rating scales and how to use them.
• Recognize how and why patients should be reassessed for
pain.
Point 2 of 23
4003
Importance of Assessment
Assessment and reassessment of pain are important for:
•
•
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Developing a pain treatment plan
Changing the plan as needed
Point 3 of 23
4004
Baseline Assessment
The initial (or baseline) pain assessment should include the
following parts:
• Review pain history and description.
• Determine type and cause of pain.
• Assess intensity of pain.
• Review analgesic [glossary] history.
• Explore attitudes and beliefs about pain and pain
treatment.
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Let’s take a closer look at each part.
Point 4 of 23
4005
Pain History and Description
The first part of the baseline pain assessment is to take a full pain
history.
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First, make sure you understand the words and terms the patient
uses to talk about pain.
Then, find out:
•
•
•
•
•
•
•
The location of the pain
Whether the pain radiates [glossary]
When the pain started
Whether the pain comes and goes
What makes the pain flare up
What the pain is like (burning, stabbing, aching, throbbing,
cramping)
Whether the patient has a family history of pain
Point 5 of 23
4006
Pain History and Description (2)
During the pain history, be certain to screen for other symptoms.
For example, ask about:
• Pain-related medical problems
• Depression
• Anxiety
• Insomnia [glossary]
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Ask how pain affect the patient’s:
• Lifestyle
• Work
• Social activity
• Family
• Sex drive
Point 6 of 23
4007
Type and Cause of Pain
Removing the cause is always the best way to treat pain.
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Therefore, the second part of the pain assessment is to look for
possible causes.
First, look for possible physiological causes.
If there is no apparent physiological cause, look for psychological
causes.
Take this opportunity to educate the patient about the types,
causes, and biological function of pain.
Point 7 of 23
4008
Intensity of Pain
The third part of the pain assessment is to determine the intensity
of the pain.
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This is important for two reasons:
• To choose proper treatment.
• To establish a “pain baseline.” [glossary] This baseline
gives you a reference point to judge the results of
treatment.
Pain intensity is measured using a pain scale.
Scales include:
• Numerical scales
• Visual analog scales
• The FACES Scale
• Behavioral scales
Let’s take a closer look at each.
Point 8 of 23
4009
Numerical Pain Scales
Numerical pain scales ask patients to rate their pain from 0 to 5, 0
to 10, or 0 to 100, depending on the scale.
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Numerical scales sometimes include verbal descriptions of pain, as
well. This can help patients choose the right number for their pain.
For example, descriptions might be:
• 0 = No pain
• 2 = Annoying pain
• 4 = Uncomfortable pain
• 6 = Dreadful pain
• 8 = Horrible pain
• 10 = Agonizing pain
Numerical scales are used for:
• Adults
• Adolescents
• Schoolchildren
Point 9 of 23
4010
Visual Analog Scales
Visual analog scales (VAS) ask patients to point to the place on
the scale that shows their pain. “No pain” is at the far left of the
scale. “Worst possible pain” is at the far right of the scale.
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Many VAS have a length of ten centimeters. This makes it possible
to measure the patient’s answer and give the pain a number value.
For example, a patient who points to the middle of the scale has a
pain value of “5 cm.”
This type of scale is used for:
• Adults
• Adolescents
• Schoolchildren
Point 10 of 23
4011
FACES Scale
The Wong-Baker FACES Scale uses a series of faces.
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The clinician must explain that each face shows a person who
feels happy or sad because of hurting or not hurting:
• Face 0 is very happy because he has no pain at all.
• Face 1 hurts just a little bit
• Face 2 hurts a little more
• Face 3 hurts even more
• Face 4 hurts a lot.
• Face 5 hurts worst of all.
The patient then chooses the face that best shows his or her level
of hurt.
The FACES Scale is used for:
• Children three years and older
• Elderly adults who are confused or forgetful
• Other adults who cannot use a VAS or numerical scale to
show their level of pain
• Other adults who prefer the FACES Scale
Point 11 of 23
4012
Behavioral Scales
The previous three scales are all self-reporting scales. This means
that patients use these scales to tell about their own pain.
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However, some patients cannot self-report. Behavioral pain scales
must be used.
For example, the FLACC Scale is useful for infants.
The clinician observes the behavior of the baby in five categories:
• F ace
• L egs
• A ctivity
• C ry
• C onsolability
Each category is given a score of 0, 1, or 2, based on observed
behavior (see table to the right). This gives a total pain score of 0
to 10.
Point 12 of 23
4013
Using Pain Scales
To treat pain effectively, pain scales must be used correctly and
consistently.
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Remember: Different scales are useful for adults, young children,
and infants.
Therefore, hospitals should have a variety of pain scales available.
Once the right scale is chosen for a specific patient:
• The patient must be taught to use the scale correctly.
• The same scale must be used consistently. This means
that the same scale should be used every time pain is
assessed on the patient.
When pain scales are used correctly and consistently, pain can be
tracked accurately over time. This makes it possible to determine:
• How pain is changing
• Whether treatment is working
Point 13 of 23
4014
Review
FLASH INTERACTION: 4014.SWF/FLA
Match the patient with the most appropriate choice of pain rating scale.
Point 14 of 23
4015
Analgesic History
The next part of the pain assessment is to review the patient’s
analgesic history [glossary].
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Find out:
• What the patient has taken (or is taking) for pain. This
should include:
• Dosage
• Frequency
• Route of administration
• The effect of the medication. This should include:
• How quickly it starts to relieve pain
• How long it takes to reach maximum pain relief
• How long the pain relief lasts
• Any side effects of the medication
• Any other successes, failures, or adverse reactions the
patient has experienced when treating his or her pain
Point 15 of 23
4016
Attitudes and Beliefs About Pain and Pain Treatment (1)
The last part of the baseline pain assessment is to explore the
patient’s attitudes about pain and pain treatment.
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It is especially important to look at any attitudes or beliefs that
might prevent the patient from:
• Reporting pain
• Following the pain treatment plan
For example, a very passive patient may not report pain. A stoic
[glossary] patient may refuse pain medication.
Take this opportunity to educate patients. Make sure patients
understand:
• The importance of reporting pain
• The importance of treating pain
Point 16 of 23
4017
Attitudes and Beliefs About Pain and Pain Treatment (2)
Some patients may be afraid of addiction to opioid analgesics
[glossary]. This can interfere with proper treatment of pain.
Be certain to ask patients about the fear of addiction. Ask about
any other medication fears.
When necessary, educate patients about addiction. Explain the
differences among:
•
•
•
Addiction
Physical dependence
Tolerance
Click on each of the items above for a brief review of key facts you
may need to explain to patients.
CLICK TO REVEAL
Addiction
Addicts show:
• Cravings for a substance
• An inability to control their use of the substance
• Use of the substance even when it is clearly
harmful
Addiction is very rare with long-term use of opioids to
treat chronic pain.
Physical dependence
Physical dependence happens when the body adjusts to
having a drug. Physically dependent patients develop drugspecific signs and symptoms when they:
• Suddenly stop using a drug.
• Rapidly reduce their dosage of a drug.
Physical dependence:
• Is normal with long-term use of opioids for pain
• Is not the same as addiction
Tolerance
With regular use of drug, tolerance can develop:
• A constant dose of the drug produces less and less
effect
• An increased dose of the drug is required.
Tolerance:
• Is normal with long-term use of opioids for pain
• Is not the same as addiction
Point 17 of 23
4018
Review
FLASH INTERACTION: 4018.SWF/FLA
Drag and drop terms from the word bank to the appropriate place in the diagram.
Point 18 of 23
4019
Reassessment
After the baseline assessment, pain must be reassessed on a
regular basis.
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Think of pain as the “fifth vital sign.”
In other words, monitor and chart this parameter just as you would
blood pressure, pulse, temperature, and respiratory rate.
Point 19 of 23
4020
Reassessment: What and Why
Monitoring and reassessing pain make it possible to:
• Identify and respond promptly to any new pain.
• Track the course of existing pain, including how the pain
responds to treatment.
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With each reassessment, ask the patient about the pain’s:
• Location
• Intensity (using the chosen pain scale)
• Character and quality
• Onset, timing, and course
Document the patient’s answers.
Point 20 of 23
4021
Reassessment: Patients Who Cannot Self-Report
Remember: Some patients cannot tell you about their pain. These
patients include:
• Infants
• Cognitively impaired patients
• Sleeping patients
In these patients, reassess pain by looking for:
•
•
Behavioral changes
Involuntary responses
Click on each item above, to learn more about the changes and
responses to look for when reassessing pain.
CLICK TO REVEAL
Behavioral changes
The following behaviors may be signs of pain:
• Sleep disturbances
• Fidgeting
• Physical tension
• Vocalization
• Increased confusion
• Withdrawal
• Agitation
• Guarding
• Grimacing
Involuntary responses
The following involuntary responses may be signs of pain:
• Sweating
• Change in respiratory rate
• Increased blood pressure
• Increased pulse rate
• Shortness of breath
• Decreased blood oxygen levels
Point 21 of 23
4022
Review
Pain should be monitored and charted routinely, just like blood
pressure, pulse, temperature, and respiration rate.
a. True
b. False
TRUE / FALSE INTERACTION
Correct: A
Feedback for A: Correct. Think of pain as the fifth vital sign.
Feedback for B: Incorrect. This statement is true. Think of
pain as the fifth vital sign.
Point 22 of 23
4023
Summary
You have completed the lesson on assessing pain.
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Remember:
•
•
•
•
When performing a baseline pain assessment:
• Review the pain history.
• Identify the type and cause of pain.
• Determine pain intensity, using an appropriate pain
rating scale.
• Review the analgesic history.
• Explore the patient’s attitudes about pain. Educate the
patient on the importance of reporting and treating
pain.
• Explore the patient’s attitudes about pain treatment.
Educate the patient on addiction, physical
dependence, and tolerance with the use of opioid
analgesics.
Pain must be reassessed on a regular basis. This makes it
possible to track how the pain responds to treatment.
Reassessment also makes it possible to identify and respond
promptly to any new pain.
Think of pain as the “fifth vital sign.”
Behavioral changes and involuntary responses may be used to
reassess pain when patients cannot self-report.
Point 23 of 23
Lesson 5: Treating Pain
5001
Introduction
Welcome to the lesson on treating pain.
FLASH ANIMATION: 5001.SWF/FLA
Point 1 of 14
5002
Objectives
After completing this lesson, you should be able to:
•
•
•
•
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Identify drugs used to treat pain.
List potential barriers to the prescription of adequate analgesic
[glossary] drugs.
Recognize issues related to the use of placebos [glossary] for
pain, and the use of analgesic drugs for elderly patients.
Cite guidelines for the use of non-drug approaches to treating
pain.
Point 2 of 14
5003
Treating Pain
There are two general types of pain treatment:
• Pharmacologic (or drug)
• Non-pharmacologic (or non-drug)
IMAGE: 5003.GIF
Let’s take a closer look at each.
Point 3 of 14
5004
Drug Treatment: Mainstay Drugs
The following drugs are commonly used to treat pain:
• Acetaminophen
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Opioids
• Opioid + non-opioid combination drugs
IMAGE: 5004.GIF
Common examples are listed in the table to the right.
Point 4 of 14
5005
Drug Treatment: Adjuvant Drugs
Some types of pain do not respond to commonly used drugs.
IMAGE: 5005.GIF
These types of pain may respond to:
• Antidepressants
• Anticonvulsants
• Corticosteroids
With these drugs:
• Pain relief is not immediate.
• There may be serious side effects.
Point 5 of 14
5006
Drug Treatment: Patient Education
Patients should be educated on drugs given for pain.
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Education should include:
• Possible side effects
• Possible adverse reactions
Point 6 of 14
5007
Drug Treatment: Monitoring and Assessment
All drug doses must be documented and assessed for effect. This
helps ensure that drugs are working to control pain.
IMAGE: 5007.GIF
The following items should be documented:
• Time of dosage
• Intensity of pain (using a pain scale) before and after
dosage
• Any side effects of the medication
• Any adverse reactions
• Patient vitals before and after dosage
Point 7 of 14
5008
Drug Treatment: Potential Barriers
Many studies have shown that pain is under-treated. Analgesics
are often not prescribed when they should be.
IMAGE: 5008.GIF
Clinicians may not prescribe analgesics because:
• They do not consider treating pain important.
• They do not know enough about treating pain.
• They are afraid of prescribing opioid to addicts or drug
dealers.
• They are afraid of regulatory audits if they prescribe
opioids.
Therefore, clinicians must be trained and educated on:
• The importance of treating pain
• Using opioids to treat pain
• Laws and regulations for prescribing opioids
Point 8 of 14
5009
Drug Treatment: Placebos
Placebos should not be used to treat pain.
IMAGE: 5009.GIF
It is unethical and improper to use placebos, in place of pain
medication, to:
• Assess or treat pain.
• Determine whether pain is “real.”
• Diagnose psychological symptoms seen with pain.
Point 9 of 14
5010
Drug Treatment: The Elderly
IMAGE: 5010.JPG
In elderly patients, drugs may have unusually strong or weak
effects. This is due to factors common in the elderly population,
such as:
•
•
•
•
Chronic disorders
Poor nutrition
Taking many drugs
Decreased drug absorption rate
Drugs in the elderly also tend to have a longer duration of activity
and a higher peak of maximum activity.
Therefore, be careful when giving analgesics to elderly patients.
Monitor these patients closely, to ensure safe and adequate
dosing.
Point 10 of 14
5011
Review
A patient is about to be given a dose of an opioid analgesic.
Intensity of pain should be measured before and after this dosage,
using a pain rating scale.
a. True
b. False
TRUE / FALSE INTERACTION
Correct: A
Feedback for A: Correct. This statement is true.
Feedback for B: Incorrect. This statement is true.
Point 11 of 14
5012
Non-Drug Treatment
Many non-drug methods have been tried to relieve pain.
IMAGE: 5012.GIF
These methods may be used:
• Alone
• In combination with one another
• In combination with drugs
Non-drug treatment can:
• Relieve pain.
• Manage pain to improve a patient’s overall functioning and
quality of life.
Point 12 of 14
5013
Non-Drug Treatment: Guidelines
Guidelines for non-drug treatment of pain include:
• Respect non-Western approaches to pain relief. Allow the
patient to use these approaches, unless specifically
contraindicated [glossary].
• Bear in mind that herbal remedies can interact with drugs.
• Measure intensity of pain (using a pain scale) before and
after all non-drug treatments, to assess effectiveness.
• Many non-drug methods focus on relieving the anxiety,
tension, and other physical symptoms that come with pain.
Drugs may be necessary to relieve the pain itself.
•
IMAGE: 5013.GIF
Point 13 of 14
5014
Summary
You have completed the lesson on treating pain.
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Remember:
• Drugs commonly used to treat pain are acetaminophen,
NSAIDs, opioids, and opioid + non-opioid combination
drugs.
• Antidepressants, anticonvulsants, and corticosteroids may
be used for pain that does not respond to commonly used
analgesics.
• Patients should be educated on drugs given for pain.
• All analgesic drug doses should be documented. Pain
intensity should be measured and documented before and
after each dosage.
• Clinicians must be trained and educated on pain
management. They must understand the importance of
treating pain, the use of opioids to treat pain, and the laws
and regulations for prescribing opioids.
• Placebos should not be used to assess or manage pain.
• Elderly patients often have altered drug metabolism.
Therefore, these patients must be monitored closely to
ensure safe and adequate dosing.
• Non-drug methods can help relieve or manage pain.
These methods can be used alone, in combination with
one another, or in combination with drugs.
• Respect non-drug approaches to treating pain. Offer drugs
when indicated.
Point 14 of 14
Course Glossary
#
Term
Definition
analgesic
subjective
acute
chronic
physiological
psychological
physiological stress response
radiate
insomnia
pain baseline
drug that relieves pain
taking place within the mind and modified by individual bias
describing a condition with a rapid onset and short but relatively severe course
describing a long-term condition
of or relating to the physical functions of the body
mental or emotional in nature
physical changes that occur in the body as a result of physical or emotional stress
to spread outward
inability to sleep
an initial measurement of pain used as the basis of comparison for future pain
measurements
stoic
opioid analgesics
analgesic
placebo
unresponsive to pain or pleasure
a class of pain-relieving drugs (heroin, codeine, methadone, etc.) derived from the opium
poppy, containing opium, or produced synthetically to give opium-like effects
pain-relieving
inert substance, “sugar pill”
contraindicate
adjuvant
to make a treatment inadvisable
describing a secondary treatment for a condition
[Pain Management]
Pre-Assessment
1. Pain is always:
a. Intense
b. Sensory
c. Caused by acute tissue damage
d. All of these answers
e. None of these answers
Correct Answer: None of these answers
Answer Rationale: Pain may be mild or severe. Pain may be sensory or emotional. Acute somatogenic pain is caused by acute tissue damage.
Psychogenic and chronic pain, however, do not have to do with tissue damage.
2. Chronic pain often produces other symptoms. These symptoms develop because of ongoing activation of the:
a. Pyramidal tract
b. Gastrointestinal motility
c. Parasympathetic pathways
d. Physiological stress response
Correct Answer: Physiological stress response
Answer Rationale: The physiological stress response produces the symptoms often seen with chronic pain. These symptoms include sleep
disturbances, high blood pressure, confusion, constipation, anxiety, and depression.
3. Patients have the right to appropriate management of pain.
a. True
b. False
Correct Answer: True
Answer Rationale: According to JCAHO, pain management is a patient right.
4. Persistent pain is unpleasant. However, the pain itself is not physically harmful.
a. True
b. False
Correct Answer: False
Answer Rationale: Prolonged pain is unpleasant. It also can be harmful to the body. This is due to prolonged activation of the physiological stress
response.
5. The first choice for treating pain is to:
a. Give the patient an opioid analgesic.
b. Identify and remove the cause of pain.
c. Prescribe acetaminophen or an NSAID.
d. Use guided imagery and relaxation techniques
Correct Answer: Identify and remove the cause of pain.
Answer Rationale: Drugs and non-drug methods are often necessary to treat pain. However, the first choice for treating pain is to identify and
remove the cause, if possible.
6. You are performing a pain assessment on a four-month-old infant. Which of the following pain scales should you use?
a. The FLACC scale
b. A visual analog scale (VAS)
c. The Wong-Baker FACES Scale
Correct Answer: The FLACC scale
Answer Rationale: Of the choices given, the FLACC scale would be best. The FLACC scale is a behavioral scale. VAS and FACES are both selfreporting scales. Therefore, these scales are not useful for an infant.
7. Visual analog scales (VAS) often measure pain in centimeters.
a. True
b. False
Correct Answer: True
Answer Rationale: VAS often use centimeters on a horizontal scale to give a number value to a patient’s pain.
8. Which of the following is a behavioral pain rating scale?
a. A numerical scale
b. The FLACC scale
c. A visual analog scale (VAS)
d. All of these answers
e. None of these answers
Correct Answer: The FLACC scale
Answer Rationale: The FLACC scale is a behavioral pain rating scale. The clinician must observe the behavior of the patient in five different
categories (Face, Legs, Activity, Cry, and Consolability). Numerical scales and VAS are self-reporting scales.
9. Which of the following statements is true?
a. For consistency, a single pain rating scale should be used on all patients throughout a facility.
b. For consistency, a single pain rating scale should be used each time pain is assessed or reassessed on a given patient.
c. For consistency, each clinician should select a single pain rating scale to use each time he or she performs a pain assessment.
d. All of these answers are correct.
e. None of these answers is correct.
Correct Answer: For consistency, a single pain rating scale should be used each time pain is assessed or reassessed on a given patient.
Answer Rationale: No single pain scale is useful for all patients. Therefore, facilities should have several pain scales available. Clinicians should
know how to use all of these scales. Once a scale is chosen for a given patient, that same scale should be used each time pain is assessed for
that patient.
10. Which of the following is (are) typical with long-terms use of opioids to treat pain?
a. Addiction
b. Tolerance
c. Physical dependence
d. Tolerance and physical dependence
e. All of these answers
Correct Answer: Tolerance and physical dependence
Answer Rationale: Both tolerance and physical dependence are normal with long-term use of opioids to treat pain. Addiction is very rare.
11. A patient develops drug-specific signs and symptoms when he stops use of a drug suddenly. This patient has:
a. Addiction
b. Tolerance
c. Physical dependence
d. Addiction and tolerance
e. All of these answers
Correct Answer: Physical dependence
Answer Rationale: Physical dependence is when the body adjusts to having a drug. Drug-specific signs and symptoms develop when the drug is
stopped or decreased suddenly.
12. You are reassessing pain on a sleeping patient. Which of the following could be a sign of pain?
a. Sweating
b. Decreased blood pressure
c. Increased blood oxygen levels
d. All of these answers
e. None of these answers
Correct Answer: Sweating
Answer Rationale: Sweating, increased blood pressure, and decreased blood oxygen levels can be signs of pain.
13. Placebos are okay for:
a. Assessing pain
b. Finding out whether pain is real
c. Diagnosing psychological symptoms seen with pain
d. All of these answers
e. None of these answers
Correct Answer: None of these answers
Answer Rationale: It is improper and unethical to use a placebo to assess or treat pain in any way.
14. Which of the following drugs is used to treat pain?
a. Opioids
b. Antidepressants
c. Anticonvulsants
d. All of these answers
e. None of these answers
Correct Answer: All of these answers
Answer Rationale: Opioids are commonly used to treat severe pain. Antidepressants, anticonvulsants, and corticosteroids also may be used, for
poorly controlled chronic pain.
15. You are performing a baseline pain assessment on a new patient. You start to take the analgesic history. You should ask:
a. What medications do you currently take for pain?
b. Do you have any problems with the medication you are currently taking?
c. When you take your medication, how much time usually passes before the medication starts to work?
d. All of these answers are correct.
e. None of these answers is correct
Correct Answer: All of these answers are correct.
Answer Rationale: All of these are important questions for the analgesic history.
16. You are dealing with a stoic patient. You should make sure this patient understands:
a. The risk of addiction with opioid analgesics
b.
c.
d.
e.
The importance of reporting and treating pain
The superiority of non-drug methods for pain management
All of these answers
None of these answers
Correct Answer: The importance of reporting and treating pain
Answer Rationale: Stoic patients often do not report pain. They may refuse pain medication. Therefore, make sure these patients understand the
importance of reporting and treating pain. You also might want to remind these patients that addiction is very rare with the use of opioids to treat
pain.
Final Exam
Question Title: Question 1
Question: The biological function of pain is to warn about injury.
Answer 1: True
Answer 2: False
Correct Answer: True
Answer Rationale: This statement is true.
Question Title: Question 2
Question: Pain is always sensory.
Answer 1: True
Answer 2: False
Correct Answer: False
Answer Rationale: Pain may be sensory or emotional.
Question Title: Question 3
Question: Acute pain causes a “fight-or-flight” response. This response includes:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Increased heart rate
Constriction of the pupils
Decreased respiratory rate
All of these answers
None of these answers
Correct Answer: Increased heart rate
Answer Rationale: “Fight-or-flight” responses include increased heart rate, dilation of the pupils. and increased respiratory rate.
Question Title: Question 4
Question: Pain may be___________.
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Idiopathic
Psychogenic
Somatogenic
Any of these answers
None of these answers
Correct Answer: Any of these answers
Answer Rationale: If pain has a physiological cause, it is somatogenic. If pain has a psychological cause, it is psychogenic. If pain has no
apparent cause, it is idiopathic.
Question Title: Question 5
Question: JCAHO standards require hospitals to:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Educate patients about pain.
Assess and reassess for pain.
Treat pain, or refer patients for treatment.
All of these answers are correct.
None of these answers is correct.
Correct Answer: All of these answers are correct.
Answer Rationale: JCAHO standards require hospitals to assess and reassess for pain, treat pain (or refer patients for treatment), and educate
patients about pain.
Question Title: Question 6
Question: You are performing a pain assessment. You should find out:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Where the pain is located
What the pain is like
How severe the pain is
All of these answers
None of these answers
Correct Answer: All of these answers
Answer Rationale: The pain assessment should find out the location, quality, character, and intensity of pain.
Question Title: Question 7
Question: Always determine the intensity of pain before treatment. This sets a pain baseline. The pain baseline can be used to judge whether
treatment is working.
Answer 1: True
Answer 2: False
Correct Answer: True
Answer Rationale: This statement is true.
Question Title: Question 8
Question: You are assessing pain on a conscious three-year-old. This patient has age-appropriate verbal and cognitive skills. Which pain scale
should you use?
Answer 1: The FLACC Scale
Answer 2: A visual analog scale (VAS)
Answer 3: The Wong-Baker FACES Scale
Correct Answer: The Wong-Baker FACES Scale
Answer Rationale: The Wong-Baker FACES Scale is the best choice for this patient. The FLACC Scale is for infants. Visual analog scales are for
older children and adults.
Question Title: Question 9
Question: On the Wong-Baker FACES Scale:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Pain is color-coded.
Pain is measured in centimeters.
Face 0 is smiling because he has no hurt at all.
The patient chooses a number that matches the intensity of his or her pain.
Correct Answer: Face 0 is smiling because he has no hurt at all.
Answer Rationale: The Wong-Baker FACES Scale uses a series of faces. Each face represents a person who feels happy or sad because of
hurting or not hurting. Face 0 is smiling because he has no hurt at all.
Question Title: Question 10
Question: Which of the following is a self-reporting pain scale?
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
A numerical scale
A visual analog scale (VAS)
The Wong-Baker FACES Scale
All of these answers
None of these answers
Correct Answer: All of these answers
Answer Rationale: Numerical scales, VAS, and the FACES Scale all help patients self-report their pain.
Question Title: Question 11
Question: ____________ result(s) in compulsive use of a drug, despite harmful effects.
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Addiction
Tolerance
Physical dependence
Addiction and physical dependence
All of these answers
Correct Answer: Addiction
Answer Rationale: Addicts use a substance compulsively.
Question Title: Question 12
Question: A higher dose of pain medication is required to treat a patient’s pain. This patient has developed:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Addiction
Tolerance
Physical dependence
Addiction and physical dependence
All of these answers
Correct Answer: Tolerance
Answer Rationale: With drug tolerance, a constant dose of a drug produces less and less effect. A higher dose is needed.
Question Title: Question 13
Question: Addiction is common in patients who use long-term opioids to treat pain.
Answer 1: True
Answer 2: False
Correct Answer: False
Answer Rationale: Addiction is very rare with long-term use of opioids to treat chronic pain.
Question Title: Question 14
Question: Behavioral signs of pain can include:
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Fidgeting
Guarding
Grimacing
All of these answers
None of these answers
Correct Answer: All of these answers
Answer Rationale: All of these behaviors may be signs of pain.
Question Title: Question 15
Question: Which of the following is an opioid?
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Answer 5:
Naproxen
Ibuprofen
Oxycodone
All of these answers
None of these answers
Correct Answer: Oxycodone
Answer Rationale: Oxycodone is an opioid. Both naproxen and ibuprofen are NSAID’s.
Question Title: Question 16
Question: Which of the following best describes the relationship between drug and non-drug methods for treating pain?
Answer 1:
Answer 2:
Answer 3:
Answer 4:
Non-drug methods frequently interfere with drugs.
If non-drug methods are used, drugs should not be used.
Many non-drug methods focus on relieving symptoms seen with pain. Drugs may be necessary to relieve the pain itself.
There is no evidence that non-drug methods work. Patients should be discouraged from trying non-drug approaches.
Correct Answer: Many non-drug methods focus on relieving symptoms seen with pain. Drugs may be necessary to relieve the pain itself.
Answer Rationale: Both drug and non-drug methods for treating pain can be effective. The two different methods can be used alone or together.
Because many non-drug approaches focus on relieving symptoms seen with pain, drugs also may be necessary to relieve the pain itself.