Pain

Definition: An unpleasant physical and emotional experience associated with or described in terms of actual or potential tissue damage

Comment/Importance to Caregiving:

  • Understanding the pain helps you share important information with your loved one’s healthcare providers that can help to guide the treatment plan
  • “Pain is whatever the older adult says it is, occurring whenever he/she says it does”

Types of Pain | Terms Used to Describe Pain | Pain Assessment & Management Terminology | Treatment Related Terminology | References | PDF

TYPES OF PAIN

Acute Pain

Definition: Pain that is usually temporary and results from something specific, such as a surgery, an injury, or an infection

Comment/Importance to Caregiving:

  • Understanding the type of pain helps you share important information that can help to guide the treatment plan
  • Ineffectively treated acute pain can turn into chronic pain
Chronic Pain

Definition: A painful experience that continues for a prolonged period that may or may not be associated with a disease

Comment/Importance to Caregiving:

  • Also called persistent pain
  • It is estimated up to 80% of individuals living in nursing homes have chronic pain
  • A variety of diagnoses contribute to chronic pain in this population, including: osteoarthritis, cancer, post-stroke pain, diabetic peripheral neuropathy, and others
Musculoskeletal Pain

Definition: Pain of the muscles, joints, connective tissues and bones

Comment/Importance to Caregiving:

  • This pain is relatively well localized and is typically worse on movement
  • This type of pain is often described as a dull, or ‘background’ aching pain, although the area may be tender to pressure
Breakthrough Pain

Definition: Pain that increases above the level of pain addressed by ongoing analgesics

Comment/Importance to Caregiving:

  • Associated with Cancer Pain
  • Reported in 2 out of 3 people with continuous persistent cancer pain
  • This pain may be sudden or gradual, brief or prolonged and spontaneous
Nociceptive Pain 

Definition: Pain caused by tissue injury in the joints, bones, muscles, and various internal organs. The patient's nervous system is functioning normally, picks up the injury and sends the information to the brain.

Comment/Importance to Caregiving

  • Nociceptive pain is typically a localized, constant pain and often described as aching or throbbing
  • This type of pain is usually time limited: when the tissue damage heals, the pain typically resolves
  • This type of pain tends to respond well to treatment with nonopioids and opioids
Neuropathic Pain

Definition: Pain initiated or caused by a primary lesion or dysfunction in the nervous system

Comment/Importance to Caregiving

  • Common words used to describe this pain include: burning, tingling, numb, squeezing & itching. There may be electric shooting sensations, often radiating down a nerve path and sensitivity over the area of skin.
  • Pain may persist for months or years beyond healing of damaged tissues
  • Neuropathic pain is frequently chronic & tends to respond less well to treatment with opioids but may respond to other drugs like anti-seizure and antidepressant medications

TERMS USED TO DESCRIBE PAIN

Onset

Definition: Description of the experience of the beginning of the pain.

Comment/Importance to Caregiving

  • Understanding the onset of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Your loved one may describe a sudden or gradual development of the pain, associated with a known injury or illness 
  • Asking about onset can also help identify pain triggered by specific movement or activity
Duration

Definition: How long the pain has been experienced and continues to be present (lasting minutes or hours)

Comment/Importance to Caregiving

  • Understanding the duration of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • As the person that knows your loved one best you may be the one to provide the most accurate information to the healthcare team, especially if your loved one is unable to self-report. This information is vital in helping to support treatment plan decisions
  • Information is critical for evaluating the effectiveness of the treatment plan
Frequency

Definition: The number of occurrences in a specified period of time; how often the pain is experienced in a given time period.

Comment/Importance to Caregiving

  • Understanding the frequency of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Knowing the frequency of pain is useful in developing treatment strategies and for individualized scheduling of care activities
Location

Definition: Site(s) of pain

Comment/Importance to Caregiving

  • Understanding the location of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Most older adults have pain in more than one location
  • Document-intensity & quality for all pain locations
  • Pain maps (drawing of a body so you can indicate where the pain is located) are very useful in documenting all pain locations, guiding therapy, etc.
Intensity

Definition: The older adult’s descriptive rating (such as a number, “5” or a word, like “moderate”) that describes the intensity or severity of the pain.

Comment/Importance to Caregiving

  • Understanding the intensity of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Also called Severity
  • Usually helpful to identify intensity for the ‘worst pain’ over a specified period as well as ‘the best the pain gets’
  • Assessing the older adult’s present pain rating and an identified pain rating acceptable to the older adult is also important
  • Use the most appropriate pain assessment scale individualized to the older adult’s cognitive and sensory abilities to determine their pain intensity level (see the FAST FACT- Caregivers: When to use Pain Assessment Tools)
Pattern

Definition: The progress of the pain over time including changes, often influenced by times of day (e.g., certain hours of the day, night or day, monthly patterns), periods of rest, or specific or general activity/movement.

Comment/Importance to Caregiving

  • Understanding the pattern of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Helps to determine if there are influences that impact the pain
  • Older adults can experience constant and/or episodic pain
  • Analgesic treatment should be tailored to these patterns
Quality

Definition: Description of the characteristics of the pain, preferably in the words used by the older adult to describe the pain.

Comment/Importance to Caregiving

  • Understanding the quality of pain helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Also called “Character” of pain
  • Helpful in determining the type of pain to select the most appropriate treatments, including analgesics and nondrug therapies
  • If the older adult has difficulty describing the pain, it may be helpful to offer examples of descriptions including: aching, sore, cramping, pounding, sharp, throbbing, dull, nagging, shooting, numb, tingling, spasm, burning, gnawing, pressure-like, radiating, stabbing, tingling, tender, knife-like, etc.

PAIN ASSESSMENT & MANAGEMENT TERMINOLOGY

Pain Assessment

Definition: The process of gathering information on the pain including the onset, duration, frequency, location, intensity, pattern, and quality of the pain.

Comment/Importance to Caregiving

  • The caregiver is often in the best position to provide the most accurate information for a Pain Assessment to guide the healthcare team in the development and ongoing updating of the treatment plan
Pain Diary

Definition: A communication tool used to share information about the daily pain experience with the healthcare team

Comment/Importance to Caregiving

  • The caregiver can use a Pain Dairy to document the daily pain experience of their loved one to monitor the effectiveness of the current pain treatment plan to share with the healthcare team
Pain Scale

Definition: A tool used to evaluate an individual’s pain intensity or behavior.

Comment/Importance to Caregiving

  • For individuals who are able to self-report a pain scale that uses a numeric rating scale (such as 1-10) or a verbal descriptor scale (such as mild, moderate or severe) may be appropriate (see FAST FACTS-When to use Pain Assessment Tools).
  • For Individuals who are NOT able to self-report there are specific Pain Scales that look at behaviors that may indicate pain (If your loved one does not have the ability to self-report, ask your healthcare provider about the appropriate tool to use).
Pain Specialist

Definition: A clinician who has received advanced training in pain management.

Comment/Importance to Caregiving

  • If you find that your loved ones’ regular provider can't help, ask him or her for the name of a pain medicine specialist. A pain specialist may be a doctor, nurse, or anesthesiologist.

TREATMENT RELATED TERMINOLOGY

Analgesic

Definition: Drugs that relieve pain without altering consciousness.

Comment/Importance to Caregiving

  • Analgesics are often part of the treatment plan, especially when pain is moderate or severe
Non-Drug Pain Management Treatments

Definition: Nondrug Treatments include activities or experiences that help provide relief of physical and psychological symptoms of pain either with or without the use of medications, or in addition to, the use of medication.

Comment/Importance to Caregiving

  • There are two categories of nondrug treatment techniques:
    1. Physical and
    2. Psychological
  • Examples of physical nondrug techniques:   
    1. Massage
    2. Cold
    3. Heat
    4. Positioning
    5. TENS
    6. Acupuncture
    7. Tai Chi
    8. Yoga
    9. Walking
    10. Qigong
  • Examples of Psychological nondrug techniques:
    1. Distraction
    2. Relaxation
    3. Music
    4. Controlled breathing & guided imagery
    5. Mindfulness-based Mediation
    6. Cognitive-Behavioral Therapy
  • Mild-to-moderate pain may be relieved by nondrug techniques alone
  • Moderate-to-severe pain may require medication in addition to nondrug treatment techniques
  • Some nondrug techniques may require professional oversite to perform
Opioid Therapy

Definition: A class of drugs used to reduce pain, generally prescribed to treat moderate to severe pain, that works by interfering with the perception of pain in the brain

Comment/Importance to Caregiving

  • Understanding the pain your loved one is experiencing helps you share important information with your loved one’s healthcare provider that can help to guide the treatment plan
  • Helping your loved one to Maintain a Daily Pain Dairy is an excellent way to share information with the healthcare team about your loved ones’ pain experience (see the FAST FACTS- Caregivers: Using a Pain Diary)
Opioid Use Disorder

Definition: A problematic pattern of opioid use that causes significant impairment or distress.

Comment/Importance to Caregiving

  • Used to be called addiction, but now diagnosed as Opioid Use Disorder
  • Opioid Use Disorder is uncommon among people living in nursing homes being treated for pain
  • Tolerance and physical dependence are normal physiologic responses to chronic medication administration, whereas Opioid Use Disorder is a disease that is not a normal response to opioid use
  • Opioid Use Disorder is more likely to occur in older adults with multiple risk factors, such as a genetic predisposition, a history of addictive behavior, or a history of abuse and/or neglect
  • It is recommended that pain be adequately controlled before reaching conclusions about concerns related to Opioid Use Disorder behaviors
  • An individual’s behaviors that may suggest Opioid Use Disorder (OUD) sometimes reflect unrelieved pain or other problems unrelated to OUD, you should report all behaviors to your loved ones’ healthcare team for evaluation

REFERENCES:

https://www.cdc.gov/opioids/; Accessed 1/16/2019

Definitions Related to the Use of Opioids for the Treatment of Pain: a consensus document from the American Academy of Pain Medicine the American Pain Society, and the American Society of Addiction Medicine, 2009. 

Public Policy Statement on the Rights and Responsibilities of Healthcare Professionals in the use of Opioids for the Treatment of Pain. A consensus document from the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine.

Promoting Pain Relief and Preventing Abuse of Pain Medications: A Critical Balancing Act, a Joint Statement. From 21 Health Organizations and the Drug Enforcement Administration, 2001. Available at:  http://www.deadiversion.usdoj.gov/pubs/advisories/painrelief.pdf  Accessed December 1, 2016.

Fine, PG, Portenoy, RK: A Clinical Guide to Opioid Analgesia, New York: McGraw Hill, 2007.

Reuben, D., Herr, K., Pacala, J., Pollock, B., Potter, J. & Semla, T. (2018). Geriatrics At Your Fingertips, 20th Ed. New York, NY: American Geriatrics Society (pp 247-268).

PDF iconPain Terminology for Caregivers - PDF Version

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