CLINICAL PAIN MEASUREMENT CLINICAL PAIN MEASUREMENT METHODSMETHODS

Z. TURK, D. ČELAN, A. AMMERZ. TURK, D. ČELAN, A. AMMERUKC MARIBOR, UKC MARIBOR,

Institute of Physical and Rehabilitation Medicine Institute of Physical and Rehabilitation Medicine

SEDARE DOLOREM SEDARE DOLOREM DIVINUM ESTDIVINUM EST

DOLOMETERDOLOMETER

ALGOMETER?ALGOMETER?

Pain evaluation through centuries:

sadness, joy, suffering, torture, bluffing, etc.

PAIN IS INFORMATION PROVIDED BY THE PATIENT – INJURED PERSON AND

EVALUATED BY A THERAPIST

PAIN CAN BE: •PHYSICAL

•PSYCHOLOGICAL

•PSYCHOGENIC

•SOCIAL

•COGNITIVE

•EMOTIONAL

•SENSITIVE

•FUNCTIONAL

•MOTIVATIONAL

MEASUREMENT MEASUREMENT METHODSMETHODS

Descriptive terms (no pain, mild, moderate, severe Descriptive terms (no pain, mild, moderate, severe pain)pain)

Numeric (0 to 10)Numeric (0 to 10)

DescriptiveDescriptive

VisualVisual

Questionnaires andQuestionnaires and

Instrumental measurement (laser, EMG, clinical Instrumental measurement (laser, EMG, clinical measurement)measurement)

Visual scales

VAS (visual analogue scale)

Different forms – numbers, images, contacts, for the purpose of analyzing results

UNIT FOR MEASURING PAIN

– PAIN INTENSITY ???

ALGORITHM - BONICAALGORITHM - BONICA

ACUTE PAINACUTE PAIN

(duration, intensity, ,measuring methods -VAS, (duration, intensity, ,measuring methods -VAS, numeric scales)numeric scales)

CHRONIC PAINCHRONIC PAIN

(visual, verbal, numeric, questionnaires, (visual, verbal, numeric, questionnaires, psychosocial tests)psychosocial tests)

CLINICAL EXAMINATIONCLINICAL EXAMINATION

InspectionInspection• SKIN: perspiration, color, sensitivity, spasticity, SKIN: perspiration, color, sensitivity, spasticity,

formform

PalpationPalpation• Pressure, kneading, compression (algometer, Pressure, kneading, compression (algometer,

dolometer)dolometer)

Neurological examinationsNeurological examinations

Neurophysiological examinations (EMG)Neurophysiological examinations (EMG)

Laser measurementsLaser measurements

ALGOMETERALGOMETER

MEASURE PAIN INTENSITYMEASURE PAIN INTENSITY

Pain is what the patient reportsPain is what the patient reports

Belive the patientBelive the patient

Measure and systematically recordMeasure and systematically record

PAIN MEASUREMENTPAIN MEASUREMENTMETHODSMETHODS

Descriptive TermsDescriptive Terms– No pain, Mild, Moderate, SevereNo pain, Mild, Moderate, Severe

Numerical ScoresNumerical Scores– Number 0 throughNumber 0 through 1010

Faces ScalesFaces Scales

Visual AnalogueVisual Analogue

Multidimensional InstrumentsMultidimensional Instruments– McGill Pain QuestionnaireMcGill Pain Questionnaire

PALM PILOT - PAIN METERPALM PILOT - PAIN METER

Palm top computerPalm top computer

Measures 4 dimensionsMeasures 4 dimensions– Pain IntensityPain Intensity– Pain ReliefPain Relief– MoodMood– Side EffectsSide Effects

One composite score from 0 to 10One composite score from 0 to 10

PALM PILOT PALM PILOT – PAIN INTENSITY – PAIN INTENSITY

SCREENSCREEN

0 – None0 – None1 – Minimal1 – Minimal2 – Mild2 – Mild3 – Annoying3 – Annoying4 – Moderate4 – Moderate5 – Incomfortable5 – Incomfortable6 – Severe6 – Severe7 – Dreadful7 – Dreadful8 – Very Severe8 – Very Severe9 – Horrible9 – Horrible10 – Worst Possible10 – Worst Possible

PRN Pain

Treatment Cycle

PatientSleeps

PatientAwakes

PatientHas Pain

CalsNurse

NurseEvaluates

Signs OutMedication

PreparesInjection

Gives Injection

MedicationAbsorbed

Pain isRelleved

PAIN DIMENSIONSPAIN DIMENSIONS

Social & Cultural ExperiencesSocial & Cultural Experiences

Tissue

Damage

Emotions & Motivation

Cognitive Conceptual

Past Experiences, Current, Espectation, Secondary Gain,Loss, Threat Perception

Epression, Fear, Anger, Arousal & Behavioural Adaptations

PAIN

PAIN PAIN

Medical Care

Psychological Support

Social Services

Vocational Rehabilitation

Clinical Pharmacology

MULTI-

DISCIPLINARY

PAIN

TEAM

PATIENT

ALGOLOGIST

– WHO IS THIS?

PAINPAINTREATMENTTREATMENT

SYMPTOMATICSYMPTOMATIC

PATHOPHYSIOLOGICALPATHOPHYSIOLOGICAL

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