Parameters and metrics to be used

Evaluating the cause of acute pain (such as back pain, chest pain) is different from evaluating chronic pain.

The history should include the following information about the pain:

  • Quality (eg, burning sensation, cramp-like pain, aching, deep, superficial, piercing and stabbing pain)
  • Danger
  • Site
  • irradiation
  • Period
  • Temporal characteristics (including type and extent of volatility and frequency of calm)
  • stimulating and mitigating factors

The patient’s level of function should be determined, with emphasis on activities of daily living (eg, dressing and bathing), work, occupational activities, and personal relationships (including sexual activity).

The patient’s perception of pain may be more important than the underlying physiological processes of the disease

What this means for the patient must be analyzed, with close attention to psychological problems, depression and anxiety.

Complaining about pain is more socially acceptable than complaining about anxiety or depression, and appropriate treatment often depends on separating these divergent perceptions.

A distinction must be made between pain and suffering, especially in a cancer patient. Suffering from job loss and fear of impending death may be as much as actual pain.

In addition, the amount of secondary gains (external conditions, incidental benefits of an illness, such as sick days or compensation) that may contribute to the relevant disability must be quantified.

A positive personal or family history of the model is often helpful in clarifying the emergency problem.

Consider whether family members tend to persist in the chronic form (eg by constantly inquiring about the patient’s health).

Patients and sometimes family members and caregivers should be questioned about the use of prescription, over-the-counter and other treatments, their efficacy and adverse effects, and the use of alcohol or recreational or illegal drugs.

intensity of pain

Pain intensity should be assessed before and after potentially painful interventions.

In patients who can speak, self-assessment is the gold standard, while outward signs of pain or distress (eg crying, grimace, body oscillations) are secondary.

For patients who have difficulty communicating and for young children, nonverbal (behavioral and sometimes physiological) indicators may become the primary source of information.

Include official measurements

  • Verbal category scales (eg mild, moderate, severe)
  • Numerical scales
  • Optical analog scale

For the digital scale, patients are asked to rate a score from 0 to 10 for their pain (0 = no pain; 10 = “worst pain ever”).

For the visual analog scale, patients should make a mark representing the degree of their pain on a 10 cm line where the left side is marked as ‘no pain’ and the right side is marked as ‘unbearable pain’.

The degree of pain is the distance in millimeters from the left end of the line.

Children and patients with low schooling or known developmental problems can choose images from a list of faces, ranging from smiling to pain-twisted faces, or fruits of different sizes, to express their perception of the intensity of the pain.

When measuring pain, the examiner should specify a period of time (eg, “on average how many times over the past week”).

Dementia patients and aphasia

It may be difficult to assess pain in patients with diseases that affect cognitive function, speech, or language (eg, dementia, aphasia).

The presence of pain is suggested by flaking of the face, frowns, or frequent blinking of the eyes.

Occasionally, a person accompanying the patient may report behavior indicating the presence of pain (eg, sudden social withdrawal, irritability, grimace).

Pain should be considered in patients who have difficulty communicating and who inexplicably change their behavior.

Many patients who have difficulty communicating can communicate meaningfully when an appropriate pain scale is used.

For example, the functional pain scale has been validated and can be used in nursing home patients with Mini Mental State Test scores of 17.

Patients treated with neuromuscular blockade

No validated tools are available for pain assessment when neuromuscular blockade is used to facilitate mechanical ventilation.

If the patient is given a sedative, the dose may be adjusted until there is evidence of consciousness.

In such cases, the use of specific analgesics is not required.

However, if the patient is sedated but continues to show signs of consciousness (eg, blinking, some eye movement in response to a command), pain should be treated based on the degree of pain that the condition generally causes (eg, burns, trauma) is considered.

If a painful procedure is required (such as diverting a bedridden patient), pretreatment should be carried out with the prescribed analgesic or sedation.

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Ozone Therapy for Pain with Oxygen: Some Useful Information



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