Nursing Assistant Monthly
PAIN
The fifth vital sign
April 2012
Copyright © 2012 Delmar, Cengage Learning. All rights reserved.
The purpose of pain
 Pain is an important survival tool
– Warns of a possible threat to health and well-being
– Causes us to seek and remove its cause
– Without pain signals, even a minor injury could lead to illness or
perhaps death
 Pain can also work against us
April 2012
Copyright © 2012 Delmar, Cengage Learning. All rights reserved.
Pain: the fifth vital sign
Types of pain
 Acute
– Usually comes on rapidly
– Time limited
– Examples: post-operative pain, a finger cut, tension headache
 Chronic
– Does not get better with time
– Examples: cancer pain, arthritis pain, pain from nerve damage
April 2012
Copyright © 2012 Delmar, Cengage Learning. All rights reserved.
Pain: the fifth vital sign
Our experience of pain depends on
 Past experience with pain
 Physical health
 Emotional health
 Messages/beliefs we learned about pain
For example:
– “complaining about pain is a sign of weakness”
– “pain is punishment for our wrongdoings”
April 2012
Copyright © 2012 Delmar, Cengage Learning. All rights reserved.
Pain: the fifth vital sign
Untreated or undertreated pain
 A common problem in nursing homes
– Older adults tend to have conditions that cause pain (arthritis,
cancer, diabetes-related circulation problems)
– Non-verbal residents may not be able to report their pain to
caregivers
– Behaviors due to pain may be misinterpreted by staff
 Untreated or undertreated pain affects life quality
– May impair ability to perform ADLs
– Leads to isolation, withdrawal from activities that were once
enjoyable
April 2012
Copyright © 2012 Delmar, Cengage Learning. All rights reserved.
Pain: the fifth vital sign
Pain and dementia
 Many residents with dementia cannot report their pain
 Behavior is a sign of an unmet need and may mean “I’m
hurting!”
 Observe behavior, especially watch for CHANGES
– Wandering, restlessness, agitation
– Angry outbursts
– Resisting care (because it hurts!)
April 2012
Copyright © 2012 Delmar, Cengage Learning. All rights reserved.
Pain: the fifth vital sign
Your role as caregiver
 Learn the signs of pain such as:
– Restlessness, crying, guarding a body part
– Withdrawn, sad, unable to sleep
– Change of behavior
 Report any signs of pain to the nurse
 Follow up to be sure the resident’s needs were addressed
April 2012
Copyright © 2012 Delmar, Cengage Learning. All rights reserved.
Pain: the fifth vital sign
Comfort measures for pain
 Medications are only part of the answer
 CNAs can help in other ways, such as:
– Proper positioning, frequent position changes
– Offering:
• A soothing warm bath, cup of herbal tea
• Gentle range of motion
• Backrub for relaxation
• To play calming music the resident enjoys
April 2012
Copyright © 2012 Delmar, Cengage Learning. All rights reserved.
Pain: the fifth vital sign
Involve the resident and family
For residents with chronic pain
 If possible, ask the resident what usually helps his or her pain
 Ask the family members if they know what helped the resident’s pain in
the past
 Let the nurse know what you learn
April 2012
Copyright © 2012 Delmar, Cengage Learning. All rights reserved.
Pain: the fifth vital sign