NURS 5461 PAIN EXAM QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS GRADED A++ LATEST UPDATE
PAIN IS COMMONLY UNDERTREATED
Patients may: Minimize their symptoms Not report pain Be unable to report pain
because of limited English proficiency or cognitive impairment • ---Clinicians may:
Inadequately assess pain Undertreat pain with ineffective therapies Encounter
intolerable adverse effects with otherwise effective therapie
PAIN INTENSITY SCALES • Unidimensional scales
Numeric Rating Scale—0 is no pain, 10 is worst pain imaginable Faces Pain Scale—
patient chooses a facial expression that corresponds to the pain Verbal Descriptor
Scale—"no pain" to "pain as bad as it could be
Multidimensional scales
McGill Pain Questionnaire Pain Disability Scale
PAIN MAP
Ask patient to indicate the locations of their pain on a drawing of a human figure •
**Consider referral to a mental health specialist (to evaluate for affective disorder
contributing to the discomfort) if the patient's pain pattern: Is erratic Is diffuse Does not
conform to an anatomic distribution
PHYSICAL EXAMINATION
, Perform complete musculoskeletal exam Fibromyalgia, osteoarthritis, or myofascial pain
is commonly either the primary source of pain or an exacerbating process Accurate
diagnosis is critical to formulating the correct therapeutic plan
3 TYPES OF PAIN SYNDROMES • Nociceptive
pain due to activation of nociceptive sensory receptors; often adequately treated with
common analgesics Somatic—well localized in skin, soft tissue, bone Visceral—due to
cardiac, GI, or lung injury, abd tumor
Neuropathic
from irritation of components of the CNS or peripheral nervous system; may respond
well to nonopioid therapies; responds unpredictably to opioids
Mixed or unspecified—
characteristics of both nociceptive and neuropathic pain; common in older adults
NEUROPATHIC PAIN examples
Peripheral or central nervous system is source, neuralgias; sharp, burning, pricking,
tingling, squeezing; associated with other sensory disturbances (eg, paresthesias and
dysesthesias); allodynia, hyperalgesia, impaired motor function, atrophy, or abnormal
deep tendon reflexes
NEUROPATHIC PAIN Rx
Tricyclic antidepressants, anticonvulsants, serotoninnorepinephrine reuptake inhibitor
antidepressants, opioids, topical anesthetics Physical and cognitivebehavioral therapy
UNDETERMINED PAIN
COMPLETE SOLUTIONS GRADED A++ LATEST UPDATE
PAIN IS COMMONLY UNDERTREATED
Patients may: Minimize their symptoms Not report pain Be unable to report pain
because of limited English proficiency or cognitive impairment • ---Clinicians may:
Inadequately assess pain Undertreat pain with ineffective therapies Encounter
intolerable adverse effects with otherwise effective therapie
PAIN INTENSITY SCALES • Unidimensional scales
Numeric Rating Scale—0 is no pain, 10 is worst pain imaginable Faces Pain Scale—
patient chooses a facial expression that corresponds to the pain Verbal Descriptor
Scale—"no pain" to "pain as bad as it could be
Multidimensional scales
McGill Pain Questionnaire Pain Disability Scale
PAIN MAP
Ask patient to indicate the locations of their pain on a drawing of a human figure •
**Consider referral to a mental health specialist (to evaluate for affective disorder
contributing to the discomfort) if the patient's pain pattern: Is erratic Is diffuse Does not
conform to an anatomic distribution
PHYSICAL EXAMINATION
, Perform complete musculoskeletal exam Fibromyalgia, osteoarthritis, or myofascial pain
is commonly either the primary source of pain or an exacerbating process Accurate
diagnosis is critical to formulating the correct therapeutic plan
3 TYPES OF PAIN SYNDROMES • Nociceptive
pain due to activation of nociceptive sensory receptors; often adequately treated with
common analgesics Somatic—well localized in skin, soft tissue, bone Visceral—due to
cardiac, GI, or lung injury, abd tumor
Neuropathic
from irritation of components of the CNS or peripheral nervous system; may respond
well to nonopioid therapies; responds unpredictably to opioids
Mixed or unspecified—
characteristics of both nociceptive and neuropathic pain; common in older adults
NEUROPATHIC PAIN examples
Peripheral or central nervous system is source, neuralgias; sharp, burning, pricking,
tingling, squeezing; associated with other sensory disturbances (eg, paresthesias and
dysesthesias); allodynia, hyperalgesia, impaired motor function, atrophy, or abnormal
deep tendon reflexes
NEUROPATHIC PAIN Rx
Tricyclic antidepressants, anticonvulsants, serotoninnorepinephrine reuptake inhibitor
antidepressants, opioids, topical anesthetics Physical and cognitivebehavioral therapy
UNDETERMINED PAIN
