WordNet

cause emotional anguish or make miserable; "It pains me to see my children not being taught well in school" (同)anguish, hurt
a symptom of some physical hurt or disorder; "the patient developed severe pain and distension" (同)hurting
a bothersome annoying person; "that kid is a terrible pain" (同)pain in the neck, nuisance
a somatic sensation of acute discomfort; "as the intensity increased the sensation changed from tickle to pain" (同)pain_sensation, painful sensation
emotional distress; a fundamental feeling that people try to avoid; "the pain of loneliness" (同)painfulness
the market value set on assets
an amount determined as payable; "the assessment for repairs outraged the clubs membership"

PrepTutorEJDIC

〈C〉〈U〉(肉体のある部分の)『苦痛』,『痛み』 / 〈U〉(精神的な)『苦痛』,心痛 / 《複数形で》骨折り,苦労,努力 / 〈C〉不快感,いやな感じ;うんざりさせるもの,やっかい者 / (肉体的・精神的に)…‘に'苦痛を与える(受動態にできない)
〈U〉評価,査定;(環境などの)状況判定 / 〈C〉評価額,課税額
《補語にのみ用いて》腹を立てて / 《補語にのみ用いて》(心が)鐘ついて / 不愉快な,気まずい
とうちゃん(papa)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/09/13 00:48:41」(JST)

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Pain is often regarded as the fifth vital sign in regard to healthcare because it is accepted now in healthcare that pain, like other vital signs, is an objective sensation rather than subjective. As a result nurses are trained and expected to assess pain.

Regulation

Pain assessment and re-assessment after administration of analgesics or pain management is regulated in healthcare facilities by accreditation bodies, like the Joint Commission. The Joint Commission began setting standards for pain assessment in 2001 stating that the route of analgesic administration dictates the times for pain reassessment, as different routes require different amounts of time for the medication to have a therapeutic effect. Oral: 45–69 minutes. Intramuscular: 30 minutes. Intravascular: 15 minutes.

Types of Assessment

Most pain assessments are done in the form of a scale. The scale is explained to the patient and they give a score. A rating is taken before administering any medication and after the specified time frame to rate the efficacy of treatment.

Number Scale

Patients rate pain on a scale from 0-10, 0 being no pain and 10 being the worst pain imaginable.

Faces Scale

A scale with corresponding faces depicting various levels of pain is shown to the patient and they select one.

Special Considerations

Patients whom cannot verbalize/comprehend pain scales are assessed with different types of scales.

FLACC

Used for neonates/infants:

Assessment	0	1	2
Face	Smiling/expressionless	Frowning	Clenched jaw/Anguish
Legs	Normal movement/Relaxed	Restless/Tense	Legs drawn up/Kicking
Activity	None/Lying quietly	Squirming/Tense movements	Arched back/Rigid/Jerking
Cry	None	Occasional whimper	Crying constantly/Screaming
Consolability	Relaxed	Easily distracted or reassured	Difficult to distract/reassure

The scores are added together to achieve a 0-10 pain score.

Addiction

Many patient's who use drugs and are on opioids, analgesics, benzodiazepines, stimulants, barbiturates, and sedative-hypnotics have the potential to become addicted. Many people with chronic illnesses, injury, and history of mental illness are prescribed these drugs. As a nurse it is difficult to assess whether the pain is real or whether the patient is seeking the narcotic. Adult patients display pain and emotions differently. Many patient's become dependent physically and mentally on these drugs.

1.name 2.age 3.sex 4.occupation 5.address 6.chief complaint of patient 7.history of patient:- present illness history past illness history medical history family history personal history 8.pain site of pain nature of pain quantity of pain on v.a.s scale type of pain 9.examination active movement passive movement 10.observation gait posture r.o.m palpation aggrevating factor relieving factor tenderness 11.treatment

Nurses Assessment

Does the patient show nonverbal signs of pain such as crying or grimacing?
Does the patient watch the clock and ask for the pain medication or sedative at the exact time its due?
Does the patient continually ask for the medication?
Does the patient continually ask the physician to increase pain medication?
What is the dose of the medication and how often does the patient ask for it?
How long has the patient been taking the drug?
Does the patient have a change in mood and behavior if they don't receive the medication at the exact time?
Have a conversation with patient. Do they want the medication because they are in pain or because they can't sleep?
Do they want the medication because they are anxious?
What is going on in the patient's life?
What are their social circumstances?
Is the nursing staff performing three non-drug interventions before administering a sedative, hypnotic or anti anxiety medication?
How many different medications is the patient on?
Is the patient gradually asking for less medication as time goes on or are the asking for more?

Assessment Findings

If the patient is continually asking for the physician to increase their pain medication or increase the frequency then they need further evaluation by both a nurse and a physician. There is a good possibility the patient is in pain. There is also a possibility that they are becoming addicted to prescribed medication. The patient's history must be taken into account as well. Medical conditions such as cancer and rheumatoid arthritis are chronic condition and can be very painful.

In long-term care facilities three non-drug interventions need to be attempted before administering anti-anxiety or anti-psychotic medications. These interventions can be giving the patient food, drinks, one on one care, back rub, changing the patient's position in bed, adjusting the temperature, and redirecting the patient's mental focus. Many times these interventions work, but many times the medication may still need to be administered.

The patient's history and diagnosis are helpful in deciding whether or not the patient is developing a substance abuse problem. A patient having social or relationship problems may need to meet with a crisis counselor.

Every shift that a nurse is on duty, they must do an assessment on the patient. If they suspects the patient is becoming addicted, they must notify the physician.

UpToDate Contents

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1. 最後の数週間における疼痛の評価およびマネージメント pain assessment and management in the last weeks of life
2. 成人における慢性疼痛の評価 evaluation of chronic pain in adults
3. 緩和ケアにおける症状の評価へのアプローチ approach to symptom assessment in palliative care
4. 新生児疼痛の評価 assessment of neonatal pain
5. 小児における疼痛の評価およびマネージメント evaluation and management of pain in children

English Journal

Modeling motivations for non-medical use of prescription drugs.

Messina BG1, Dutta NM1, Silvestri MM1, Diulio AR1, Garza KB2, Murphy JG3, Correia CJ4.
Addictive behaviors.Addict Behav.2016 Jan;52:46-51. doi: 10.1016/j.addbeh.2015.07.024. Epub 2015 Jul 26.
INTRODUCTION: Non-medical use of prescription drugs (NMUPD) is a growing problem among college-aged individuals. Motivations for use of a substance have been shown to predict consumption behavior across a variety of substances, but research on motivations for engaging in NMUPD is limited. We hypothe
PMID 26355398

Understanding factors that influence participation in physical activity among people with a neuromusculoskeletal condition: a review of qualitative studies.

Newitt R1, Barnett F1, Crowe M1.
Disability and rehabilitation.Disabil Rehabil.2016 Jan;38(1):1-10. doi: 10.3109/09638288.2014.996676. Epub 2015 Jan 14.
PURPOSE: This review aims to describe the factors that influence participation in physical activity (PA) in people with neuromusculoskeletal (NMS) conditions.METHODS: A systematic search of six databases was conducted. Articles were included if the study qualitatively explored factors that influence
PMID 25586798

Calcium Scoring and Cardiac Computed Tomography.

Parikh S1, Budoff MJ2.
Heart failure clinics.Heart Fail Clin.2016 Jan;12(1):97-105. doi: 10.1016/j.hfc.2015.08.008.
Although recent advances in noninvasive imaging technologies have potentially improved diagnostic efficiency and clinical outcomes of patients with acute chest pain, controversy remains regarding much of the accumulated evidence. This article reviews the role of coronary computed tomography (CT) ang
PMID 26567977

Japanese Journal

Assessment of intraoral mucosal pain induced by the application of capsaicin

Terayama Ryuji,Maruhama Kotaro,Tsuchiya Hiroki,Mizutani Masahide,Iida Seiji,Sugimoto Tomosada
Archives of Oral Biology 59(12), 1334-1341, 2014-12
… ObjectiveTo develop an objective method for assessing nociceptive behaviour in an animal model of capsaicin-induced intraoral pain. … Injury to the IAN exaggerated the behavioural and c-Fos responses evoked by intraoral capsaicin.ConclusionsThe intraoral application of capsaicin is a valid and reliable method for studying intraoral pain and hyperalgesia following nerve injury. …
NAID 120005477122

Comprehensive Health Check for Workers(CHCW)による線維筋痛症患者の評価

永田勝太郎,近藤麻乃,津田彰,伏島あゆみ
心身医学 54(11), 1039-1046, 2014-11-01
… 痛VASとCHCWの総得点との相関を検討すると,有意な逆相関がみられた(y=-0.5952x+94.036, r=0.600884, p<0.01).考察:CHCWによる評価でFMS群では,生きざまの歪みが潜在していることが明確になった.FMSの治療に際しては,単にpain freeだけを目的にした治療にとどまらず,患者固有のQOLを高め,自己実現を図るような全人的な治療が必須であると考えられた.また,治療歴のあった患者群で,CHCWの評価が低かったことは,本症の一般的治療戦略に, …
NAID 110009865707

Trial of Objective Assessment of Nociceptors-Pain Using Functional MRI in the Brain ─ Assessment by the fMRI Signal at Lateral Sulcus ─

NAGANO Yoshihiko,NAGANO Michiharu,TOKUNAGA Fumio,SEKI Takaharu
大阪教育大学紀要　第Ⅲ部門　自然科学・応用科学 63(1), 67-74, 2014-09-30
… An objective measure for assessing pain has yet to be established. … We quantitatively applied heat stimulation around the heat pain thresholds （about 43 and 52℃） for two subtypes of a thermal pain nociceptor to the anterior part of the left foot joint, and qualitatively investigated brain regions in which functional magnetic resonance imaging （fMRI） signals occurred based on the intensity and spread of the signals. …
NAID 120005479214