1. Asking appropriate questions

2. Passing on information and documentation

Two types of pain

Nociceptive

The Palliative Care Expert Group (2010) explained that nociceptive pain can occur at three levels.

• Damage to the skin or other subcutaneous tissue, for example ulcers, can cause patients to describe the pain as "stinging" or "sharp" in nature.
• Pain from bone or joints can be described as a "dull ache", for example someone with bone metastases.
• Damage or pressure to organs or lymph nodes deeper within the body can cause the patient to complain of a "pressure" or a "cramp".

Neuropathic

Neuropathic pain is also referred to as nerve pain. It is the result of damage or pressure placed on the nerve directly or on the patient's spinal cord. This can result in the patient complaining of "numbness", "tingling" or "burning".

Neuropathic pain can occur for many palliative patients as a result of damage to the nerves during surgery or due to chemotherapy or radiotherapy.

Pain assessment in the cognitively impaired patients

Pain assessment in people who are cognitively impaired can be more challenging for the health care team. For example people with advanced dementia cannot control their vocalisations therefore the health care team rely on observing their behaviour and facial expression. Pain assessment tools have been specifically developed and validated for this group, looking at discomfort or pain observed by the health professional rather than relying on the person with dementia expressing pain verbally.

Pain Assessment IN Advanced Dementia Scale (PAINAD)

https://www.apsoc.org.au/PDF/Publications/Pain_in_RACF2-Appendices/6_APS_Pain-in-RACF-2_Appendix-6_PAINAD.pdf

Abbey Pain Scale

https://www.apsoc.org.au/PDF/Publications/APS_Pain-in-RACF-2_Abbey_Pain_Scale.pdf

Pain