Pain its assessment and Treatment

Pain its assessment and Treatment
Many medical problems found in remote medicine have an element of pain attached to them weather through injury or a medial cause such as dental, abdominal and chest pain.

Therefore, an understanding of the assessment and treatment of pain is essential

When assessing a patient and taking a history, always ask open questions or seek clarification rather than use closed questioning technique. It is well documented that when asking closed questions patients often agree with you even if they are not experiencing what you ask them about. This is because patients often feel that the questioner knows more about the condition than they do and if asked if they suffer a symptom feel they should have it so agree to please the questioner. It is better to ask, “What sort of pain is it” rather than “Is it a crushing pain”. After you have finished asking questions summarise the information and ask if your impression is correct and do, they wish to change or expand on anything. Some patients are very verbose in response to open questioning, so on occasions a mixture may need to be used.

If the patient has pain, then this can be assessed using either the OPQRSTA or SOCRATES aide memoires .

OPQRSTA 
(O)nset
When did the pain start, what were you doing or had been doing before it started?
(P) Provoke, Palliate or Prevent
Does anything bring the pain on (Provoke), lessen (Palliate) or prevent it? Pain that is more intense when taking a deep breath is more likely to be caused by problem with the lungs or the muscles between the ribs (Intercostals). But a patient with a constant central chest pain is more likely to have a heart problem.
(Q)uality
What is the pain like is it sharp, dull, crushing, or tight? Be cautious with this as the patient’s idea of what the pain feels like may not fit with a textbook answer. A person may describe both the discomfort caused by a heart attack and asthma as a heavy pain. But others could separately describe them as crushing and tight.
(R)adiation / (R)epeat
Does the pain go anywhere else, both chest and abdominal pain can often spread through to the back, arms, neck, and shoulders? In the case of shortness of breath, the ‘R’ for Radiation becomes Repeat i.e. has this happened before and what was the outcome.
(S)everity
How bad is the pain, is it at a constant level or does it come and go? A good measure is to use a Pain score, ask the patient to set a number against the pain “where zero is no pain and ten is the worst pain they have experienced” again this can be subjective but is a good measure to see if treatment is effective. Score the pain at the beginning and after each intervention that could relieve it.
 
(T)ime
How long and how frequent is the pain.
(A)ssociated Symptoms
Such as nausea or a feeling of doom felt by people having a heart attack.
 
SOCRATES
(S)ite
Where is the Pain
(O)nset
When did the pain start, what were you doing or had been doing before it started?
(C)haracter
What is the pain like is it sharp, dull, crushing, or tight? Be cautious with this as the patient’s idea of what the pain feels like may not fit with a textbook answer. A person may describe both the discomfort caused by a heart attack and asthma as a heavy pain. But others could separately describe them as crushing and tight.
(R)adiation
Does the pain go anywhere else, both chest and abdominal pain can often spread through to the back, arms, neck and shoulders? In the case of shortness of breath, the ‘R’ for Radiation becomes Repeat i.e. has this happened before and what was the outcome.
(A)ssociated Symptoms
Such as nausea or a feeling of doom felt by people having a heart attack.
(T)ime,
How long and how frequent is the pain.
(E)xacerbating/relieving factors
Does anything bring the pain on (Exacerbating), lessen (relieving) or prevent it? Pain that is more intense when taking a deep breath is more likely to be caused by problem with the lungs or the muscles between the ribs (Intercostals). But a patient with a constant central chest pain is more likely to have a heart problem.
 (S)everity
How bad is the pain, is it at a constant level or does it come and go? A good measure is to use a Pain score, ask the patient to set a number against the pain “where zero is no pain and ten is the worst pain they have experienced” again this can be subjective but is a good measure to see if treatment is effective. Score the pain at the beginning and after each intervention that could relieve it.

It’s beyond the scope of this article to discuss all the injuries and problems that can cause pain but some will be covered in future posts.

Local anaesthetic
Local anaesthetic has many uses in the wilderness setting as it allows the practitioner to deaden an area of the patient’s body which allows painful procedures to be carried out more comfortably. It has advantages over general anaesthetic as the patient does not need to be paralysed or sedated. This will be discussed in a future post
Oral. Inhaled and injected Medication
The following pain-relieving medication is cover on our Expedition Medicine Courses and is available post course for bulk purchase for remote foreign travel.
ASPIRIN SOLUBLE 300MG TABS
IBUPROFEN 400MG TABS
PARACETAMOL 500MG TABS
TETRACAINE 1% DROPS POM for treatment of Eyes
CO-CODAMOL 500MG/30MG TABS POM
NAPROXEN 500MG TABS POM
PENTHROX POM
TRAMADOL 50MG CAPS (POM & Schedule 3 CD)
TRAMADOL 100MG INJ (POM & Schedule 3 CD)
LIDOCAINE 1% 5ML AMPS POM

See our Expedition Medicine Courses for further details