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The pain questions in this interview assess the presence of pain, pain

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frequency, effect on function, intensity, management and control.

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Information about pain that comes directly from the resident provides symptom

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specific data for individualized care planning. Pain can cause suffering and can

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interfere with rehabilitation and be associated with low mood. Most residents

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who are capable of communicating can answer questions about their pain. Testing

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shows, that they recall moderate or severe pain, even with a 5-day look back.

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"Alright. Mrs. White let's move on to a question about physical pain and how

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you've been feeling in the last 5 days, ok. Have you had pain or hurting at any

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time in the last 5 days?"

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"No. I don't want to bother anyone. It's not so bad."

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"I'm here because I need to know how you're feeling, so we can help you. And,

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please don't worry that what you're telling me is a bother. Have you had pain or

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hurting at any time in the last 5 days?"

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"I'm in pain a lot on my my hip hurts. I had surgery. They said I fell and

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broke it."

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"How much of the time have you experienced pain or hurting in the last 5 days?

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Would you say almost constantly, frequently, occasionally or rarely?"

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"I'm in a lot of pain."

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"Okay. Would you say almost constantly or frequently?"

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"Almost constantly."

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"Alright. Alright, I'm going to talk to your doctor and care team about how often

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you're in pain. I just have a few more questions to ask so we can get an

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accurate picture of how much pain you're in. Now, over the past 5 days has pain

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made it hard for you to sleep at night?"

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"Yes, it hurts too bad to sleep."

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"Okay. Over the past 5 days have you limited your day to day activities because

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of pain?"

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"Yes, it hurts too bad to move. I just want to be still."

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"Please take a look at this pain scale and rate your worst pain over the last 5

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days on a 0 to 10 scale. With 0 being no pain and 10 being the worst pain you

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can imagine. This will help me give the doctor accurate information.

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"8." "8, I see. Alright, we're going to work with you on that pain, and I'm also

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going to check to see what medications your doctor has ordered for your pain

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right now. And, I'm going to share what you've just told me with your care team, so

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we can get started on helping you to feel better right away. Is there anything

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else you want to tell me about your pain?"

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"No, thank you."

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"You're welcome"

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Some observers have expressed concern that residents may not complain and may

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deny pain. However, the regular and objective use of self-report pain scales

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enhances residents' willingness to report. In fact, multiple studies have shown

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that rates of self-reported pain are often higher than observed rates. This resident

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had not let anyone know about her pain, and by limiting her activities had avoided

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frequently demonstrating signs of pain. April could have shown the resident the

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0 to 10 scale or the verbal descriptor scale to rate the intensity of the pain.

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She used the 0 to 10, or numeric, rating scale to ask Mrs. White to rate her

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worst pain and gave verbal definitions of the 0 and 10 values. April may have

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used the 0 to 10 scale because the resident had used the scale before, or it is

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preferred by Mrs. White's providers. If Mrs. White had had difficulty using the

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0 to 10 scale, April would've tried the verbal descriptor scale where the

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resident would've been asked to rate the intensity of her worst pain as mild,

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moderate, severe, very severe or horrible.

