Hi, thanks for joining me for this presentation on pain screening and assessment techniques. The readings will reinforce what we are learning today and the optional materials will give you an opportunity to dive deeper. I agree with Dr. Betty Ferrell, a palliative care expert and nurse researcher from the city of Hope in Duarte, California. She says if we can't access pain, we're never going to be able to relieve pain. Unfortunately, how you're feeling today, or asking a person to rate pain intensity is about as close as many health care providers get in assessing pain. By looking at the whole person, we can better understand the pain experience. We will use the example of a ladder to learn about pain assessment. I think it's about getting to know the person's pain, understanding the pain experience and what it means to the person and family caregiver. Believing the person's pain report and letting them know you believe them, validating the pain by expressing your commitment to easing their suffering. And finally, communicating your understanding of their pain experience to others. I developed the WILDA pain assessment guide for patients experiencing pain who were hospitalized at the University of Colorado Health. WILDA incorporates five key components and begins with an open ended question. Tell me about your pain. This helps the patient to tell his story, focusing on the most difficult aspects of the pain experience. This guide is also available in multiple languages. Let's break it down and look at each component. So asking how the person describes pain using plain language, helps health care providers determine pain causes and management strategies. For example, if a person complains of achy, throbby pain in a bone or a muscle that she can point to, the patient may have what we call somatic pain. Pain that's described as squeezing, cramping, pressure like pain, often starts in deep organs and is called visceral pain. And lastly, if you hear the words burning, shooting, numb, electrical jolts, radiating, like a fire, the person may have pain associated with nerve damage. This is called neuropathic pain. We always start by asking, if zero is no pain and ten the worst pain possible, what is your pain right now? What is your pain last 24 hours? What was your worst pain? And what is your pain score, after you do something to relieve the pain? Pain intensity can also be measured using adjectives, such as mild, moderate, severe. Or having the person point to a face that shows how he feels. Another important question to ask is, what is your comfort or function goal? Where do you want your pain to be? Research tells us that a pain rating score greater than four out of ten can interfere with a person's ability to function or complete daily tasks. And may require an adjustment in the pain treatment. However, we don't dose pain medicines relying solely on a patient's pain intensity score. We look at the whole person and other things he or she may tell us. So ask, where is your pain? Do you have a pain in more than one location? More than one area? Encourage the person to point or place a finger on the area involved. So let's do a knowledge check. True or false. Most persons including cancer patients have two or more pain locations. [MUSIC] The answer to this is true. The majority of cancer patients have pain in two or more sites, therefore it's crucial to ask questions about pain location. The pain you may be talking about may be different than the pain the patient is talking about. So ask the patient, is your pain always there? We call that persistent pain. Or does the pain come and go? We call that intermittent or breakthrough pain. Or maybe you have both types of pain. What we do know is that the majority of persons will have both types of pain. One that's always there, it's a baseline type pain. And the other one that comes and goes. And we call that breakthrough pain. 65% of persons experience breakthrough pain, which is a pain flare up that typically occurs four to five times a day without warning. We want to know about pain duration. Because it can help us determine whether or not long or short acting pain medicines, or both are needed to help the pain. Another important thing to ask is, what makes the pain better? What makes the pain worse? If someone hurts when walking or bathing, or pain interferes with function or hobbies, medicines or other pain treatments may need to be tried at least an hour before that activity, to achieve comfort. We'll talk about a variety of other things that are used to make pain better in another lesson. But it's important to find out what works and doesn't work, to manage pain for this person. Next, you'll read some information that will prepare you to check your knowledge on pain assessment. Thanks for your time.