Please forward answers to: melissa.luebbe@ctca-hope.com - answer the discussion question in the comment box on the blog.
Questions:
1) What are some of the possible causes of neuropathic pain?
2) Describe and give an example of Post Traumatic Neuropathic Pain Syndrome.
How would this syndrome affect an individuals every day life?
3) What type of treatments are available for patients diagnosed with neuropathic
pain?
Discussion question: What questions would you ask a patient in order to assess
them for neuropathic pain? Patients diagnosed with Neuropathy to the lower
extremities are at risk for falls. What recommendations could you give to help a
patient maintain their safety in the hospital and at home?
Follow comments for guest blogger this month!
them for neuropathic pain? Patients diagnosed with Neuropathy to the lower
extremities are at risk for falls. What recommendations could you give to help a
patient maintain their safety in the hospital and at home?
Follow comments for guest blogger this month!
After reviewing the various pain assessment questionaires, I really liked the 'painDETECT' format for the initial questions for our oncology patients suffering from acute and chronic neuropathic pain. It is simple for the patient to fill out and provides the nurse and PEC teams with the details of the patients neuropathic pain. Upon further questioning I'd inquire as to what forms of pain relief have been tried, what is working and/or not working for the patient thus far, and a current list of medications. For patients with neuropathy to their lower extremeties I'd instruct the patient and family regarding using night lights to help decrease the risk of falls at home and in the hospital. The visual cues can greatly aid to increase proprioception when ambulating. The multitude of fall precautions utilized in the hospital setting also apply to the home setting as well, ie: removing obstacles (throw rugs), clearing pathways, belongings with in reach...Instructing the patient to be acutely aware of their decreased sensation can aid in patient compliance with regards to fall precautions.
ReplyDeleteTo assess my patients for neuropathic pain would be a series of questions to give me a history of how things have been going. These questions would include: a description, location, severity, pattern, aggravating and alleviating factors, and any medications they have tried or are currently on to help lessen the pain.
ReplyDeleteRecommendations I would give my patients would be to remove any throw rugs as they are easily tripped over, have well light room and hallways at night to easily be able to see if something is in your path, and have objects within reach. And as always I encourage my patients to ask for help and don't be scared to do it!!
I ask patient's if they are experiencing any numbness, tingling, pain or altered sensations to any part of their body to assess for neuropathic pain. As far as patient's with neuropathy to lower extremities it is extremely important to educate patient's on how to keep themselves safe at home. A physical therapy referral may be necessary to evaulate their gait and to assess if a ambulatory device may be indicated. Due to lack of sensation, all throw rugs and loose articles on the floor should be eliminated. Teaching patient to test water temperature with a thermometer or a part of the body with intact sensation before submerging a limb into water can prevent injury. Stress the importance of wearing properly fitting shoes and to inspect the feet daily for any sores/trauma. These are a few things that nurses can teach patient's with lower extremity neuropathy.
ReplyDeleteIn order to assess patients for neuropathic pain, I feel it would be necessary to perform a detailed pain assessment on them, and also perform a physical exam to better understand what the patient is feeling. Questions I would ask the patients with neuropathic pain would consist of: “what is the onset or pattern of your pain?” “can you give me a description of where your pain is, what does it feel like and how often does it occur?” “how intense is your pain?” is there anything that helps control the pain you are experiencing?” “what types of medications are you on, and are they effective?”
ReplyDeleteRecommendations I would provide to my patients to help maintain their safety in the hospital and at home would be making sure their call light is always at reach for assistance, having a physical therapy referral prior to leaving the hospital for safety at home, teaching them the importance of properly fitting shoes, no loose carpets etc, making sure patients are aware of their own home medications in what they can use for pain and how often, teaching them the importance to sensitivity to hot/ cold esp after certain types of chemotherapy patients are taking.
To assess patient with neuropathic pain.
ReplyDeleteask them details about the onset of pain, quality of pain description, location and what treatment pharmacological / nonpharmacological makes it better or worse and how is this affecting activity of daily living
Recommendation for home: remove throw rugs,ask for help as needed, always wear proper fitting shoes, bath rails and railings as needed
Recommendation hospital: make pt fall risk, keeping bed rails up, give pt. call light, transport pt. in wheelchair.
Agree with all. I like holistic approaches which focus on healing from inside out such as control of comorbid conditions like diabetes, and eating a nutritional diet high in antioxidants. There are other therapies such as brain based/laser and infrared/whole body vibration/exercise with oxygen. Control of sx will help reduce safety issues.
ReplyDeleteIn order to assess for neuropathic pain, determine if any of these symptoms are present. Sensations of pins and needles, heat, burning, impaired temperature sensitivity, shock like sensations, painful joints. The area that a patient in inhabiting should be free from objects that they may trip on. Patients should use assistive devices as needed for ambulation and always wear the best possible shoes
ReplyDeleteThe assessment should include a detailed pain hx. It should include
ReplyDeletequestions about the onset, pattern, description, location, intensity,
aggravating and relieving factors and current medications they take. Also
alternative modalities for pain control, their effectiveness and the impact
it has on the pts. ADL’s. Physical exam should include sensory testing with
tools that may include a pinprick, pressure, cold, heat and vibration. In
Addition evaluate muscle strength and tone, deep tendon reflexes and
cranial nerve function.
To keep patients safe at home and in the hospital, we can assess their
environments. In hospital settings we should have their call lights close
to them. Bed alarms on if needed. Clean up spills right away. At home the
patient should remove loose rugs, wear socks with traction so they don’t
slip. Use shower chairs if needed in the shower. Always let their doctor
know of any changes occu with the neuropathy.
The assessment of neuropathic pain requires a detailed pain history and physical examination . Question shpuld include about the description, location , intensity, aggravating and relieving factors, previous and current phramacological and non- pharmacological treatment and their effectiveness and the impact if pain in their daily living.I recommend for those pt who were diagnosed with neuropathy when they are at home first and foremost is their safety like making sure their pathways , stair are clear of any toys , rugs that can make them tripped. There should be proper lighting and well fitted shoes. and whenever they are admitted in the hospital , we make sure that they are aware of using their call light and they are within reach .
ReplyDeleteTo assess neuropathic pain you need a detailed pain history and physical examination, including questions about onset and temporal patterns, description, location, intensity, aggravating and relieving factors. You can also use pain scale with all of these components, which is familiar to the patient already. Because patients with neuropathic is a fall risk, we should implement fall risk policy, in our hospital we let our patient wear a yellow gown to recognizes these patient right away. keep call light beside patient; keep environment safe, clatter free; education patient & caregiver to call when patient going to the bathroom. At home, same principle; use bells to keep in bedside; use safety device in the bathroom or toilet bowl.Also educate patient and family members of safety issues.
ReplyDeleteIt’s important to determine when their pain began, if at any time there was an injury that could account for the pain, the type and quality of pain experienced, character of pain what makes the pain better or worse. While hospitalize It is important that patients feel they are not a bother by using their call system, they should wait for assistance when up to the bathroom or ambulating. At home they should remove all rugs that do not have skid proof backing, Patients should use rails in the bathroom to help with stabilization. Patients should also be informed of medic alerts devices that can be used in cases of emergencies.
ReplyDeleteCommon questions I would ask my patients are the “typical” pain questions including where the pain is located, a description of the pain, intensity, aggravating and relieving factors, and any medications or therapies that have helped in the past. The answers to these questions will give me a better idea of how I can help them. If a patient has neuropathy in the lower extremities it would be wise for them to make sure any area rugs are picked up off the floor and that they do not have items laying around their house that they may trip on. It would also be recommended that they make sure the areas in which they are walking in are well lit and if they have any needs at home they can call us. It is important that they know we are available to assist them make their lives as easy as possible.
ReplyDeleteI would ask patients with neuropathic as well as any pain,when it started, how it was evaluated and what has worked and not worked. I would encourage the patient in the hospital as well as outpatient to employ safety precautions such as good lighting, no loose rugs, and to call upon family as well as staff for support to help reduce fall risk. I would let the patient know that they are not alone and also seek other alternatives to help manage neuropathic pain. Nancy C
DeleteTo assess for neuropathic pain, ask if patient is having numbness or tingling sensations, or burning pain in extremities; if pain is interfering with activities of daily living; if it is difficult to grasp objects, button clothing, etc; if there is a decreased sensitivity to hot/cold; if anything makes pain better or worse. Recommendations for safety: wear closed toe shoes, wear gloves in cold weather, use rubber gloves when washing dishes, inspect hands/feet for broken skin, use thermometer for bath water, keep hallways and rooms free of obstacles and well-lit. It is always important to make caregivers both at home and the hospital aware of neuropathic pain and/or numbness. Use call light and ask for assistance when getting up, PT eval for possible use of Rebuilder, inform health care providers so appropriate medications/supplements can be prescribed.
ReplyDeleteAssessment includes pain description(pins/needles, heat, burning, numbness,tingling), location, when pain was first noted, was pain associated with a treatment or procedure, impaired temperature sensitivity and touch sensitivity, and painful joints. I advise to wear safe shoes, instruct that bare feet are easily injured without the patient's knowledge if numbness is present. Shoes should fit well, not slide off feet, stable heels. Check temp of bath water and shower with elbow, not hands or feet if impaired sensation is present. Remove tripping hazards such as rugs, clutter, and decorative items on the floor. Use care with stairs, use handrails. Remember to include the family in education discussions.
ReplyDeleteIn assessesing for neuropathic pain the usual pain assessment that is done for patients would happen. This would consist of asking WILDA questions but also including questions about numbness, and tingling of extremities.
ReplyDeletePatients that have neuropathy should be educated on assessing their hands and feet often. They should always wear shoes when they are moving about. They should be educated to oberve their surroundings when walking. Getting PT involved to assess with assessment and treatment is ideal
To assess for neuropathic pain, one would need to assess the type of pain (stabbing, aching, etc), the location, the duration, the onset, the aggrevating factors, and alleviating factors, if there is numbness or tingling along with it.
ReplyDeleteEducation is the key to reducing falls with patients with neuropathic pain. One should have a clear pathway in the home free of any objects on the floor that could be tripped over or run into. They should be assessed daily for any cuts or injuries that may not be felt with numbness. They should have non-skid shoes or socks on when walking.
THe treatments available for patients with neuropathic pain is gabapentin or neurontin, lyrica, and other anticonvulsant and antidepressant drugs. Electrical stimulation also is an alternative treatment.
I would ask the patient if they experience sensations of pins and needles, heat or burning, impaired temperature sensitivity, numbness, and electric shock-like sensations; whether or not the pain becomes worse with touch, and whether the joints are painful.
ReplyDeleteI would suggest removing throw rugs from their home, adding treads to stairs, wearing non-slip shoes, using assistive devices, having call lights closeby.
Assessing for neuropathic pain should be done during each patients nursing assessment. If the patient does have neuropathic pain, the degree of the pain should be determined. Ask the patient is they are dropping objects or if they can button or snap their shirts/pants. It is also important to inform the physican and PEC team. Medications such as anticonvulsants, opiods and antidepressants can be ordered and are helpful. Other non-medication forms of therapy are also effective. These may include, massage, physical therapy, accupunture and hypnosis. Remind patients to be careful and inspect their hands and feet daily.
ReplyDeleteWhen assessing a patient for neuropathic pain I would ask are you experiencing any numbness or tingling in your hands or feet especially, are they able to do "simple tasks" like handling small objects or buttoning their shirt. These patients are at risk for fall. I would always encourage them to call before getting out of bed so someone could walk with them to the bathroom, or wherever they wanted to go. Also I would encourage to patient to wear shoes or slippers when ambulating.
ReplyDeleteWhen assessing a patient for neuropathic pain, I would assess their past history of pain. This assessment should include onset of pain, location, type of pain, their presumed cause of pain, relief measures, aggravating measures, description of pain and treatments used. For a patient at home with neuropathy to the lower extremity, it is very important to educate on the proper shoes, removal of rugs or floor obstacles, testing of bath/shower water with hands/arms instead of feet and daily assessment of feet/legs for any signs or symptoms of infections.
ReplyDeleteQuestion you might want to ask- Do you have numbness, pain, burning, or pins and needles feeling in your hands or feet? Do you have difficulty buttoning your shirt, or picking up small objects, or distinguishing different textures? Do you have impaired temperature sensitivity, does pain become worse with touch, are your joints painful?
ReplyDeleteManagement of the pain can be pharmacological,or it could be through massage, or accupunture, or hypnosis. Physical therapy often uses tens unit.
In hospital setting make sure call light is within reach for patient, pathways are clutter free, assistive devices such as walker are available and with- in reach if needed.
At home, in addition to above, make sure there is help with cooking and bathing, area rugs are well secured so as not to be a slipping hazard. Area that have stairs, should be well lit.
Questions to ask:
ReplyDelete1) Do you have difficulty grasping or picking up objects?
2) Can you dress yourself without hardship? (Buttons, zippers, clasps)
3) Do temperatures bother you? (Hot, cold)
4) Can you type/write well?
I always suggest for a PT consult, if warranted, at CTCA. I have had patients that have had great success with TENS! :)
Theresa Rodriguez, Infusion
Because pain is so subjective and individual, I would ask the patient if they are having any new or unusual feelings or symptoms. I would provide examples such as numbness, tingling, feeling like “pins and needles”, and sensitivity to temperatures, etc. During the physical exam I would obtain as much detail using words that are easily understood by the patient.
ReplyDeleteEducation is key in preventing falls. I would ask a few questions to gather an understanding of their living situation at home. Then I could make specific suggestions such as keeping a small light on, wearing gripper socks, etc.
I would ask the patients if they are having numbness or tingling or if they have any loss of sensation in their hands or feet. A rebuilder or physical and occupational therapy could be used for both home and hospital patients to help manage the nueropathy.
ReplyDeleteWhen assessing a pt for neuropathy I ask them if they have numbness/tingling in their hands or feet. It yes I then ask them if the can button their shirt or uase a cell phone. Lower extremties- Can they tell where They are putting their foot when walking and if the step off of a curb down upon the street can they tell when their foot touches the ground. Also if they can tell sensations to temperatures such as water. When in the hospital pts should ask for help when getting up and walking. If they do not have senations of temperatures have some one help them if they are in the hospital or at home. Be very careful when they are cooking at home or using the microwave and they can take something out of the microwave and burn themselves badly because they can tell it is hot. Pts need to take up all throw rugs, keep clutter off the floor, use a walker when walking.
ReplyDeleteI ask patients if they have and problems with numbness or tingling to feet or hands, or pain. Do they have problems with hot and cold sensations to hands and feet, or feelings of pins and needles? Do they have difficulty with grasping objects? I instruct them to always wear protective coverings to their feet and avoid injury due to loss of sensation. Keep pathways clear.
ReplyDeleteA detailed pain history is important and it should include questions about the onset, location, description, duration and what helps patients relieve pain and always get a list of current medications that they take. physical exam should include sensory testing, muscle strength and tone. assessing patient's environment is important in keeping patient's safe at home or in the hospital. instruct patient to wear socks with traction so that they don't slip, ask patients to remove any loose rugs and using shower chairs so that they don't fall.
ReplyDeleteTerry W.
ReplyDeleteIn order to assess a patient re: neuropathic pain, I would ask many questions. Such as: Are there sensations of pins an needles or is it numbness, unable to tell if feet are touching the floor? Do hot or cold temperatures cause pain? Is the pain constant or intermittant and what level 1/10 of pain is there. What makes the pain worse? Is it more difficult to lift common everyday items? What other specifics have they noticed? Based on their observations and reports, I would recommend safty precautions, asking for help as needed, see if the doctor would recommend a change in pain medications or others based on severity. Teaching the patient the risk for falls may be greater with decreased sensations. More care with sharp objects, or going up and down stairs, crossing area rugs must be taken with alertness.
A detailed pain history is important and it should include questions about the onset, location, description, duration and what helps patients relieve pain and always get a list of current medications that they take. physical exam should include sensory testing, muscle strength and tone.
ReplyDeleteapply tools