Assessment
Use a pain scale, or a pain ruler
Remember that pain has an emotional as well as physical component. When you catch your thumb in a door you shake it and look at it. If it does not bleed too much but still wiggles and the pain goes quickly, then that is mostly "red" - physical. However the longer a pain lasts the more the emotional component becomes part of the problem.
The
emotional component is made up of three aspects. There is anxiety and worry and
typically we worry about two things. We worry about the "meaning" of
the pain, why is it there, what is causing it, what is going on. Then we worry
about the future and how the pain will affect us and our lives and our work and
relationships.
Pain
also makes us unhappy, although not necessarily depressed. This typically
occurs in three ways. It affects us directly to make us miserable. It commands
our attention, both consciously and subconsciously so we are listening for the
pain thus hearing it louder and more often. Finally it isolates us socially.
The
final aspect of the emotional component is the frustration that accompanies it.
We become frustrated that it does not go away, that promised cures do not work,
and that that life gets worse.
Thus,
the physical component can be viewed as the transmission of the message up to
the brain and the emotional component can be viewed as the unpleasantness
experienced. Of course the degree of disability and the behavioural changes are
subsequent phenomena.
Physiology
Pain is felt, and travels up the spinothalamic tract to the thalamus.
Treatment
Use WHO analgesic ladder
Combining two weak opioids isn't considered good practice.
References
https://www.frca.co.uk/article.aspx?articleid=100118
https://www.frca.co.uk/SectionContents.aspx?sectionid=148
https://www.paintoolkit.org/
https://www.change-pain.co.uk/
https://www.bscah.com/
Treatment
Use the WHO analgesic ladder
