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Canyon College

online pain assessment and intervention in nursing practice course at Canyon College

COURSE SYLLABUS: Pain Assessment and Intervention in Nursing Practice


Course Title: NR440 - Pain Assessment and Intervention in Nursing Practice
Department: Health Sciences
Instructor: Richard A. Sherman, PhD - - Vita
Credits: 4 Semester Credits


Course Objectives:

Pain is among the most common reasons patients approach the health care community and is, tragically, among the least successfully managed problems. The assessment and management of acute and chronic pain are fraught with ignorance, poor training, difficulties, complexities, and controversies all of which combine to produce pervasive misdiagnosis and ludicrously improper, ineffective care. Thus, patients with both acute and chronic pain frequently receive poor care from the medical community and are left to fend for themselves as best they can in the world of rumor, self-medication, and charlatans.

It is the objective of this course to provide you with the information you need to understand the underlying problems, be able to perform a reasonable assessment of patients with chronic and acute pain both on and off the ward, recognize when pain is not being appropriately or adequately ameliorated, and to be able to make or recommend interventions consistent with your clinical skills. Specifically, this course intends to:
  1. Provide you with a basic understanding of the physiology, biochemistry, and psychology underlying pain mechanisms.
  1. Provide you with sufficient knowledge about how pain mechanisms work to apply the knowledge to their evaluative and therapeutic interventions.
  1. Give detailed information about several pain syndromes (including RSD, low back pain, and phantom limb pain) so you will be abreast of current knowledge and be aware that similar depths of knowledge exist for most pain syndromes and must be searched out before attempting to evaluate or treat people with the problem.
  1. Summarize the strengths and weaknesses of evidence supporting the efficacy of self-regulatory interventions for prevention and reduction of various pain problems.
  1. Provide extensive examples of how to perform evaluations and non-pharmacological interventions.
How we are going to proceed through the course:

This home study course is divided into 25 units. Each unit consists of a recorded audiovisual lecture, one or more chapters of reading in the texts, review questions to be answered, and a real time recitation with me. The lecture portion of the course is presented through a series of audiovisual lectures profusely illustrated by power-point slides. There isn’t enough lecture time to cover all of the practices – especially those related to pharmacology - so your reading will be very important. When you sign up for the course, I will mail you a CD containing the audiovisual lectures, background materials, and a copy of the slide set upon which the lectures are based so you can make notes on your copy of the slides as you attend the lecture. After each lecture, you will answer a brief series of essay questions about each topic covered during the lecture, e-mail your answers to me, and then speak with me by phone about each topic. This will give you an opportunity to ask questions and for me to fill in gray areas and provide additional information on topics of special interest to you. There are hopefully several assessment and intervention practices you are or will become especially interested in. You will do four reports on these topics of special interest to you. Three will be brief (between four and six double- spaced pages) reports and the fourth will be an in depth evaluation (between ten and twelve double spaced pages) of one topic which is in an area of assessment or intervention you are likely to incorporate into your professional practice.

Contacting me: The best way to contact me is via e-mail at I check my e-mail several times per day, seven days per week unless I am away at a meeting, etc. If I am going to be unavailable for a few days while you are taking this course, I will let you know. Our post- unit phone chats need to be scheduled in advance by e-mail but can be virtually any day of the week within limited hours.

To take this course, you must have Internet access capable of handling attachments, you must be able to make phone calls to me, and you must be able to get the required books and articles.

Lecture Topics:
  1. Introduction
  2. Basic physiology related to pain
  3. Basic Psychophysiology (stress – pain relationships, etc.)
  4. Mechanisms of typical pain disorders
  5. Assessment techniques
  6. Interventions (physical, surgical, behavioral, alternative, and pharmacological)
Required Texts: Online Bookstore
  1. Pain: A textbook for Therapists. Edited by Jenny Strong, Anita Unruh, Anthony Wright, G. Baxter. Published by Churchill Livingstone of NY. 2002. ISBN #: 0443059780
  1. Turk, D, Melzack R: Handbook of Pain assessment; 2nd Edition. Guilford Press of NY. 2001.
    ISBN #: 157230488X
  1. Sherman, R: Applied Psychophysiological Techniques in Pain Assessment and Intervention. To be published by the Association for Applied Psychophysiology in 2002, Supplied on the CD.
Optional reading:

  1. Wolf's Headache and other head pain - 7th Edition. Edited by Stephen Silberstein, Richard Lipton and Donald Dalessio. Oxford University Press of NY 2001
    ISBN #: 0195135180

  1. Mark Schwartz et al: Biofeedback: A Practitioner's Guide. Guilford Press of NY, 1995. (New edition due in 2002)
Lectures and their associated reading:
You should do the assigned reading either before or "attending" the lectures.

1.   Background and basic concepts (Strong 1)
2.   Determining credibility of techniques (Turk 31-34)
3.   Stress – pain relationships, psychological factors (Sherman 1, Strong 4 – 6, 22, Turk 1 – 10)
4.   Physiological bases of pain 1 – muscles (Sherman 1 – 3, Strong 17)
5 & 6.   Physiological bases of pain 2 and 3 – nerves (Strong 2 & 3)
7.   Physiological bases of pain 4 – blood flow (Sherman 3)
8.   Assessment 1 – basic concepts and psychophysiological Techniques (Sherman 4 & 5, Strong 7, Turk 15 – 22, 29, 30)
9.   Assessment 2 – trigger points
10.   Assessment 3 – headaches (Turk 11, 24 - 26)
11.   Assessment 4 – low back pain (Turk 23)
12.   Assessment 5 – phantom limb pain (Sherman 3, Turk 27, 28, Strong 18)
13.   Assessment 6 – abdominal pain, chest pain, & complex patients (Turk 30)
14.   Intervention 1 – basic concepts, surgical and physical interventions (Turk 12, Strong 8, 10, 11, 13, 14, 20, 21)
15 & 16.  Interventions 2 & 3 – alternative medicine interventions (Strong 12)
17 - 19.   Interventions 4 - 6: behavioral medicine interventions (Strong 9, 14, 15)
20 - 23.   Interventions 7 – 10: Biofeedback 1 – 4 (Sherman 5 – 7)
24.   Interventions 11 – pharmacological intervention (Strong 16)
25.   Success rates and conclusion


Requirements for Library & Internet access: You can’t pass this course without either having access to fully equipped professional level library or purchasing all of the text books. You will also need to be able to use the National Library of Medicine’s medical literature sites (www.nih.gov/health) so you can locate citations (and frequently abstracts) for material you will need for your papers.

Methods of Evaluation:

Your grade will be based on (1) the answers to your “end-of-unit” essays and (2) your papers.
End of unit essay questions:

These are the questions described above which you will send me after watching each lecture and doing the course reading. Answers do not have to be in formal paragraph format but they must be logical and understandable. The answers to your “end-of-unit” essays are worth 33% of your grade.

Semester papers:

You will write four papers for this course. Papers are graded for grammar, originality, and factual content. They must be fully referenced. Only use professional references. Do not get your information from “popular” Internet sites, lay magazines, etc. Each paper will describe the technique, state how it is applied in nursing practice, state the claims of the techniques adherents, and present a detailed analysis of the strengths and weaknesses of the technique’s efficacy. The three brief papers are due after lectures 3,5, and 7 while the in-depth paper is due one week after you complete the last lecture. You will be docked one full grade for each week the paper is late. Only truly excellent papers will receive an “A”. You can e-mail drafts of papers to me in advance of their due dates for an initial look-over. I will make recommendations for strengthening the final result. Specifications for the papers are as follows:
  1. Brief papers: Write a paper not less than three nor more than six double-spaced pages long on any topic in pain assessment or management which you and I agree upon in advance. The short papers are worth 33% of your grade (11% for each paper).
  2. Write a paper not less than ten nor more than twelve double-spaced pages long on any topic in pain assessment or management which you and I agree upon and which you are very likely to incorporate into the kind of practice you want to go into. The long paper is worth 33% of your grade.
Note: Plagiarism on a paper results in automatic failure and the maximum academic disciplinary action the school can bring.

Grading scale:

A
B
C
D
F 		-
-
-
-
- 		Excellent
Good
Average
Below average
Failing 		90% or more
80% or more up to 90%
70% or more up to 80%
60% or more up to 70%
Below 60%