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A Client Care Module for Nurse Aides:

Understanding Pain Management

...Developing top-notch CNAs, one inservice at a me

We hope you enjoy this inservice, prepared by

registered nurses especially

for nursing assistants like you!

After finishing this inservice, you will be

able to:

Describe the nursing assistant’s role in pain

management.

List at least six ways to tell if someone is in pain.

Describe at least three non-drug methods for

reducing pain.

Discuss some of the common barriers to pain management and how you can deal with them.

Demonstrate in your daily work ways to help your

clients manage their pain.

If you are studying the inservice on your own, please do the following:

Read through all the material. You may find it useful to have a highlighting marker nearby as you read. Highlight any information that is new to you or that you feel is especially important.

If you have questions about anything you read, please ask _________________________.

Take the quiz. Think about each statement and pick the best answer.

Check with your supervisor for the right answers. You need 8 correct to pass!

Print your name, write in the date, and then sign your name.

Keep the inservice information for yourself and turn in the quiz page to _____________________________ no later than _______________. Show your Inservice Club Membership Card to ___________________ so that it can be initialed.

Email In the Know at [email protected] with your comments and/or suggestions for improving this inservice.

THANK YOU!

Instructions for the Learner

A Client Care Module:

UNDERSTANDING PAIN MANAGEMENT

Developing Top-Notch CNAs, One Inservice at a Time

A Client Care Module: Understanding Pain Management

You enter Ms. Bonnie's room to help her with morning care. As you help her get out of bed, you notice that she is grimacing. It looks like something hurts.

She grabs her cane and begins to limp toward the sink. You know she uses a cane because of the arthritis in her knee, but you have never seen her limp like this.

You ask, "Ms. Bonnie, are you okay? Are you in pain?" Ms. Bonnie replies, "It's nothing I can't handle. Just my old creaky bones." You continue to monitor and stay close by in case she needs help getting to her chair.

You were right to stay close because she does need help. Once you get her back to the chair, you take a look at her knee. Her left knee is swollen to nearly double the size of her right knee. You touch it and it feels warm.

You ask Ms. Bonnie, "On a scale of 0 to 10 (with 10 being the worst pain you've ever had) how would you rate the pain you are feeling right now?"

Ms. Bonnies tells you, "Oh it's just maybe a 7 or 8."

When you complete Ms. Bonnie's care, you go straight to Angela, the RN in charge and report your findings. You tell her, "Ms. Bonnie in room 34 has a swollen left knee that is warm to the touch. She is limping and grimacing. She rates the pain as a 7 or 8 out of 10." Then, you chart those same words in Ms. Bonnie's chart.

It is estimated that in the United States nearly 80 million people suffer from pain. Pain can be chronic (long lasting) or it can be acute (something that just started and usually goes away quickly).

Minimum pain management standards set by the Joint Commission require that patients be asked about pain on their first assessment and throughout the duration of care.

Even though Ms. Bonnie tried to brush off her pain, you were persistent and observant. Treatment was started and no further damage was done to Ms. Bonnie’s knee.

Keep reading to learn all about pain management. You’ll find out how to check for pain, how to report it, and how to care for and support clients, like Ms. Bonnie, when they are experiencing pain.

MORE THAN JUST OLD CREAKY BONES

Inside This Inservice:

What is Pain? What is Pain Management?

2

Your Role in Pain Management

3

How You Know Someone Is in Pain

4

Barriers to Pain Management

5

Pain Medications 6

Non-Drug Pain Treatments

7-8

Preventing Pain 9

Managing Pain 10

© 2016 In the Know, Inc. www.knowingmore.com

May be copied for use within each physical location that

purchases this inservice from In the Know. All other

copying or distribution is strictly prohibited.


Grab your favorite highlighter! As you read this inservice, highlight five things you learn that you didn’t know before. Share this new information with your co-workers!

WHAT IS PAIN?

Did you know that pain affects more Americans than diabetes, heart disease, and cancer combined?

More than one-quarter of Americans (at least 100 million people) report that they have had a problem with pain over the past year that lasted longer than 24 hours.

About one-third of people who report pain say that their pain is severe and impacts their daily life.

More women than men report (or maybe admit) that they are in pain.

When asked about common types of pain, a recent survey found that low back pain was the most common type of pain, followed by severe headaches or migraines and neck pain.

© 2016 In the Know, Inc. Page 2

Pain is usually unwelcome and uncomfortable. But, believe it or not, pain is also natural and necessary. It has an important purpose—to protect people from harm. For example:

Pain causes little Cindy to pull her fingers away from a hot stove—before they become badly burned.

The pain from a sprained ankle keeps Jim off his feet for a few days—giving the ankle a chance to heal.

Mildred’s sudden chest pain warns her that she may be having a heart attack—giving her time to get to the doctor.

In these examples, pain is actually helpful. Without the pain, Cindy could suffer a serious burn, Jim could permanently damage his ankle, and Mildred could die without warning.

Unfortunately, pain can also become constant, unbearable, and devastating. Instead of protecting people from harm, pain can destroy their ability to live normal lives. To prevent this from happening to your clients, it’s important to learn all you can about pain management.

WHAT IS PAIN MANAGEMENT?

Pain management is a basic part of good client care—because . . .

Every client has the right to relief from pain!

All members of the healthcare team must work together to:

Take every client’s report of pain seriously.

Determine every client’s level of pain. A one-time assessment is not enough. It must be done on a regular basis.

Treat all pain according to the physician’s orders—being sure to use pain medications effectively.

Explore additional ways to manage the pain—besides drugs.

Help clients and their families learn about all the different ways in which pain can be reduced or eliminated, including the benefits, risks, and costs of each potential treatment.

YOUR ROLE IN PAIN MANAGEMENT

Helping clients manage their pain takes teamwork and communication. Every member of the healthcare team has a role in pain management.

YOUR ROLE IS TO:

1. OBSERVE FOR AND REPORT ALL SIGNS AND SYMPTOMS OF PAIN. It’s important to know what to look for, when to look for it, and how to report your observations.

What: See page 4 of this newsletter to learn how you will know if your client is in pain.

When: Observing for pain can happen any time, but it’s important to pay close attention during personal care, during transfers and ambulation, following activities, and following any pain management interventions.

Report: Always give a verbal report of signs or symptoms of pain to the nurse or supervisor. Follow your workplace policy on documenting your observations in the client’s chart. Be sure to document the name and title of the person to whom you gave the verbal report and any instructions you were given.

2. OBSERVE FOR AND REPORT ANY SIDE EFFECTS OF MEDICATIONS. All medications have potential side effects. See page 6 to learn about the side effects of common pain medications. Report any observations you make to the nurse or your supervisor right away. When the side effects are serious, the medication may need to be stopped or changed.

3. DELIVER SOME NONDRUG TREATMENTS. See page 7 to learn all about safe, non-drug treatments that a doctor may order for managing your client’s pain. Examples include massage, heat or cold packs, exercise, and positioning.

There are also some things you can do without a doctor’s order, like play soothing music, teach your client deep breathing techniques for relaxation, read to your client, or even pray (when appropriate).

4. PROVIDE SUPPORT AND GET HELP FOR CLIENTS IN PAIN. Pain can impact every part of a person’s life. Be prepared to intervene and report any symptoms of:

“EVERYDAY” PAIN

Can be caused by:

Mild headaches

Menstrual pain

Pulled muscles

Everyday pain usually goes away by itself or when treated drugs like aspirin, Tylenol and Motrin.

ACUTE PAIN

Can be caused by:

Injuries

Surgery

Acute pain doesn’t last too long. It usually goes away by the time the person heals.

CHRONIC PAIN

Can be caused by:

Diseases (like cancer)

Conditions (like arthritis)

Pressure sores

Migraines

Chronic pain lasts for months—or even years. Doctors may not be able to figure out the cause of chronic pain.


Poor appetite.

Slow-healing wounds.

Increased stress.

Sleep disturbances.

Loss of strength and mobility.

Anxiety.

Depression.

Thoughts of suicide.

WHAT THE BEST WAY TO MEASURE PAIN?

There are a number of ways to measure pain—depending on the client’s age, mental status, and language abilities. For example:

A numbered rating scale , usually ranging from 0 to 10. Zero means no pain and 10 is the worst pain ever. The client picks the number that best describes his or her pain at that time.

A drawing of the human body. The client circles all the areas of the body that hurt and puts an X on the spot that hurts the most.

An interview with the client to discuss pain, including its intensity, duration, and location.

A checklist of items including physical and emotional reactions to pain, such as “crying”, “clenching teeth,” and “holding stomach.”

How do you measure pain at your workplace? Does it work? Do you feel like you need another option? Talk about it with your supervisor!


HOW YOU’LL KNOW SOMEONE IS IN PAIN Sometimes it’s easy to know when your client is in pain. For example, you walk into Mr. Brown’s room and right away he tells you that he’s having horrible pain!

Some words clients may use to describe pain include:

Pounding

Aching

Sharp

Heavy

Crushing

Shooting

Deep

Gnawing

Stretching

Tight

Stabbing

Pressing

Burning

Electrical

Prickling

Pins and needles

Dull

Pinching

Cramping

Squeezing

Pulsing

It comes and goes.

It’s always there.

It keeps me awake.

I can’t help but feel grumpy.

This is unbearable.

It gets worse when I move.

It seems better in the morning.

It’s tearing me up.

The pain keeps me from doing the things I want to do.

BUT, WHAT IF A CLIENT CAN’T TALK TO YOU? It’s important to watch for non-verbal clues that your client is in pain. These signs can include:

Remember: by paying close attention to your clients, you should be able to tell when they are hurting—even if they don’t say a word.

MOVEMENTS You may see:

Twisting or rocking.

Being restless.

Wringing their hands.

Clenching or grinding their teeth.

Rubbing or holding a body part.

NOISES You may hear:

Moaning.

Groaning.

Whimpering.

Crying.

Screaming.

BEHAVIOR You may notice:

Preferring to be alone.

Losing interest in their appearance.

Suddenly grumpy or irritable.

Trying to hide the pain from you or from family members.

PHYSICAL SIGNS You may observe:

Higher blood pressure

Rapid pulse

Sweating

Nausea


BARRIERS TO PAIN MANAGEMENT

SUFFERING IN SILENCE

Have you ever cared for the “silent sufferer”?

There are many reasons why your clients may try to hide their pain. For example:

They’re afraid of bothering the doctor or nurse and don’t want to be labeled as a “whiner.”

Pain medications make them feel sick, so they’d rather suffer.

They believe that talking about pain is a sign of weakness.

They don’t want their loved ones to worry about them.

They want to “save” their pain medications for when the pain gets really bad.

How do you help your silent sufferers control their pain?

What can you say to ease their fears about reporting pain or taking prescribed pain medications?

You may encounter some barriers to pain management. These are conditions that keep pain management from successfully resolving pain. They include:

FEARS—Some people may be afraid of becoming addicted to prescription pain pills and refuse to take them (or take too little). Others may avoid taking pain medicine because they’re afraid of the side effects.

Fact: Doctors have found that the risk of becoming addicted to pain pills is low. When used as directed to treat pain, most people have no trouble quitting the medication once their pain is gone.

Fact: Some side effects are only temporary and most side effects can be controlled.

ATTITUDES OF THE HEALTHCARE TEAM—Not every healthcare worker knows how to help people cope with pain and some have their own opinions about pain that can get in the way of relief for a client. For example, Jim, a CNA, used to be in the Marines. He believes that everyone should be able to tolerate pain without complaining about it. He gets very impatient when his clients “act like babies” about their pain.

Fact: Everyone who works in health care must put their own feelings about pain aside—and learn to accept each client as an individual. There is no “right” or “wrong” way to react to pain.

ATTITUDES OF CLIENTS AND THEIR FAMILIES—A client’s personal beliefs about pain may make it more difficult to manage the pain and family members may also have strong beliefs that make pain management difficult.

Fact: The client and his or her family must participate in the treatment plan for pain management to be successful.

FEELING GOOD—As soon as they start to feel better, some people tend to overdo. They rush back into their regular activities. . . and the pain usually comes back.

Fact: Pushing too hard too soon can bring on a new cycle of pain.

COST—Some insurance companies refuse to pay for pain management and both pain medications and therapies can be expensive.

Fact: Every year, Americans spend $120 billion because of pain.

STATE LAWS—Some states have laws making it hard for physicians to prescribe narcotics—even when they are necessary to manage pain.

Fact: Studies show that up to 75% of hospital patients suffer from needless pain—and that doctors tend to give too few pain medications, not too many.

Working with clients in the home often requires coming up

with creative solutions to uncommon problems.

THE PROBLEM: You are caring for Max, a 68-year- old man who suffers with severe pain from nerve damage in his back.

He takes his pain medication as prescribed but still has unbearable pain between doses.

WHAT YOU KNOW: You’ve talked to the nurse. She is contacting the doctor about increasing or changing the medicine— and that’s a good plan, but Max needs some relief right now!

GET CREATIVE: What will you do? Think of three creative solutions to this problem.

TALK ABOUT IT: Share your ideas with your co-workers and supervisor and find out how they would solve this problem.

MANAGING PAIN WITH MEDICATIONS


There are different types of pain medications that the doctor may order for your clients. They include:

Anti-Inflammatory Drugs—These include ibuprofen (Motrin and Advil) and aspirin.

Acetaminophen—This is another name for Tylenol. It works well on mild to moderate pain.

Narcotics—These include drugs like codeine and morphine. Typically, narcotics are used only when the pain is severe or constant.

Anti-Depressants and Anti-Seizure Drugs—These help fight the tingling or burning pain that is caused by damaged nerves.

HOW IS PAIN MEDICATION GIVEN? Your clients might take their pain medications in a number of different ways. These include:

Some pain medications are given at a regular time around the clock. For example, Mrs. Smith takes a pain pill every four hours—day and night.

In addition, some pain medications are only given PRN, or “as necessary.” This means that the drug is only given if the client is having pain. For example, two hours after taking her scheduled pain pill, Mrs. Smith begins to hurt again. She takes one of her PRN pain pills to tide her over until her next regular pain pill.

WHAT ARE THE SIDE EFFECTS? Many pain medications have similar side effects, like:

Constipation—Encourage your clients to drink lots of water, to eat fruits and vegetables, and to get some exercise.

Drowsiness—If your clients feel sleepy, protect them from falling down.

Nausea & Vomiting—Ask your supervisor if the client’s medications should be taken with food or milk to prevent an upset stomach.

Confusion—Be sure to tell your supervisor if your client seems more confused after taking pain meds.

Dry Mouth—Make sure your clients have plenty to drink, especially fresh water.

Itchy Skin—Apply skin lotion to areas of dry, itchy skin.

Fluid Retention—Be sure to weigh your clients regularly if they seem to retain fluid.

As a pill. In a liquid.

As a suppository. By an injection.

Through an IV. As a skin patch.

NON-DRUG PAIN MANAGEMENT Non-drug treatment options for pain fall under these two categories:

Activities that DO NOT require a doctor’s order include:

Distraction—To distract a client from pain you may try to play a game, like cards, watch television or a movie or get them to talk about the “old days.”

Backrub/shoulder massage—Offer a massage after a warm bath, before bed or any time the need arises.

Music—Music can be a distraction and can reduce tension and anxiety.

Positioning—Immobile clients should be gently repositioned at least every two hours. Follow your workplace policy.

Reading—If you client can read, be sure to provide books, magazines, and newspapers. If your client is unable to read because of poor vision or other problems, offer to read to him.

Prayer—Research shows that prayer is the most common non-drug way of controlling pain.

Comfort foods—Comfort food can make people feel physically and mentally better!

COMPLIMENTARY & ALTERNATIVE MEDICINE (CAM) Complimentary medicine involves non-conventional practices that are usually used together with conventional medicine. For example, Mary, a 67-year-old woman with arthritis, uses yoga and meditation in addition to conventional medicine to relieve pain.

Here are some common CAM practices that may relieve pain:

HELPING MS. BONNIE

Remember Ms. Bonnie from the beginning of this inservice? The doctor started her on an anti-inflammatory med to reduce the swelling and ease the pain.

Ms. Bonnie refused narcotics because she said she doesn’t like the way they make her feel.

What other non-drug pain management treatments do you think might be helpful to Ms. Bonnie?

_______________________

_______________________

_______________________

What activities could you try on your own (without a doctor’s order)?

_______________________

_______________________

_______________________

Share your ideas with your co-works and supervisor—and find out what they would do.


PHYSICAL INTERVENTIONS Exercise Splinting/Orthotics Cold/heat Massage Vibration Positioning Whirlpool Liniments

MENTAL INTERVENTIONS Talking/Listening Relaxation Music Imagery Meditation/Prayer Deep breathing Distraction Humor

Yoga

Tai-Chi

Meditation

Hypnosis

Chiropractic

Acupuncture

Pet Therapy

Music and Art Therapy

OTHER COMMON PAIN MANAGEMENT TREATMENTS


PHYSICAL THERAPY (PT) PT helps to relieve pain with a number of different methods. These include:

Exercise—Therapists can teach your clients special strengthening and stretching exercises that help reduce pain.

Heat and Cold—Heat helps most with muscle pain and cold helps reduce swelling.

Whirlpool baths—Similar to a “Jacuzzi,” a whirlpool bath offers warmth and massage at the same time.

Ultrasound—Ultrasound therapy sends sound waves into the muscles to “warm” them up.

Massage—Used to relieve muscle ache or tension.

HOW YOU CAN HELP:

Follow any instructions the therapist gives you. This may include helping the client with an exercise plan.

Ask your clients if a warm bath or a massage would help with their pain.

Never let your client fall asleep with a heating pad in the bed.

OCCUPATIONAL THERAPY (OT) Occupational therapists often work with clients who are in pain. They help them by:

Teaching them new ways to perform daily activities so that their pain is reduced. For example, an occupational therapist can help a person with disabling arthritis learn new ways to get dressed or cook a meal.

Helping clients get any special devices they need to reduce pain, such as a long shoe horn or a special spoon.

HOW YOU CAN HELP:

Follow any instructions the therapist gives you about client care.

Tell the therapist if a client complains of pain while performing his or her daily activities.

ELECTRICAL STIMULATION This method for managing pain—often called TENS—involves sending a low “dose” of electricity through the skin near the area of pain.

People who use TENS wear a small machine strapped around their waists.

They adjust the strength of the current until they feel a slight tingling.

HOW YOU CAN HELP:

Remind the client to use the TENS machine according to instructions.

Make sure the batteries are working in the TENS machine.

ACUPUNCTURE This ancient Chinese technique involves inserting thin needles under the skin at specific points in the body.

The needles are “wiggled” or “twirled” until the pain is relieved.

Some people report that the relief lasts for hours—or even days.

Not everyone believes that acupuncture works, but many others swear that it does.

HOW YOU CAN HELP:

Watch for signs of infection at the sites where your client has had acupuncture.

Let your supervisor know if your client expresses an interest in having acupuncture.

IMAGINE THAT! The first known use of electrical stimulation for pain control was nearly 2000 years ago.

A Greek named Scribonius Largus wrote that pain could be relieved by standing on an electrical fish at the seashore.

HELP YOUR CLIENTS PREVENT PAIN

The best way to “manage” pain is to prevent it! Here are a few tips for helping your clients avoid the most common types of pain:

NECK PAIN Remind your clients to use good posture. They should try to keep their neck

in straight alignment with their spine.

Make sure your clients don’t sleep without a pillow or they may wake up with stiff, sore, neck muscles. However, too many pillows can also cause pain. The goal is for the neck and spine to be in proper alignment.

FOOT PAIN Encourage your clients to wear properly fitting shoes that support their feet.

Athletic shoes are a good choice for many people.

Protect your clients’ feet from fungus, germs, and bacteria by helping them keep their feet clean, dry, and covered with clean socks.

HEADACHE PAIN Make sure your clients drink plenty of fluids. Even mild dehydration can

bring on a headache.

Encourage clients to get enough sleep by sticking to a regular bedtime ritual.

Help your clients stand up straight. People with poor posture are more likely to have headaches.

Remind your clients that eating meals on a regular schedule can help prevent headaches.

JOINT PAIN Remind your clients to use their strongest joints whenever possible. For

example, if they have arthritis in their fingers, show them how to hold a mug with the palms of both hands, rather than with their thumb and fingers. (This uses the strength in their wrists, not their fingers.)

Suggest that your clients move their joints daily—with as much range of motion as they can do without pain. They should move slowly and gently, without jerking or bouncing. If your clients are unable to exercise their joints by themselves, ask your supervisor if you can assist them with range of motion exercises.

BACK PAIN Help your clients put their body in alignment

when they sleep. A small pillow between the knees when lying down will help keep the hips aligned.

If your clients tend to sit in the same position for hours, suggest that they move and stretch every thirty minutes.


1. It is estimated that in the United States nearly 80 million people suffer from pain.

2. Pain can be chronic (long lasting) or it can be acute (something that just started and usually goes away quickly).

3. The Joint Commission requires that patients be asked about pain on their first assessment and throughout the duration of care.

4. Every client has the right to relief from pain!

5. Helping clients manage their pain takes teamwork and communication. Your role is to observe and report all signs of pain and side effects of medication, as well as deliver some non-drug treatments as directed.

Now that you‘ve read this inservice on pain

management jot down a couple of things you learned that you didn’t know before.

_______________________

_______________________

_______________________

_______________________

_______________________

_______________________

_______________________

_______________________

_______________________

_______________________

_______________________

_______________________

_______________________

HELP YOUR CLIENTS MANAGE PAIN


Assist your clients so they avoid getting overtired. Being tired can make pain seem worse.

Help your clients balance their sleep and awake time. For example, Mr. Jones naps all day and then lies awake all night worrying about his pain. He would be better off taking a couple of short naps during the day so he can get some sleep at night.

Some people find that being distracted helps them cope with pain. Find out what hobbies or interests your clients have and help them get involved in suitable activities. It may be something as simple as listening to music or reading a good book.

Encourage your clients to get as much exercise as possible. Remind them that if they don’t move around, their muscles will become stiff and sore. But, don’t let them overdo it!

Keep your clients laughing! It has been proven that laughter releases certain chemicals in the body that act as a natural pain medication. (Have you ever noticed how good you feel after you’ve let loose with a real “belly” laugh?)

Remember that pain-relief creams (such as Ben Gay or Capsin) are medications—even though they’re sold over the counter. Check with your supervisor before applying any medicated cream or ointment. (It may be against regulations.)

Help your clients keep a diary of their pain—writing down when it begins, when it gets worse, and what helps relieve the pain.

Understand that your clients will probably have good days and bad days. So, be flexible about your client care, providing more assistance on days when the pain is bad—and less on days when a client can do more for himself.

Be sure to tell your supervisor if pain is keeping a client from performing everyday activities.

Don’t take it personally if clients who are in pain are short-tempered with you. They may feel very frustrated and discouraged from having to deal with their pain, especially if it is chronic.

Watch out for signs of depression. People who suffer from pain have a higher risk of developing depression.

If a client asks you for a PRN pain pill, let a nurse or a family member know that the client is in pain and needs attention.

Document any specific words that your clients use to describe their pain such as: sharp, aching, pounding, stabbing, or tingly.

Notify your supervisor when you know—or suspect—that your client is in pain. Every client has the right to feel relief from pain!

Pain has the power to make someone’s life miserable. However, you have the power to make life better for your clients—

by doing all you can to help manage their pain.

Are you “In the Know” about pain management? Circle the best choice or fill in your answer. Then check your answers with your supervisor!

1. Pain is natural and necessary because it: A. Prevents further harm. C. Warns you of danger.

B. Signals a problem D. All of these.

2. The nursing assistant’s role in pain management includes: A. Giving narcotics. C. Observing and reporting signs of pain.

B. Adjusting the TENS machine. D. Recommending certain exercises.

3. Your client tells you she suffers from frequent headaches as a side effect of her medications. You should:

A. Tell her to stop taking those medications. B. Help her stay hydrated, get enough sleep, and eat regular meals. C. Tell her that there is nothing she can do—and to just deal with it. D. Recommend she take a few of her husbands leftover narcotics for pain.

4. A pain management treatment that a nursing assistant can do without a doctor’s order is: A. Massage C. Chiropractic manipulation. B. Acupuncture. D. None of the above.

5. True or False Most people who take narcotic pain medication will become addicted.

6. True or False People who suffer from pain have a higher risk of developing depression.

7. True or False To prevent neck pain, you should suggest sleeping without a pillow.

8. True or False A common side effect of pain medication is diarrhea.

9. True or False A PRN drug is only given if the client is having pain.

10. True or False There is no way to know for sure if a non-verbal client is in pain.

Inservice Credit:

Self Study 1 hour

Group Study 1 hour

File completed test in employee’s personnel file.

EMPLOYEE NAME (Please print):

________________________

DATE: __________________

I understand the information presented in this inservice.

I have completed this inservice and answered at least eight of the test questions correctly.

EMPLOYEE SIGNATURE:

________________________

SUPERVISOR SIGNATURE:

________________________

A Client Care Module: Understanding Pain Management


understanding pain management - suncrestcare.comapr) pain managem… · pain management is a basic...

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