ermteruel

DeFiNiTiOnS oF pAiN

is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Pain

personal private sensation of hurt. a harmful stimulus that signal current or impending tissue damage. a pattern of responses to protect the organism from burn.

the experiencing person says it is existing whenever the person say it is

whatever

Pain is a part of aging If a person is asleep, they are not in pain 3. If pain is relieved by nonpharmaceutical pain relief techniques, the pain was not real anyway 4. Real pain has an identifiable cause 5. It is better to wait until a client has pain before giving medications
1. 2.

Very young or very old people do not have as much pain 7. Some clients lie about the existence or severity of their pain 8. Addiction occurs with prolonged use of morphine or morphine derivatives 9. The same physical stimulus produces the same pain intensity, duration and distress in different people
6.

Clients experience severe pain only when they have had major surgery. 11. The nurse or other health care professionals are the authorities about a clients pain 12. Visible or physiologic or behavioral signs accompany pain and can be used to verify its existence.
10.

tErMiNoLoGiEs

 Radiating

perceived at the source of

pain

Referred

the pain and extends to the nearby tissues

felt in a part of the body that

pain

is considerably removed or far from the tissues causing the pain

Excessive

sensitivity to pain

the amount of pain stimulation a person requires before feeling pain least level of pain that the patient is able to detect

Includes the ANS and behavioural responses to pain types: ANS response

autonomic reaction of the body that often

Behavioural response
coping with pain.

protect the individual from further harm. (automatic withdrawal of hand from hot object.)

is a learned response used as a method of

maximum amount and duration of pain that an individual is willing to endure greatest level of pain that the patient is able to tolerate

the

point which the person becomes aware of the pain

tRiAd Of PaiN

pErCePtiOn

1.Pain

Receptor 2.Pain Stimuli 3.Pain Fibers

pain Free

receptors nerve ending in the skin that respond only to intense, potentially damaging stimuli.

1. 2. 3.

Mechanical Thermal Chemical

Pain Fibers Fibers Pain

There are two separate pathways that transmit pain impulses to the brain: (1) Type A-delta fibers are associated with fast, sharp, acute pain and 2) Type C fibers are associated with slow, chronic, aching pain

pAiN sYnDrOmEs

1.Referred Pain 2.Radiating Pain

3.Psychogenic Pain 4.Neurologic Pain 5.Phantom Limb Pain 6.Intractable Pain

no pathologic cause

Caused: Mental Emotional Behavioral factors induced by social rejection, broken heart, grief, love sickness, or other such emotional events.

 s/s:

Headache,
back pain

stomach

pain

MAIN PROBLEM:
neurologic

system

Damage

PNS & CNS Nerve fibers

Alcoholism Amputation Back, leg, and hip problems Chemotherapy Diabetes Facial nerve problems HIV infection or AIDS Multiple sclerosis Spine surgery

Painful perception perceived in a missing body part or in a body part paralyzed from a spinal cord injury

 This

type of pain is a chronic pain that is resistant to cure or relief.

pAtHo PhYsiOLoGy oF pAiN

1.Transduction
3.Perception

2.Transmission 4.Modulation

Transduction Transmission 3. Perception 4. Modulation

1. 2.

cerebral cortex Somato sensory cortex association cortex limbic system

endogenous opioids (endorphins & enkephalins

chemical substances
spinal and medullary dorsal horn periaqueductal gray matter hypothalamus amygdala in the CNS)

serotonin 5HT norepinephrine gamma amino butyric acid (GABA)

TyPeS oF pAiN

Categories of pain according to its 1. Origin 2. Onset 3. Cause or etiology

1.

Superficial Cutaneous Pain Deep Somatic Pain

occurs over body surface or skin segments. occurs in the skin, muscles and joints (musculoskeletal muscle, bone, periosteum, cartilage, tendons, deep fascia, ligaments, joints, blood vessels and nervous) pain from body organs

2.

3.

Visceral Pain

Acute pain

Chronic malignant pain

following acute injury, disease or some type of surgery

Chronic nonmalignant pain

associated with cancer or other progressive disorder

in the persons whose tissue injury is non progressive or healed

Mechanical trauma blockage of body duct tumor muscle spasm

Thermal or cold extreme heat

Chemical Tissue ischemia Blocked artery

Stimulation of pain receptors accumulation of lactic acid

gAtE cOnTroL ThEoRy

Melzack and Wall

Psychological Physiological Cultural

Factors influencing reaction to pain

Infant: perceive pain and respond to its increasing sensitivity Toddler: respond by crying and anger because they perceive it as a threat to security or sense that pain is a punishment School age: try to be brave and not to cry or express much pain so parents and nurse will not be angry with them Adolescent: may not want to report pain in front of peers because they perceive complaints of pain as weakness Adult: may not report pain for fear that it indicates poor diagnosis. Nurse may mean weakness and failure

Pain Management

Pharmacologic Treatment

Analgesics :
Non opioids/ non- narcotic analgesics

NSAIDs

Narcotic analgesics / opioids

Adjuvants / co- analgesics Local anesthesia Patient controlled analgesia Epidural analgesia

Ex. Acetaminophen acetyl salicylic acid

Ex :
Ibuprofen Naproxen Indomethacin Piroxicam Ketoralac

Ex: meperidine methylmorphine morphine sulphate fentanyl

 Sedatives, Ex:

anti-anxiety agents, muscle relaxants

Amitriptyline Hydroxyzine diazepam

A drug delivery system which is a safe method for post operative, trauma & obstetrics, burns, terminal care pediatrics and cancer pain management Involves self IV drug administration

Goal : to maintain a constant plasma level

of analgesic so that the problems of client with needed dosing (PRN) are avoided Client preparation & teaching is important Check IV line & PCA device regularly

Easy access for clients for medication

Allows self administration with no risks

Pain relief without depending on nurses Small doses of medications at short intervals for sustained pain relief Stabilized serum drug levels Decreased anxiety

Patient becomes dependent on PCA If mobility is contraindicated, client may move due to decreased or no pain by PCA Respiratory depression Side effect may be constipation Mechanical failure of pump Relatives may press button for client

Wrong programming parameters

Incorrect placing of syringe can cause infusion of excessive drug doses

Costly & if client may not understand the system

6. Local

7. Spinal

anesthesia 8. Epidural anesthesia

TREATMENT

SURGICAL

NONPHARMACOLOGIC

A.Cognitive Behavioral Approaches:

1. Distraction

2. Reducing Pain Perception

3. Bio-feed back

Goals:

to provide comfort to correct physical dysfunctions to alter physiological responses to reduce fears associated with pain related immobility

Examples: 1. Acupressure / acupuncture 2. Cutaneous stimulation (massage, heat application, TENS) 3. Binders, Chiropractic

Pain History

LOCATION:

Where is your pain? INTENSITY:

Visual Score

0 Verbal Score No pain

1-2-3 Hurts little

4-5-6 Hurts a lot

7-8 Really hurts a lot

9-10 Extremely hurts

Observer scoring

Appears pain free

Comfortable except on movement

Uncomfortable

Distressed can be comforted

Distressed