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Marilyn GrippingSept. 18, 2010

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DisclaimerThe views and opinions I present today

are entirely my own. They do not necessarily reflect the views of the Calgary Health Region, or either of Norquest or Bow Valley Colleges.

My views and opinions should not be construed as an official explanation or interpretation.

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Disclosure I have no relationship that could be perceived as placing me in a real or apparent conflict of interest in the context of this presentation.

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What is Pain? “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” (Jovey, page 9)

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“Whatever the person experiencing it says it is and exists whenever he says it does.” (Linton, 202)

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Factors Influencing Pain Experience

Pain ThresholdPain ToleranceAgePhysical ActivityNervous System Integrity

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Surgery/AnesthesiaCultureReligious BeliefsPast Experiences/AnxietySituational Factors

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Perception of PainAfferent pathways

NociceptorsCNS

Pain receptorsSpinal cordBrain

Efferent pathwaysDescending pathway

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Endorphins and EnkephalinsBody’s natural opioid-like

substancesBlock transmission of pain to spinal

cordIndividuals produce different

amounts

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Decrease EndorphinsProlonged stress

PainUse of opioids

Alcohol

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Increase EndorphinsBrief stress

PainLaughter,ExerciseAcupunctureTranscutaneous Electrical Nerve Stimulation

(TENS)Massive TraumaSexual Activity

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Gate-Control TheoryPain reflects both physical and psychosocial factors

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Gate-Control Theory

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Gate-Control Theory – con’t

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Gate-Control Theory – con’t

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Types of PainAcuteSubacuteChronicBaseline PainBreakthrough Pain

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Categories of PainNociceptive

SomaticVisceral

NeuropathicCNCP (Chronic Non-Cancer Pain)

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Pain SeverityPain ScalePain is rated on a scale of 0-10 where “0” is no pain and “10” is the worst pain imaginable or the worst pain the person has ever had.

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Statistics1/3 of all people suffering with chronic pain

are treated successfully with NSAIDsChronic pain in elderly is very common and is

often undertreatedRisk of addiction is usually less than the need

to control chronic pain

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The Treatment ContinuumMost efficient use of locally available

medical resourcesMore available, less expensive, less

invasive, fewer side effectsLess available, more expensive,

more invasive, more side effects

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Examples:PhysicalPsychologicalPharmacologicalInvasive Therapies

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Prescribing of pain medsDose to effectExceptions:

NSAIDSAntidepressantsAnticonvulsants

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Analgesic Ladder

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AdjuvantsDrugs primarily developed to treat other conditions

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Bibliography Dhalla, Irfan A, et al. (2009). Prescribing of opioid analgesics and

related mortality before and after the introduction of long-acting oxycodone. CMAJ-JAMC, 181 (12), 891-896.

Fischer, Benedikt, Rehm, Jurgen (2009). Deaths related to the use of prescription opioids. CMAJ-JAMC, 181 (12), 881-882.

Jovey, Roman D. (Ed). (2008). Managing Pain – The Canadian Healthcare Professional’s Reference. (2008 Edition). City: Purdue Pharma.

Kozier, B., Erb. G., Berman, A., Snyder, S., Bouchal, D.S.R., Hirst, S., et al. (2010). Fundamentals of Canadian Nursing: Concepts, process and practice (2nd Canadian ed.) Toronto: Pearson Education Canada.

Linton, A. (2007). Introduction to medical-surgical nursing (4th ed.). Philadelphia, PA: Saunders.