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Pain Management
• Patrice Levy, RN• Therapeutics NURS 7724• November 25, 2002
Objectives
• Define pain• Define addiction, physical dependence,
tolerance, and adjuvant analgesic
• Identify the types/classification of pain
• Explain the pain mechanisms
• Identify the barriers to pain management and harmful effects of unrelieved pain
Definition of Pain
• Pain is an unpleasant sensory and emotional experience associated with acute or potential tissue damage, or described in terms of such damage.– IASP, APS - 1992, Mersky, Bogduk - 1994
Definition of Pain
• Pain is whatever the experiencing person says it is, existing whenever he says it does
• McCaffery - 1968
Definitions
• Addiction: Psychologic dependence. A pattern of compulsive drug use characterized by continued craving for an opioid for effects other than pain relief.
• Tolerance: A decrease in one or more effects of the opioid
• Physical Dependence: is the occurrence of withdrawal symptoms when the drug is stopped.
Definitions
• Adjuvant analgesic: A drug that has a primary indication other than pain.
Types of Pain
• Acute Pain- brief pain that subsides as healing takes place
• Cancer Pain
• Chronic Nonmalignant Pain
Classification of Pain
Nociceptive- term used to describe how pain becomes conscious
• Neuropathic- abnormal processing of sensory input by the peripheral or CNS
Nociception Pain Pathway
Transduction- Conversion of one energy from another, begins in the periphery when a noxious stimulus causes tissue damage.
• Transmission- movement of impulses from the site of transduction to the brain.
• Perception- conscious experience of pain.
• Modulation- inhibition of nociceptive impulses.
Nociception - The Process
Nociceptive Pain
• Somatic Pain- arises from bones, joints, muscle, or connective tissue. Usually described as aching or throbbing in quality. Pain is well localized.
• Visceral Pain- arises from the visceral organs, GI tract/pancreas.
Neuropathic Pain
• Centrally Generated- results from injury to• the CNS or peripheral nervous system
• Peripherally Generated- generalized or
• specific pain along a damaged nerve.
Barriers to Pain Management
• Health Care Professionals
• Inadequate knowledge• Lack of education• Poor assessment• Regulatory Constraints
Barriers of Pain Management
• Patients and the Public• Reluctance to report pain• Reluctance to take analgesics• Concerns about addiction• Concerns about tolerance• Desire to be a “good patient”
Barriers to Pain Management
• Health Care System
• Pain assessment and treatment a low priority in daily practice
• Restrictive regulation of controlled substances
Harmful Effects of Unrelieved Pain
• Endocrine System overactivity
• Cardiovascular– Hypercoagulation– Increase Heart Rate– Increase Blood Pressure– Increase Cardiac Workload– Increase Oxygen Demand
• Respiratory– Muscle Spasm– Decrease Tidal Volume– Decrease Vital Capacity– Decrease Alveolar
Ventilation
• Genitourinary– Urinary Retention– Hypokalemia
Harmful Effects of Unrelieved Pain
• Gastrointestinal– Increase intestinal Secretion– Increase smooth muscle tone– Decrease Gastric Emptying– Decrease Intestinal Motility
• Musculoskelatal– Muscle Spasm– Impaired Function– Fatigue– Imobility
• Cognitive Function– Mental Decline
• Immune Function– Decrease Immune Function– Decrease NK Cell Activity
• Developmental Effect– Experience associated with
pain remembered and this can have an effect on future behavior
Harmful Effects of Unrelieved Pain
• Future Pain– Poorly controlled acute
pain can predispose patients to debilitating pain syndromes.
– Phantom Pain– Herpetic Pain
• Quality of Life– Impact of unrelieved
pain on quality of life is significant , ranging from decreased physical activity to hopelessness and suicidal ideations
Conclusion
• The power point presentation on pain management discussed the basic mechanisms underlying the causes and effects of pain.
References
Fanciullo, G, (2000). Acute Pain Management , Symposium Spotlight: The 16th Annual Meeting of the American
Academy of Pain Medicine, New Orleans, La., Feb. 24-27.
Joint Commission on Accreditation of Healthcare Organization, (2000). Pain assessment and management an
organizational approach. Oakbrook, Il.: Joint Commission on Accreditation of Healthcare Organization.
McCaffery, M. & Ferrell, B. (1999). Pain Clinical Manual (2nd ed.). St. Louis: Mosby.
Phillips, D. (2000). JCAHO pain management standards are unveiled, JAMA, 284 (4).
Rubinger, H, & Gardner, Richard, (2002). Pain and Suffering, Continuing Care, 21, (4), 22.
Smith,Rita, Curi, M., Silverman, A, (2002). Pain Management: The global connection, Nursing Management, 33 (6), 27.
Stratton, L. (1999). Evaluating the effectiveness of a hospital pain management program, Journal of Nursing Care
Quality, 13 (4), 8-18.
U.S. Department of Health and Human Services, Agency for Health Care Policy and Research: Acute Pain Management
in Adults: Operative Procedures. Pub 92-0019.
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