Pain

Pain and It’s ManagementObjectives

• Define Pain• Assessing Pain• Pain Treatment

Define Pain

• Sensation of hurting or strong discomfort• Subjective, can’t be measured objectively• #1 complaint by patients seeking medical

care• Usually accompanies:

inflammationtissue damageinfectiontrauma

Purpose of Pain

• Protective function; motivates person to remove cause

• Each disease produces characteristic patterns which helps with diagnosis

How Patients Express Pain

• Perceptions from past experience

• Pain threshold & tolerance

• Cultural expression• Age• Anxiety or stress level• Depression• Activity level

How Pain Travels

Pain Gate TheoryExplains why thoughts and emotions affect pain

www.PainClinic.org

Pain Mechanisms – Normal Sensations

Sensory Cortex

SkinStimulation

Dorsal Horn

BrainStem

LimbicSystem

FeelingHappy

NormalHR, BP, RR,Skin temp

Descending Inhibition

Closing The Gate

CVS / RS Centres

www.PainClinic.org

What Happens In Acute Pain

Sensory Cortex

Dorsal Horn

BrainStem

LimbicSystem

FeelingHappy

NormalHR, BP, RR,Skin temp

Descending Inhibition

Closing The Gate

CVS / RS Centres

SensitisedDorsal Horn(Wind Up)

BrainStem

PainPerception

CVS / RS Centres

RaisedHR, BP, RRCold Skin

LimbicSystem

PainBehaviour

Descending Inhibition

Helps Close The Gate

SkinStimulation

TissueInjury

www.PainClinic.org

Recovery After Acute Pain

Sensory Cortex

Dorsal Horn

BrainStem

LimbicSystem

FeelingHappy

NormalHR, BP, RR,Skin temp

Descending Inhibition

Closing The Gate

CVS / RS Centres

SensitisedDorsal Horn(Wind Up)

BrainStem

PainPerception

CVS / RS Centres

RaisedHR, BP, RRCold Skin

LimbicSystem

PainBehaviour

TissueInjury

Descending Inhibition

Helps Close The Gate

TissueHealing

Dorsal HornWinds Back Down

BrainStem

PainSubsides

CVS / RS Centres

NormalHR, BP, RRWarm Skin

LimbicSystem

FeelingHappy

Descending Inhibition

Helps Close The Gate

www.PainClinic.org

Why Does Chronic Pain Develop ?

Sensory Cortex

Dorsal Horn

BrainStem

LimbicSystem

FeelingHappy

NormalHR, BP, RR,Skin temp

Descending Inhibition

Closing The Gate

CVS / RS Centres

SensitisedDorsal Horn(Wind Up)

BrainStem

PainPerception

CVS / RS Centres

RaisedHR, BP, RRCold Skin

LimbicSystem

PainBehaviour

TissueInjury

Descending Inhibition

Helps Close The Gate

Setting The Scene

Badly Managed Acute Pain

Emotionally Sensitive Patient

Low IQ and ability to understand

Poor Coping Skllls

Previous Bad Pain Experiences

Pain Goes on For Longer

Surgical Complications

Poor Descending

Inhibition

- Gate Wide Open

ContinuingPain Input

PermanentlySensitised

Dorsal Horn

Activated

Silent

Channels

BrainStem

ChronicPain

CVS / RS Centres

? Risk of Hypertension

+ Angina

LimbicSystem

ChronicPain PtChronicPain Pt

Referred Pain

• Pain that comes from area other than site where it originates due to shared sensory nerve pathways

Assessment of Pain

• P=place• A=amount• I=interactions• N=neutralizes

Pain Drawings

Pain Treatment

• #1 choice for treatment of pain is medication

• Classifications of medications for pain treatment:opioidnon-opioidanalgesicsanestheticsanti-inflammatoriesPCAplacebo

Pain Treatment Alternatives

BIOFEEDBACK

Yoga

Aromatherapy

Massage

Therapeutic Touch

Humor

Relaxation