Pain

PAINermteruel

DeFiNiTiOnS oF

pAiN

By: (IASP) International Association for Study of Pain Pain is an unpleasant

sensory and emotional experience

associated with actual or potential

tissue damage.

By: Stenbacka 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.

By: Mc Caffery (1979)

whatever the experiencing

person says it is existing whenever the person say it is

II. Misconceptions and Myths of Pain

1. Pain is a part of aging2. If a person is asleep, they are

not in pain3. If pain is relieved by non-

pharmaceutical 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


6. 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


10. Clients experience severe pain only when they have had major surgery.

11. The nurse or other health care professionals are the authorities about a client’s pain

12. Visible or physiologic or behavioral signs accompany pain and can be used to verify its existence.

tErMiNoLoGiEs

Pain Related TermsRadiating pain

perceived at the source of the pain and extends to the nearby tissues

Referred painfelt in a part of the body that is considerably removed or far from the tissues causing the pain

Hyperalgesia

Excessive sensitivity

to pain

Pain Threshold/ sensation

the amount of pain stimulation a person requires before feeling pain

least level of pain that the patient is able to detect

Pain Reaction Includes the ANS and behavioural

responses to paintypes: ANS response

autonomic reaction of the body that often protect the individual from further harm. (automatic withdrawal of hand from hot object.)

Behavioural response is a learned response used as a method

of coping with pain.

Pain Tolerance maximum amount

and duration of pain that an individual is willing to endure

greatest level of pain that the patient is able to tolerate

Pain Perceptionthe point which the

person becomes aware of the pain

tRiAd Of PaiN

pErCePtiOn

TRIAD OF PAIN PERCEPTION

1.Pain Receptor

2.Pain Stimuli3.Pain Fibers

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

The Pain Stimulus

1. Mechanical2. Thermal3. Chemical

Pain FibersThere 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 fibersare associated with slow, chronic, aching pain

Pain Fibers

pAiN sYnDrOmEs

Pain Syndromes

1.Referred Pain2.Radiating Pain3.Psychogenic Pain4.Neurologic Pain5.Phantom Limb Pain6.Intractable Pain

Psychogenic Pain no pathologic cause

Caused: Mental Emotional Behavioral factorsinduced by social

rejection, broken heart, grief, love sickness, or other such emotional events.

Psychogenic Pain

s/s:

Headache, back pain stomach pain

Neurologic Pain

MAIN PROBLEM:

neurologic system

Neurologic Pain

Damage PNS & CNS Nerve fibers

What causes neuropathic pain?

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

Two common areas of neuralgia

Phantom Limb PainPainful

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

Phantom Pain

6. Intractable painThis type of

pain is a chronic pain

that is resistant to

cure or relief.

pAtHoPhYsiOLoGy

oF pAiN

Physiology of Pain

1.Transduction2.Transmission3.Perception4.Modulation

Physiology of Pain

1. Transduction2. Transmission3. Perception4. Modulation

3. Perception

cerebral cortex Somato sensory

cortex association cortex limbic system

4. Modulation 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

Types of PAIN

Categories of pain according to its

1. Origin2. Onset3. Cause or etiology

According To Location/origin1. Superficial Cutaneous Pain

occurs over body surface or skin segments.

2. Deep Somatic Pain occurs in the skin, muscles and joints

(musculoskeletal – muscle, bone, periosteum, cartilage, tendons, deep fascia, ligaments, joints, blood vessels and nervous)

3. Visceral Pain pain from body organs

Types of PAIN (Onset) Acute pain

following acute injury, disease or some type of surgery

Chronic malignant pain

associated with cancer or other progressive disorder

Chronic nonmalignant pain

in the persons whose tissue injury is non progressive or healed

Types of PAIN (Cause/Basis)Mechanical trauma blockage of body duct tumor muscle spasm

Thermal or cold extreme heat

ChemicalTissue ischemia Blocked artery

Stimulation of pain receptors

accumulation of lactic acid

gAtE cOnTroL ThEoRy

Melzack and Wall

Factors influencing

reaction to pain Psychological Physiological

Cultural

Age (Physiological) 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

Pharmacologic Pain Relief Interventions

Analgesics : Non opioids/ non- narcotic analgesics NSAIDs Narcotic analgesics / opioids Adjuvants / co- analgesics Local anesthesia Patient controlled analgesia Epidural analgesia

1 . Non – Narcotic Analgesics

Ex. Acetaminophen acetyl salicylic acid

2. NSAIDs

Ex : IbuprofenNaproxenIndomethacin PiroxicamKetoralac

3. Narcotic Analgesics/Opioids

Ex: meperidinemethylmorphinemorphine sulphatefentanyl

4. Adjuvants Sedatives, anti-anxiety agents, muscle relaxants

Ex: AmitriptylineHydroxyzinediazepam

5. Patient Controlled Analgesia (PCA)

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

Advantages of PCA 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

Disadvantages of PCA 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

OTHERS: (Anesthesia)

6.Local7.Spinal

anesthesia8.Epidural

anesthesia

SURGICAL TREATMENT

Dorsal Rhizotomy:

Cordotomy or spinothalamic tractotomy

NON-PHARMACOLOGIC

Non pharmacologic interventions

A.Cognitive Behavioral Approaches:

1. Distraction

Cognitive behavioral approachescontd…

2. Reducing

Pain Perception


3. Bio-feed back

5. Guided Imagery


B. Physical ApproachesGoals: to provide comfort to correct physical dysfunctions to alter physiological responses to reduce fears associated with pain

related immobilityExamples: 1. Acupressure / acupuncture2. Cutaneous stimulation (massage, heat application,

TENS)3. Binders, Chiropractic

1. Acupressure / Acupuncture

2. Cutaneous Stimulation



Cutaneous stimulation contd…

Cutaneous stimulation contd…

3. Binders

5. Rest and Sleep

Chiro-practic

6. Use of Placebos

Pain History

Pain History

LOCATION: “Where is your pain?”

INTENSITY:

Visual Analogue Scale

Verbal Score

0 1-2-3 4-5-6 7-8 9-10

Nopain

Hurts little

Hurts a lot Really hurts a lot

Extremely hurts

Visual Score

Observerscoring

Appears pain free

Comfortable except on movement

Uncom-fortable

Distressed can be

comforted

Distressed

Health & Medicine

Pain