Pain Management

PAIN MANAGEMENT

Pain is an unpleasant sensory and emotional experience associated With actual or potential tissue damage. (American Pain Society (APS], 2003; Gordon, 2002)

"Pain is whatever the experiencing person says it is, existing whenever he says it does”

It is not the responsibility of the patient to prove that they are in pain; it is the nurse's responsibility to accept their report.

Nature of pain:

·        Unique to each individual

·        Complex, involving physical, emotional and cognitive components

·        Pain uses a person's energy

·        It interferes with personal relationships

·        You cannot measure it objectively

Physiology of pain:

The physiological processes related to pain perception are described as "NOCICEPTION"

There are 4 main processes related to pain:

·        Transduction

·        Transmission

·        Modulation

·        Perception

Types of pain:

    Pain maybe described in terms of:

·        Location

·        Duration

·        Intensity

·        Etiology

Location:

Where it is the body

Pain may be:

Radiating- spread to other areas

Referred- arise in different area of the body

       Eg: cardiac pain may be felt in the shoulder or left arm

            Duration:

        Acute pain: Pain is directly related to tissue injury and   resolves when tissue heals.

       Short duration

       Chronic pain: pain that persists beyond 6 months secondary to chronic disorders

            Intensity:

          Using a standard O (no pain)----- 10 (worst )

       1-3: mild pain

       4-6: moderate pain

       7-10: severe pain

            Etiology:

       2 broad categories : physiologic pain and neuropathic pain

ü Physiological pain: is experienced when an intact, properly functioning nervous system sends signals that tissues are damaged

ü Somatic pain: originates in the skin, muscles, bone or connective tissue. Eg: pain in ankle sprain

ü Visceral pain: results from activation of pain receptors in the organs Eg: cramping abdominal pain

ü Neuropathic pain: is experienced by people who have damaged or malfunctioning nerves

ü Peripheral neuropathic pain: results from damage of peripheral nerves. Eg: phantom limb pain

ü Central neuropathic pain: results from malfunctioning nerves in the central nervous system. Eg: spinal cord injury

Concepts associated with pain:

•     Intraactable pain: a pain state for which there is no cure possible after accepted medical evaluation and treatments have been implemented. The focus of treatment turns from cure to pain reduction, functional improvement, and the enhancement of quality of life.
•     Nocioceptive pain: pain that is directly related to tissue damage. E.g. damage to skin
•     Pain threshold: The process of recognizing. defining and responding to pain.
•     Pain tolerance: the most pain an individual is willing or able to tolerate before taking actions
•         Due to abnormal nerve functioning:

ü Allodynia: sensation of pain from a stimulus that normally does not produce pain.Eg. light touch

ü Dysesthesia: an unpleasant abnormal sensation that can be either spontaneous or evoked

ü Hyperalgesia: increased sensation of pain in response to a normally painful stimulus

      Factors affecting pain experience:

v Ethnic and cultural background

v Development stage

v Environment and support people

v Past pain experiences

v Meaning of pain

 Nursing management:

Assessment: Pain history - COLDERR

Character

Onset

Location

Duration

Exacerbation

Relief

Radiation

  Intensity: measure the intensity using a numeric rating scale or a Wong baker FACES rating   scale

             Nurses role:

Ø Acknowledging and accepting patients pain

Ø Assisting support persons

Ø Reducing fear and anxiety

Ø Preventing pain: provision of pain relief before it occurs

Ø Pharmacological pain management: narcotics/opiods, NSAIDS

Non pharmacological pain management:

                                      Cutaneous stimulation:

                 1. Massage

                 2. Application of heat or cold

                 3. Acupressure

       4. Contralateral stimulation -- stimulating the skin in an area opposite to the painful area. Used when the pt cannot be touched because it is hypersensitive, when pain is felt in the missing body part.

•          Immobilization/bracing: splints, supporting devices

Transcutaneous electrical nerve stimulation (TENS):

applying low voltage electrical stimulation directly over identified pain areas, along peripheral nerve areas or along the spinal column.

•         Relaxation and guided imagery
•         Music therapy

Restorative and continuing care:

• Pain clinics — treat patient as and OP
•  Palliative care hospitals- manage chronic pain
• Hospices care for pt at the end of life