Pain

Term One VN Program

Overview

Definition of pain
Pain Theories
Types of pain
Acute vs. Chronic Pain
JCI standards on pain
Nursing Responsibilities: overview
Nursing Process
Comfort and Discomfort

Pain
Pain defined
Pain is an unpleasant sensory and
emotional experience associated with
actual or potential tissue damage, or
described in terms of such damage.
International Association for the Study of Pain (IASP) and
the American Pain Society (APS)

Pain
Pain is defined as:
A complex, abstract, personal experience
An unpleasant sensation caused by noxious
stimulation of the sensory nerve endings
Serves as a warning system to the body
because it often occurs where there is
actual or potential tissue damage
May be a cardinal sign of inflammation
Can occur when there is no tissue damage,
such as the pain of grief or the pain of
migraine headaches

 What happens if we cant feel pain?

Congenital Insentivitiy to Pain with
Anhidrosis (CIPA)
Rare genetic disorder where child cant
feel any pain or hot and cold sensation
Disorder of the small nerve fibers

Pain
Remember that pain is subjective.
Your patients perception of their
pain will be influence by their past
history of pain, their past
experiences and their learned
experiences.
Your patient knows their pain and
they are the only expert in when it
comes to understanding their pain.

Pain

This self portrait depicts Frieda Kahlos despair with

her neuropathic pain problem, showing a fractured
spine, nails penetrating her skin, emotionless
tearing, and an overall outlook of hopelessness

Pain

The Lingering Pain

Pain is a distressful feeling or sensation signaling possible acute
injury.
Perception of pain differs in different cultures and individuals.
Pain may persist even after the painful causing stimulus is
removed.
For example memories of a painful experience in life may
persevere to lingering pain.
Dr Mohamed Osman,
Physician and Artist

Pain Theories
Theories of Pain Transmission
Gate Control Theory
Theory suggests that pain impulses
can be regulated or even blocked by
gating mechanisms located along
the central nervous system.
The proposed location of gates are
in the dorsal horn of the spinal cord.

Pain
Pain and other sensations of skin and
muscle travel the same pathways
through the large nerves in the spinal
cord.
If cutaneous stimuli occur, the gate
through which the pain impulse must
travel is temporarily blocked by the
stimuli.

Pain, interuption of
impulses by stimuli

Pain
Endorphins
The body contains a natural supply of
morphine-like substances called
endorphins.
Stress and pain activate endorphins.
Analgesia results when certain endorphins
attach to opioid receptor sites in the brain
and prevent the release of
neurotransmitters, thereby inhibiting the
transmission of pain impulses.
Pain relief measures, such as
transcutaneous electrical nerve
stimulation, acupuncture, and placebos,
are believed to cause the release of
endorphins.

Pain
Types of Pain are:
Chronic: >6 mos
Acute: <6 mos
Referred: felt at another site
Synergistic:the combination of other
phenomenon such as fatigue or
depression can change ones
perception of their pain.
Intermittent: comes and goes
Intractable: does not go away

Pain

Acute Pain

Chronic Pain

Intense and of short

duration
Usually lasts less than 6

months
Generally provides a
warning to the individual of

actual or potential tissue

damage
Creates an autonomic
response that originates

within the sympathetic

nervous system
Floods the body with
epinephrinefight or
flight response

Pain lasting longer than 6

months
Can be continuous or
intermittent and may be as
intense as acute
Does not serve as a warning
sign of tissue damage; may be
due to damage that has
already occurred
Patient may develop chronic
low self-esteem, change in
social identity, changes in role
and social interaction, fatigue,
sleep disturbance, and
depression

Trivia: Unoficially the top most

painful conditions

Cluster headaches
Complex Regional Pain Syndrome
Trigemeninal Neuralgia
Bone Cancer
Renal Colic

Overview

Definition of pain
Types of pain
Acute vs. Chronic Pain
JCI standards on pain
Nursing Responsibilities:
overview
Nursing Process
Comfort and Discomfort

Pain
Under the new JCAHO (Joint
Commission on Accreditation of
Healthcare Organizations)standards,
health care providers are expected to
be knowledgeable about pain
assessment and management.
And facilities are expected to develop
policies and procedures supporting the
appropriate use of analgesics and
other pain control therapies.

Pain
Key Concepts JCAHO
Patients have the right to appropriate assessment.
Patients will be treated for pain or referred for
treatment.
Pain is to be assessed and regularly reassessed.
Patients will be taught the importance of effective
pain management.
Patients will be taught that pain management is
part of their treatment.
Patients will be involved in their care decisions.
Routine and prn analgesics are to be administered
as ordered by their MD.
DC planning and teaching will be based on the
patients needs

Pain

Nurses are responsible for the

following(Overview):
Assess/monitor the patient for
impaired comfort
Provide effective pain relief
Assess/monitor effectiveness of pain
treatment
Evaluate patients response to pain
relief measures
Provide teaching about pain meds

Pain
Nursing Assessment
Ask your patient about their pain:
What does it feel like? Ex, ache, burning,
dull, gnawing, sharp
Intensity: Rate the pain from 0-10
Location: Where is the pain?
Duration: How long have you had the pain?
What makes the pain worse? Better?
How does it affect your lifestyle?
Other symptoms such as itching, nausea?

Pain in the body and

what it tells you!!!

Chest
Right upper shoulder
Epigastric
Epigastric to Right lower
quadrant
Costovertebral angle

Pain
Nursing assessment
Objective data will reveal:
Tachycardia
increased rate and depth of respiratons
Increased BP
Pallor
Dilated pupils
Increased muscle tension
Some patients will have subjective signs with no
observable objective signs! STOICISM
You may see facial grimaces, frowning or gritting of
teeth

Pain

Sharp Pain

Pain

Dull Pain

Pain

Severe Pain

Pain

Chronic Pain

Pain Nursing Process

Nursing Diagnoses

Acute Pain
Chronic Pain
Risk for Pain
Fatigue
Disturbed Sleep Pattern
Impaired Physical Mobility

Pain Nursing Process

Goals & Outcomes
Patient verbalizes acceptable level of pain
relief and ability to engage in desired
activities.

Pain Nursing Process

Interventions (implementation)
Positioning
Acknowledge patients pain
Administer medications as ordered
Educate patient regarding pain
medications
Provide comfort measures
Warm blanket
Lift, not pull, patient up in bed; handle
gently.

Pain - Treatment
Noninvasive Pain Relief Technique
Transcutaneous electrical nerve
stimulation (TENS)
Provides a continuous, mild electrical
current to the skin via electrodes. Blocks
pain impulses.

Distraction
Relaxation
Guided imagery
Hypnosis
Biofeedback

Guided meditation for

pain
www.youtube.com/watch?
v=vW7y6qJMz5c

Pain - Treatment
Invasive Approach to
Pain
Nerve blocks
Epidural analgesics
Neurosurgical
procedures
Acupuncture

Pain - Treatment

Epidural Procedure

Pain -Treatment

Epidural

Pain - Medications
Medication for Pain Management
Nonopioids
Acetaminophen and nonsteroidal
anti-inflammatory drugs-NSAIDS
(aspirin, ibuprofen, and naproxen
sodium)
Most widely available and frequently
used analgesic group
Used primarily for mild to moderate
pain

Pain - Medications
Medication for Pain Managemen
Opioids
Morphine, meperidine (Demerol), and
codeine
Act on higher centers of the brain to
modify perception and reaction to pain
Manage moderate to severe acute pain
Tolerance and physiological dependence
are unusual with short-term postoperative
use, and psychological dependence and
addiction are extremely unlikely after
taking opiates for acute pain

Pain - Medications

Opium Poppy

Pain - Medications
Pain Mechanisms Affected by Each Analgesic
Group
Nonopioids
Exert analgesic effects through the
inhibition of prostaglandin production
Opioids
Relieve pain mainly by action in the CNS,
binding to opiate receptor sites in the brain
and spinal cord
Adjuvant analgesics are diverse
medications that assist the analgesic action
Composed of diverse classes of drugs that
relieve pain via a variety of mechanisms

Pain - Medications

Patient-Controlled Analgesia (PCA)

This drug delivery system allows patients to
administer pain medications whenever needed
Analgesia is more effective when the patient,
rather than the nurse or physician, is in control.
Patient must be alert, oriented, and able
to follow simple directions
If administer by someone else,
this is termed is termed PCA
by proxy

Pain - Medications

Pain Medications

Nursing principles for pain medication

administration
Know the patient history of pain meds
Select the proper medications for that
particular pain.
NSAIDS for milder pain and opiates for more
severe pain
Morphine and hydromorphone are choices
for long term management of pain.
IV administration is immediate, IM or Sub Q
work within an hour and PO meds can take
up to 2 hours

Pain Medications
Know your optimal doses for adult,
children and elderly!
Assess the right time and interval for
med administration.
Dont wait until is severe as it will be
harder to control.
Choose the right route, IV and PO are
preferred.
IM and sub q are less reliable due to
possible absorption problems and
have risk for abscess formation

Pain Nursing Process

Evaluation
Reassessment of pain
Is pain medication working?
Does the patient report
decreased pain?
What objective signs support
your conclusion?

Overview

Definition of pain
Types of pain
Acute vs. Chronic Pain
JCI standards on pain
Nursing Responsibilities:
overview
Nursing Process
Comfort and Discomfort

Comfort
The meaning of comfort
One of the greatest challenges for
the nurse is to provide comfort to the
patient.
Comfort
To give strength and hope, to cheer,
and to ease the grief or trouble of
another
Promoting physical and psychological
comfort is a vital part of the role of a
nurse.

Comfort

To give strength and hope to, to ease the grief

or trouble of.

Discomfort
The lack of comfort can be the result of
many factors and can take many forms,
including:

Anxiety
Constipation
Constricting edema
Depression
Diaphoresis
Diarrhea
Distention
Dry mouth

Dyspnea
Fatigue
Fear
Flatus
Grief
Headache
Hopelessness

Discomfort

To make uncomfortable or uneasy

Comfort
The nurse should pursue methods to assist
the patient in achieving relief from
discomfort.
Actively listen to the patient.
Recognize discomfort signals even when the
patient cannot verbalize.
Be diligent in efforts to relieve patients
discomfort.
Assess for pain and address pain advocate
for the patient!
If interventions are not successful, pursue
alternative interventions.

Done!