Pain & Pain
Management
Karen Joyce L. Jimeno
Pain
The 5th vital sign
“Whatever the person experiencing pain says it is,
existing whenever the person says it does.” (Margo Mc
Caffery - -nurse pioneer in Pain Management)
“An unpleasant sensory and emotional experience
associated with an actual or potential tissue damage.”
(Int’l. Association for the Study of Pain/IASP)
Present in every aspect of the client
A subjective experience
A person’s defense mechanism
Types of Pain
1. Acute Pain – lasts for few seconds up to less
than 6 months
a. Somatic pain – arises from nerve receptors
- Originating in the skin or close to the surface
of the body
b. Visceral pain – arises from body organs due to
stretching, inflammation, and ischemia
c. Referred pain – perceived in the area distant
from the site of stimuli.
2. Chronic Pain - prolonged pain
a. Recurrent Acute Pain – episodes of pain with
pain-free episodes
b. Non-malignant Pain – non-life threatening
pain that persist beyond the expected time of
healing
3. Central Pain – related lesion in the brain that
produces increased frequency/burst of
impulses that is perceived as pain
4. Phantom Pain - a syndrome that
occurs following the amputation of a
body part
5. Cancer-related Pain - pain secondary
to cancer of any type
Physiology of Pain
Gate Control Theory
– a theory that uses the analogy of a gate to
describe how impulses from damaged
tissues are sensed in the brain.
Closed Gate Open Gate
Painful stimulus Painful stimulus
Large fiber activation Small fiber activation
Closes the gate Opens the gate
Inhibits the transmission to the Allows transmission to the gate
brain (enkephalin)
Pain perception
Limits pain perception
Pain Pathway
Stimulus (chemical, mechanical, thermal)
Nociceptor (free nerve endings)
Peripheral nerve (afferent fiber)
Synapse
Spinal Decussation (cross over)
Spinothalamic tract (pain)
Reticular Formation (pons, medulla, aware & alert)
Thalamus
Somatosensory cortex - - parietal lobe (locate pain)
Hypothalamus (stress response)
Limbic system (emotional response)
Phases of Pain Transmission
1. Transduction – conversion of a chemical information in
the cellular environment to electrical impulse
- Stimulus to nociceptors
2. Transmission – peripheral nerve fiber forms synapses
with neuron in the spinal cord
- Nociceptors to the spinal cord
3. Perception – wherein brain experiences pain at conscious
level
- Spinal cord to the brain
4. Modulation – the brain interacts with the spinal cord in a
downward fashion to alter the pain experience
Factors Affecting Pain Response
Age
Gender
Socio-culturalinfluences
Emotional status
Knowledge
Past experience (s) to pain
Nursing Assessment for Pain
Pain assessment is highly subjective
Subjective Data: the most reliable indicator
of the presence and degree of pain
Objective Data: tachycardia, tachypnea,
diaphoresis, HPN, pallor, dilated pupils,
increased muscle tension, weakness,
grimace, guarding behavior
Pain Assessment Factors
(Jimenez, 1998)
P – attern (stimulate/trigger) (precipitate -
when it occurs; aggravates; alleviates)
Q – uality/quantity (dull, sharp, throbbing,
shooting, burning, tingling, etc.)
R – adiation (location/region)
S – everity/scale
T – ime (onset, duration, interval0
Pain Rating Scales
Visual Analog Scale
Numeric Pain Scale
Faces Pain Rating Scale (Wong-Baker)
Poker Chips Scale
Simple Descriptive Pain Intensity Scale
Nursing Diagnoses for Pain
Acute pain / Chronic Pain
Activity intolerance r/t unrelieved pain
Ineffective coping strategies r/t lack of knowledge of
possible coping
Powerlessness r/t to lack of participation in decision-
making process
Anxiety r/t past experience of poor comfort
Sleep pattern disturbance r/t unrelieved pain
Knowledge deficit r/t lack of exposure to informational
sources
Fear r/t anticipation of pain experience
Management for Pain
I. Non-pharmacologic
a. Independent Interventions
- Establish therapeutic relationship
• trust – good working relationship
- Teach patient strategies to relieve pain
- Reduce anxiety through proper
explanation of the nature of pain and
outcome of treatment
b. Dependent Interventions
• Ice/cold therapy – effective only within 24 hours
- Decreases edema; vasoconstriction
• Heat therapy – increases blood flow; vasodilatation
Nursing Considerations:
• Cold therapy – when using superficial cold
techniques:
- Cover the cold source with a cloth or towel
- Do not apply cold to areas being treated with
radiation; that have open wounds; or have poor
circulation
• Heat therapy - do not apply heat to an area
that is being treated with radiation, is
bleeding, has decreased sensation, or has
been injured in the past 24 hours
• Do not use any menthol-containing
products because these may cause burns
• Cover the heat source with towel or cloth to
prevent burns, nerve injury, and frost bites.
Physical Therapies for Pain:
Acupuncture – technique of Traditional Chinese
Medicine which uses very thin needles
Massage
Superficial – moving the hands or fingers over the
skin slowly or briskly with long strokes or in circles
Deep – applying firm pressure to the skin to maintain
contact while massaging underlying tissues
Trigger-point – a circumscribed hypersensitive area
within a tight band of muscle that is caused by an
acute/chronic muscle strain (neck, back, arms)
Exercise - enhances circulation, cardiovascular
fitness, edema, muscle strength and flexibility,
enhances physical & psychosocial functioning
- An exercise program should be tailored to the
physical needs & lifestyle of the patient & should
include aerobic exercise, stretching, &
strengthening exercises
o Transcutaneous Electrical Nerve Stimulator
(TENS) – delivery of an electric current through
electrodes applied to the skin surface over the
painful region, at trigger points, or over a
peripheral nerve
Cognitive Therapies
Distraction – involves redirection of attention
onto something & away from the pain (ex.
Watching TV; listening to music, conversing,
etc.)
- A simple but powerful strategy to relieve
pain
- It is important to match the activity with the
patient’s energy level and ability to
concentrate
Hypnosis – a structures technique that enables the
patient to achieve a state of heightened awareness
and focused concentration that can be used to alter a
patient’s pain perception.
- Should be administered only by specially trained people
Relaxation Strategies – are varied, but their goal is
to reach a state that is free from anxiety & muscle
tension
- Relaxation response requires a quiet environment, a
comfortable position, & a mental devise as a focus of
concentration (e.g. a person’s breathing, a word, a
sound)
- May include: relaxation, breathing, music therapy,
meditation, guided imagery, & muscle relaxation
