INTRODUCTION

The word 'pain' originates from the Latin word

'poena' meaning a fine or a penalty. Pain is often
described as an unpleasant sensation that can vary
from mild, localized discomfort to severe distress.
pain is the body's protective mechanism
DEFINITION
Pain is an unpleasant sensory and emotional
experience arising from actual or potential tissue
damage or described in terms of such damage." -
International Association for the Study of Pain
MECHANISM OF PAIN

Pain is a vital function of the human body, involving

nociceptors and the CNS to transmit messages from
noxious stimuli to the brain.
Nociceptors are sensory fibers that are accountable
for detecting harmful or potentially harmful noxious
stimuli and conveying electrical signals to the
nervous system.
Nociceptors are present in skin, visceral organs,
muscles, joints and meninges to detect a range of
stimuli, which may be mechanical, thermal or
chemical in nature
PROCESS OF PAIN

TRANSDUCTION TRANSMISSION

PERCEPTION MODULATION
Transduction
It is the process of conversion of mechanical, thermal,
or chemical stimulation of neuronal action
potential.In this signals occurs at the level of
peripheral nerves mainly in free endings
Transmission
It is the process of movement of pain impulses from
the site of transduction to the brain.
Perception
It occurs when pain is recognized, defined and
responded by the individual. In the brain, nociceptive
input is recognised as pain. There is no , precise
location where pain perception occurs.
Modulation
It includes the activation of descending pathways that
exert inhibitory effects on the transmission of pain.
Modulation of pain signals can occur at the level of
the periphery, spinal cord, brain stem, and cerebral
cortex.
TYPES OF PAIN
BASED ON DURATION:
BASED ON LOCATION :

REFERRED PAIN RADIATING PAIN

BASED ON INTENSITY:
BASED ON CAUSES:

NONCICEPTIVE NEUROPATHIC PSYCHOGENIC

PAIN PAIN PAIN
 FACTORS AFFECTING PAIN:

SOCIO AGE
PERCEPTION
CULTURAL
OF PAIN
FACTOTS
CONTD..,

GENDER ANXIETY PAST

EXPERIENCE
PLACEBO EFFECT
PAIN ASSESSMENT
History Collection:
1. Pain characteristics
2. Pattern of pain
3. Intensity of pain
4. Pain quality
5. Associated symptoms
6. History of pain relief measures
7. History of illness
PHYSIOLOGICAL ASSESSMENT:

• Tachycardia
• Tachypnea
• High blood pressure
• SPO2 may decrease
• Facial grimacing
• Sad face
• Crying
• Moaning
COMMON PAIN SCALES
PHARMACOLOGICAL PAIN
RELIEVING MEASURES:
Approaches of analgesic administration:
Individual approach:
Medications are effective when the dose and interval
between are individualized according to each patient.
Balanced analagesia:
It refers to use of more than one form of analgesia
(NSAIDs, local anesthetics) concurrently to get more
pain relief with fewer side effects
Pro re nata PRN:
In past standard method used in by most nurses administering
analgesia was to administer the analgesic pro re nata (PRN), 'as
needed without specific time
Preventive approach:
Pain management by administering analgesic agents is considered
the safest strategy because a therapeutic serum level of
medication is maintained. These are administered at set intervals .
Patient -controlled analgesia:
It allows patients to control the administration of their own
medication within predetermined safety limits. This approach can
be used with oral analgesic agents as well as with continuous
infusions of opioid analgesic agents by intravenous,
subcutaneous, or epidural routes.
Non -Opioids:
NSAIDs are the primary non-opioids for acute and chronic
pain resulting from a variety of disease processes including
trauma, arthritis, surgery, and cancer. NSAIDs are both
analgesic and anti-inflammatory, and may be useful for the
treatment of pain
Characteristics of agents:
• There is an analgesic ceiling to their analgesic properties,
that is increasing the dose beyond an upper limit provides no
greater analgesia.
• They do not produce tolerance .
• Many are available without a prescription.
Opioids:
Opioids are most powerful analgesics. Opioids are prescribed
for moderate to severe pain when non-opioids are not effective
in pain management . Common examples of mild opioids
include tramadol, codeine, morphine. fentanyl.
Mechanism of action:
Opiods blocks calcium channels on nociceptive afferent
nerves to inhibit release of neurotransmitters such as substance
P and glutamate which contribute to nociception.
Side effects of opioids:
constipation ,nausea,and vomiting,respiratory depression.
 INVASIVE THERAPIES:
Therapeutic nerve blocks:
A group of nerves, called a ganglion
or plexus, that causes pain to a
specific organ or body part can be
blocked with the medication
injection into a specific area of the
body. The injection of this nerve-
numbing substance is called a nerve
block.
Neuroablative technique:
Neuroablative technique may
carry out for severe pain that is
unresponsive to all other
therapies. In neuroablation,
nerve is destroyed, thereby
interrupting the pain.
Neuroaugmentation:
Neuroaugmentation is an invasive
procedure for chronic pain
management. It involves electrical
stimulation of the brain and the
spinal cord. Currently, spinal cord
stimulation (SCS) is performed
much more often than brain
stimulation. SCS is used to manage
patients with chronic radiculitis,
complex regional pain syndrome,
and ischemic pain.
Implantable opioid infusion
pumps:
These are surgically implanted
pumps that deliver opioid
agents directly to the spinal
cord . These pumps are
expensive. These devices are
advanced modalities for
management of severe ,
chronic, intractable malignant
or non malignant pain.
Platelet rich plasma therapy:
This treatment involves
injecting a patients own
blood into an injured area to
speed up the healing . It is
used to treat musculoskeletal
conditions, such as tendon
and ligament injuries and
osteoarthritis. It can reduce
the need for anti
inflammatory medication or
opioids.
Inter fascial plane block:
It is the type of regional
anesthesia that involves
injecting local anesthetic
into the space between
muscle layers.It is used to
treat pain after surgery and
or often used for abdominal
and chest wall surgery. It
can be performed using
ultrasound guidance .A
Deeper understanding of
facial tissue anatomy and
structure is needed.
NON PHARMACOLOGICAL
THERAPIES:
Massage:
It's a common therapy for pain
management many different massage
techniques or exist .For example
moving the hands or finger over the
skin slowly or brisky with along
strokes in circles, or a plane from skin
pressure to maintain contact while
massaging the underline tissue Trigger
point massage on a circle area with in a
tight band of muscle is applied.
Physical exercise:
It is a critical part of
management of paint for
patients with chronic
muscular skeletal pain
exercise acts via many
mechanism to relieve pain it
enhances the circulation
and cardiovascular fitness
reduces the edema increases
the muscles strength and
flexibility and enhances the
physical and psychological
functioning.
Transcutaneous electrical nerve
stimulation:
It involves the delivery of an
electrical current through
electrodes applied over the skin
surface over the painful area as
trigger points or over the peripheral
nerve .TENS can be effectively
used to for cancer pain , labour
pain and pain associated with
diabetic neuropathy.
Percutaneous electrical nerve
stimulation :
It stimulates the deeper peripheral
tissues through the insertion of a
needle to which the stimulator is
attached near a large peripheral or
spinal nerve .The amount of
electrical current is regulated to
provide maximum pain relief . If
the PENS successfully reduces the
patients pain then a permanent
peripheral nerves stimulator is
implanted surgically, it is used to
treat chronic pains like neuropathic
headache and chronic post surgical
pains.
Accupuncture :
It is a technique of
traditional Chinese
medicine in which very
thin needles are used to
stimulate the specific
points around
body .Needles are
inserted to body at
designated points. It is
applied various
conditions including the
muscular skeletal
conditions back pain
post surgical pain
peripheral neuropathic
cream and headache.
Acupressure:
In acupressure physical
pressure is apply to
acccupuncture points
with the aim of clearing
blockages in this
meredians .Pressure
may be applied by hand
by elbow or with
various devices.
Heat therapy
It can be applied using an
electric Heating pad hot pack
hot moist compresses or a lot
or hot water bottle .For
exposure to the areas of body
a hot bath or hot shower is
recommended. Heat therapy
aids muscle relaxation which
in turn can ease pain and
alleiviate stiffness of painful
joints or muscles by
enhancing circulation and
blood flow to the region.
Cold therapy:
It is also known as
cryotherapy. It is application
moist or dry cold to the skin.
dry cold can be applied over
by means of an ice bag, moist
cold by means of towel soaked
in ice water or immersion in
bath or under running cold
water. cryotherapy works by
reducing the blood flow over
particular area which can
significantly reduce the
inflammation which process
pain especially around a joint
or tendon.
Diversional therapy is an
individual specific
technique for mild pain.
It involves the redirection
of patients attention to
something and away
from the patient. It can be
achieved by engaging the
patient any other activity
that can hold his her
attention.
Hypnosis:
Hypnosis is a
structural therapy that
enables the patient to
achieve a state of
heightend awareness
and focussed
concentration that can
be used to alter the
patient pain
perception. hypnosis
should be administered
and monitor by specific
trained clinician only
Psychotherapy or
Cognitive Behavioral
Therapy:
Cognitive behavioral
therapy (CBT) is a form
of psychotherapy that
identifies and develops
skills to change negative
thoughts and behaviors.
It changes awareness of
pain and develop better
coping skills, even if the
actual level of pain stays
the same.
Therapeutic Touch:
Therapeutic touch (IT) is an
alternative healing therapy.
Touch is an important
sensory experience that
impacts people physically,
socially, and emotionally. In
this therapy, healing occurs
via nonphysical energy
systems and the healer's
intention.This therapy
believe it to correct
imbalances and remove
painful sensations.
Biofeedback :
It is a technique that trains people to improve their
health by controlling certain bodily processes that
normally happen involuntarily, such as heart rate,
blood pressure, muscle tension, and skin
temperature.
Procedure:
• Electrodes are attached to the
person skin sends information
to small monitoring computer.
• Person becomes aware of
measure values.
• Bio feedback therapist then
leads person in mental
relaxation exercises.
• Through trial and error
person can learn to identify
mental activities that coil
bring about physical changes.
Music therapy:
It can be used as an
adjuvant with other
modalities for the
management of chronic
pain . Music therapy
helps to elevate the
mood of the patient and
serves as a distraction.
Aromatherapy:
It refers to therapeutic use
of essential oils observed
through the skin or
olfactory system . Olfactory
stimulation by
aromatherapy can result in
immediate reduction in pain
as well as change of
physiological parameter.
Aquatherapy:
It is also known as hydrotherapy is
treatment method that uses water
based exercises to a alleviate pain
by leveraging the buoyancy and
warmth of water. It particularly
beneficial for the individual with
joint pain , muscle tension and
arthritis where reduced weight
bearing pressure on joints can
greatly ease comfort. It allows the
gentle moment and exercise while
minimising stress on the body.
Desensitation:
Desensitization it is a
therapeutic technique where a
sensitive area of body is
gradually exposed to different
textures, temperature or
pressure to gradually reduce its
hypersensitivity and pain
response. It works by exposing
sensitive area to controlled
stimuli like touch with different
texture. The Nervous System
slowly adops and becomes less
reactive to those stimuli and
decreases pain perception
Micro current electrical neuro
muscular stimulation:
It is a physical therapy that uses
the small electrical currents to
stimulate the body's tissue.
Electrodes placed on the skin to
send weak electrical signals into
body .It is used to treat pain
inflammation and injuries.
Nursing management of patient
with pain
• Stay with the patient for a while.
• Allow the client to talk and express feelings and fears.
• Communicate empathy and a willingness to listen.
• Give the client some sense of control by encouraging
• input into the nursing care plan.
• Use therapeutic touch or other measures, such as giving
a back rub and applying a cool cloth to relieve physical
tension, promote comfort and help the client relax.
• Inform the client whenever a procedure is likely to be
painful and encourage the client to express the pain.
• Identify the source of pain and eliminate or reduce
pain.
• Assess the client current use of medications or
paint relief ask for alternative modalities used to
paint relief as a well.
• Provide a relaxing and calm environment to
promote rest.
• Assess patient pain level every second hourly.
• Document patient response to pain management.
The Effectiveness of Aromatherapy in Reducing
Pain: A Systematic Review and Meta-Analysis
Aromatherapy refers to the medicinal or therapeutic use of essential oils
absorbed through the skin or olfactory system. Recent literature has
examined the effectiveness of aromatherapy in treating
pain. Methods. 12 studies examining the use of aromatherapy for pain
management were identified through an electronic database search. A
meta-analysis was performed to determine the effects of
aromatherapy on pain. Results. There is a significant positive effect of
aromatherapy (compared to placebo or treatments as usual controls) in
reducing pain reported on a visual analog. Based on the available
research, aromatherapy is most effective in treating postoperative pain
(SMD = −1.79, 95% CI: −2.08, −1.51, p < 0.0001) and obstetrical and
gynecological pain (SMD = −1.14, 95% CI: −2.10, −0.19, p < 0.0001).
Conclusion. The findings of this study indicate that aromatherapy can
successfully treat pain when combined with conventional treatments.
Effect of aquatic physical therapy on chronic low back pain: a systematic review and meta-
analysis

Background
Chronic low back pain is a common musculoskeletal disease. With the increasing
number of patients, it has become a huge economic and social burden. It is urgent to
relieve the burden of patients. There are many common rehabilitation methods, and
aquatic physical therapy is one of them. The purpose of this systematic review and
meta-analysis is to summarize the existing literature and analyze the impact of
aquatic physical therapy on pain intensity, quality of life and disability of patients
with chronic low back pain.
Methods
Through 8 databases, we searched randomized controlled trials on the effect of
aquatic physical therapy on patients with chronic low back pain. These trials
published results on pain intensity, quality of life, and disability. This review is
guided by Cochrane Handbook for systematic reviews of interventions version 5.1.0.
The level of evidence was assessed through GRADE.
Results
A total of 13 articles involving 597 patients were included. The results
showed that compared with the control group, aquatic physical therapy
alleviated the pain intensity (Visual Analogue Scale: SMD = -0.68, 95%CI:-
0.91 to -0.46, Z = 5.92, P < 0.00001) and improved quality of life (physical
components of 36-Item Short Form Health Survey or Short-Form 12: SMD =
0.63, 95%CI:0.36 to 0.90, Ζ = 4.57, P < 0.00001; mental components of 36-
Item Short Form Health Survey or Short-Form 12: SMD = 0.59, 95%CI:0.10
to 1.08, Ζ = 2.35, P = 0.02), and reduced disability (Roland Morris Disability
Questionnaire: SMD = -0.42, 95%CI:-0.66 to -0.17, Ζ = 3.34, P = 0.0008;
Oswestry Disability Index or Oswestry Low Back Pain Disability
Questionnaire: SMD = -0.54, 95%CI:-1.07 to -0.01, Ζ = 1.99, P = 0.05).
However, aquatic physical therapy did not improve patients' pain at rest
(Visual Analogue Scale at rest: SMD = -0.60, 95%CI:-1.42 to 0.23, Ζ =
1.41, P = 0.16). We found very low or low evidence of effects of aquatic
physical therapy on pain intensity, quality of life, and disability in patients
with chronic low back pain compared with no aquatic physical therapy.
Conclusions
Our systematic review showed that aquatic physical therapy could benefit
patients with chronic low back pain. However, because the articles included
in this systematic review have high bias risk or are unclear, more high-quality
BIBLIOGRAPHY:
D.Ellakuvana Bhaskar, Textbook of advanced
nursing practice, second edition, published by
jaypee brothers medical publishers,pg.no:276-282.
Sheebeer.P.Basheer,Textbook of advanced nursing
practice, second edition, published by jaypee
brothers medical publishers, pg.no: 280-292
Sowmiya kuriyan , A textbook of nursing
foundation,first edition -2019,Alwin medical
publishers, pg.no : 319- 327.
BIBLIOGRAPHY:
JOURNALS:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9717486/
https://pmc.ncbi.nlm.nih.gov/articles/PMC5192342/
NET REFERENCE:
https://medlineplus.gov/pain.html
https://www.healthline.com/health/pain