Chapter 20 Pain Management Copyright 2013 Wolters Kluwer

Pain • Definition of pain • The process of pain – Transduction – Transmission

Phases of Pain Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Is the following statement true or false? C-fibers carry impulses rapidly at

Answer False. C-fibers carry impulses at a slower rate of 0. 5 to 2

Pain (cont’d) • Pain theories – Endogenous opioids o Endorphins o Dynorphins o Enkephalins

Mechanism of Pain Transmission and Interference Copyright © 2013 Wolters Kluwer Health | Lippincott

Pain (cont’d) • Types of pain – Cutaneous – Visceral – Neuropathic – Acute

Question • Phantom limb pain belongs to which of the following categories of pain?

Answer c. Neuropathic Phantom limb pain is an example of neuropathic pain, which is

Question • Is the following statement true or false? Somatic pain is discomfort that

Answer False. Somatic pain is discomfort generated from deeper connective tissue. Cutaneous pain is

Pain Assessment Standards • Pain: the fifth vital sign • JCAHO standards • Compliance

JCAHO Components of a Comprehensive Pain Assessment Copyright © 2013 Wolters Kluwer Health |

Pain Assessment Data • Components of brief or basic pain assessment • Questions to

Components of Pain Assessment Copyright © 2013 Wolters Kluwer Health | Lippincott Williams &

Pain Intensity Assessment Tools • Four types of pain assessment tools – Numeric scale

Pain Intensity Assessment Tools (cont’d) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams

Pain Management • Treatment biases • Pain management techniques • Drug therapy – Nonopioid

World Health Organization Analgesic Ladder Copyright © 2013 Wolters Kluwer Health | Lippincott Williams

Pain Management (cont’d) • Opioid drugs (cont’d) – Patient-controlled analgesia – Intraspinal analgesia •

Pain Management (cont’d) • Surgical approaches – Rhizotomy – Cordotomy Copyright © 2013 Wolters

Client and Family Teaching: Pain and Its Management Copyright © 2013 Wolters Kluwer Health

Pain Management (cont’d) • Nondrug/nonsurgical interventions – Education – Imagery – Meditation – Distraction

Pain Management (cont’d) • Nondrug/nonsurgical interventions (cont’d) – Heat and cold – Transcutaneous electrical

Pain Management (cont’d) • Nondrug/nonsurgical interventions (cont’d) – Percutaneous electrical nerve stimulation – Biofeedback

Percutaneous Electrical Nerve Stimulation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams &

Nursing Implications • Various nursing diagnoses • Addiction • Placebos Copyright © 2013 Wolters

General Gerontologic Considerations • Pain in older people • Assessment of pain in older

General Gerontologic Considerations (cont’d) • Assessment of pain in older people (cont’d) – Older

General Gerontologic Considerations (cont’d) • Pain control measures for older people (cont’d) – Topical

Question • Is the following statement true or false? Older adults are less sensitive

Answer False. Age-associated changes in pain perception, sensitivity, and tolerance affect the experience of

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Question • Is the following statement true or false? C-fibers carry impulses rapidly at a rate of approximately 5 to 30 meters per second. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False. C-fibers carry impulses at a slower rate of 0. 5 to 2 meters a second. A-delta fibers, which are large myelinated fibers, carry impulses rapidly at a rate of approximately 5 to 30 meters per second. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Phantom limb pain belongs to which of the following categories of pain? a. Cutaneous b. Visceral c. Neuropathic d. Acute Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer c. Neuropathic Phantom limb pain is an example of neuropathic pain, which is often experienced days, weeks, or even months after the source of the pain has been treated and resolved. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False. Somatic pain is discomfort generated from deeper connective tissue. Cutaneous pain is discomfort that originates at the skin level and is a commonly experienced sensation resulting from some form of trauma. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pain Assessment Data • Components of brief or basic pain assessment • Questions to be asked during admission assessment • Underassessed and undertreated clients Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pain Intensity Assessment Tools • Four types of pain assessment tools – Numeric scale – Word scale – Linear scale – Picture scale • Different scales for different ages Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pain Management (cont’d) • Opioid drugs (cont’d) – Patient-controlled analgesia – Intraspinal analgesia • Adjuvant drugs • Botulinum toxin therapy Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pain Management (cont’d) • Nondrug/nonsurgical interventions (cont’d) – Heat and cold – Transcutaneous electrical nerve stimulation – Acupuncture and acupressure Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pain Management (cont’d) • Nondrug/nonsurgical interventions (cont’d) – Percutaneous electrical nerve stimulation – Biofeedback – Hypnosis Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations • Pain in older people • Assessment of pain in older people – Fear and anxiety can cause them to endure pain – Downplaying of pain – Misleading data Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations (cont’d) • Assessment of pain in older people (cont’d) – Older people with cognitive impairment • Pain control measures for older people – Adverse effects of certain drugs Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

General Gerontologic Considerations (cont’d) • Pain control measures for older people (cont’d) – Topical application of heat – Determining appropriate route for individual medication administration – Increased sensitivity to narcotics among older people Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False. Age-associated changes in pain perception, sensitivity, and tolerance affect the experience of pain in older adults. Therefore, it is a dangerous assumption to believe that older adults are less sensitive to pain stimuli. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins