Chapter 42 Pain Copyright 2004 by Delmar Learning

Pain § Pain is a universal experience. § Pain is a state in which an individual experiences and reports the presence of severe discomfort or an uncomfortable sensation. § Pain is a subjective experience. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 2

Pain § Nature of Pain • Can be a protective mechanism to prevent further

Nature of Pain § Common Myths About Pain • The nurse is the best judge of a client’s pain. • If pain is ignored, it will go away. • Clients should not take any measures to relieve their pain until the pain is unbearable. • Most complaints of pain are purely psychological. • Taking pain medication causes addiction. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 4

Types of Pain § Pain can be described in two basic ways: • Cause

Types of Pain § Cutaneous pain is caused by stimulation of the cutaneous nerve endings in the skin. § Somatic pain is nonlocalized and originates in support structures. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 6

Types of Pain § Visceral pain is discomfort in the internal organs. • Referred pain is pain originating from the abdominal organ. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 7

Types of Pain § Acute pain is most frequently identified by sudden onset and relative short duration. § Recurrent acute pain is identified by repetitive episodes that may recur over a prolonged period of time or throughout the client’s lifetime. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 8

Types of Pain § Chronic Pain • Long-term, (lasting 6 months or longer), persistent, nearly constant, or recurrent pain • Produces significant negative changes in client’s life • May last long after the pathology is resolved Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 9

Types of Pain § Chronic malignant pain occurs as a result of progressive tissue injury. § Chronic nonmalignant pain occurs in persons who do not have progressive tissue injury. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 10

Physiology of Pain § Nociceptive pain is the process by which an individual becomes

Physiology of Pain § Four principle processes are involved in nociception. • • Transduction Transmission Perception Modulation Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 12

Nociceptive Pain § Transduction of pain involves the changing of noxious stimuli in sensory

Nociceptive Pain § Transmission of pain involves the movement of impulses from site of

Reflex Arcs Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 15

Transmission of Pain § Gate Control Theory of Pain • Recognizes the psychological aspects of pain. • A gate control system serves to block the individual’s s perception of pain. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 16

Gate Control Theory: Blocking Transmission of Pain Copyright 2004 by Delmar Learning, a division

Nociceptive Pain § Perception of pain occurs when the pain impulse has been transmitted to the cortex and the person develops conscious awareness of the intensity, location, and quality of pain. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 18

Nociceptive Pain § Modulation of pain refers to activation of descending neural pathways that

Factors Affecting the Pain Experience § § Age and gender Stress and anxiety Previous experience with pain Cultural norms and attitudes Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 20

Pain Assessment § Data Collection • • • Intensity Location Quality (radiating, burning, diffuse) Associated manifestations Aggravating factors Alleviating factors Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 21

Pain Assessment § Data Collection • Pain threshold is the level of intensity at which pain becomes appreciable or perceptible and varies with each individual and type of pain. • Pain tolerance is the level of intensity or duration of pain the client is willing or able to endure. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 22

Data Collection § Assessment Tools • • Initial Pain Assessment Tool Pain Intensity Scales Pain Diary Psychosocial Pain Assessment Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 23

Data Collection § Developmental Considerations • Infants, children and adolescents • Older clients Copyright

Nursing Diagnoses § Acute Pain § Chronic Pain Copyright 2004 by Delmar Learning, a

Outcome Identification and Planning § Planning focuses on mutual goal-setting to reach realistic outcomes. § Both nonpharmacologic and pharmacologic interventions are used in planning strategies to control or maintain clients at desired levels of functioning and pain. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 26

Implementation § Nurse-Client Relationship • Trust • Client Education Copyright 2004 by Delmar Learning,

Implementation § Principles of Pharmacologic Pain Management • Combine analgesics • Maintain therapeutic serum levels • Choose appropriate routes of administration Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 28

Implementation § Principles of Pharmacologic Pain Management • Pain Medications - Nonsteroidal anti-inflammatory drugs (NSAIDS) - Opioid analgesics - Local anesthesia • Tolerance, Physical Dependence, and Addiction • Respiratory Depression Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 29

Implementation § Treatment of Neuropathic Pain • Focus of treatment is optimizing functional abilities.

Implementation § Cognitive-Behavioral Interventions • • • Distraction Reframing Biofeedback Cutaneous stimulation Transcutaneous stimulation Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 31

Implementation § Complementary and Alternative Therapies • • • Acupuncture and acupressure Herbs Nutrition Physical stimulation Relaxation techniques Environment manipulation Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 32

Evaluation § § Client’s facial expression and posture Presence (or absence) of restlessness Vital sign monitoring Ongoing use of pain assessment tools Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 33