PAIN Pain Is unpleasant sensory and emotional experience

Pain § Is unpleasant sensory and emotional experience associated with actual and potential tissue

Sources of Pain § Nociceptive: pain that is usually transmitted after normal processing of

PHYSIOLOGY OF PAIN SOURCES Injury, Inflammation Chemical/Thermal Heat, Cold PAIN RECEPTORS (Nociceptors) Histamine, Bradykinin,

Duration of pain § Acute pain: generally rapid in onset, varies in intensity from

Origin of Pain § Physical cause — cause of pain can be identified §

Perception of Pain § Pain threshold: is the lowest intinsity of stimulus that causes

Common Responses to Pain § Physiologic: ↑BP, ↑HR, ↑RR, pupil dilation, muscle tension and

Factors Affecting Pain Experience § § § § Culture Ethnic variables Family, gender, and

General Assessments of Pain § § § § § Patient’s verbalization and description of

Pain assessment tools WILDA Scale – Words that describe the pain – Intensity of

Diagnosing Pain § § Type of pain Etiologic factors Behavioral, physiological, affective response Other

Nursing Interventions for Pain § Establishing trusting nurse-patient relationship § Initiating nonpharmacologic pain relief

Manipulating Pain Experience Factors § § § Remove or alter cause of pain Alter

Nonpharmacologic Pain Relief Measures § § § § § Distraction Humor Music Imagery Relaxation

Pharmacologic Pain Relief Measures § § Analgesic administration Nonopiod analgesics e. g. NSAIDs Opioids

Why clients may be reluctant to report pain: § Unwillingness to trouble staff who

Additional Methods for Administering Analgesics § § § Patient controlled analgesia Epidural analgesia Local

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PAIN

Pain § Is unpleasant sensory and emotional experience associated with actual and potential tissue damage. § It is considered the fifth vital sign. § It is one of the human body defense mechanisms that indicates the person is experiencing problem.

Sources of Pain § Nociceptive: pain that is usually transmitted after normal processing of noxious stimuli – Cutaneous (superficial): usually involves the skin or the subcutaneous tissue – Somatic: is diffuse or scattered and originates in tendons. – Visceral: is poorly localized and originates in body organs § Neuropathic: results from injury or abnormal functioning of peripheral nerves or CNS § Psychogenic: unknown physical cause

PHYSIOLOGY OF PAIN SOURCES Injury, Inflammation Chemical/Thermal Heat, Cold PAIN RECEPTORS (Nociceptors) Histamine, Bradykinin, Serotonin, E-prostaglandin DISCHARGE IMPULSES Electrical Activity to spinal cord and onto the Brain BRAIN = Electrical activity becomes the experience of PAIN

Duration of pain § Acute pain: generally rapid in onset, varies in intensity from mild to severe, lasts from brief period to less than 6 months § Chronic pain: may be limited, intermittent or persistent but lasts for 6 months or longer and interferes with normal functioning. – Remission: when the pain present but the patient does experience symptoms – Exacerbation: reappear of symptoms – Intractable pain: resistant pain to therapy, and persists despite a variety of interventions

Origin of Pain § Physical cause — cause of pain can be identified § Psychogenic — cause of pain cannot be identified § Referred — pain is perceived in an area distant from its point of origin

Perception of Pain § Pain threshold: is the lowest intinsity of stimulus that causes the subject to recognize pain § Adaptation § Modulation of pain – Neuromodulators – Endorphins, dynorphins enkephalins

Common Responses to Pain § Physiologic: ↑BP, ↑HR, ↑RR, pupil dilation, muscle tension and tension rigidity, pallor, ↑adrenaline level, ↑blood glucose § Behavioral: moving from painful stimuli, grimacing, moaning, crying, restlessness, protecting painful area § Affective: exaggerated weeping, withdrawal, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, powerlessness.

Factors Affecting Pain Experience § § § § Culture Ethnic variables Family, gender, and age variables Religious beliefs Environment and support people Anxiety and other stressors Past pain experience

General Assessments of Pain § § § § § Patient’s verbalization and description of pain Duration of pain Location of pain Quantity and intensity of pain Quality of pain Chronology of pain Aggravating and alleviating factors Physiologic indicators of pain Behavioral responses Effect of pain on activities and lifestyle

Pain Assessment Tools

Pain assessment tools WILDA Scale – Words that describe the pain – Intensity of pain – Location of pain – Duration of pain – Aggravating or alleviating factors

Diagnosing Pain § § Type of pain Etiologic factors Behavioral, physiological, affective response Other factors affecting pain process

Nursing Interventions for Pain § Establishing trusting nurse-patient relationship § Initiating nonpharmacologic pain relief measures § Considering ethical and legal responsibility to relieve pain § Teaching patient about pain

Manipulating Pain Experience Factors § § § Remove or alter cause of pain Alter factors affecting pain tolerance Initiate nonpharmacologic relief measures

Nonpharmacologic Pain Relief Measures § § § § § Distraction Humor Music Imagery Relaxation Cutaneous stimulation Acupuncture Hypnosis Therapeutic touch

Pharmacologic Pain Relief Measures § § Analgesic administration Nonopiod analgesics e. g. NSAIDs Opioids or narcotic analgesics Adjuvant drugs e. g. anticonvulsants, antidepressants, . .

Why clients may be reluctant to report pain: § Unwillingness to trouble staff who are perceived as busy § Fear of injectable route of analgesic administration § Belief that pain is to be expected as apart of the recovery process § Belief that pain is a normal part of aging § Belief that expression of pain reveal weakness § Concerns about side effects and risks especially of opioid drugs

Additional Methods for Administering Analgesics § § § Patient controlled analgesia Epidural analgesia Local anesthesia