1st lecture pain (ncm103)

8/4/2019 1st Lecture Pain (NCM103)

1/6

GATE OPEN > PAINGATE CLOSED > NO PAIN

Care of Clients with Problems In Oxygenation,

Fluids and Electrolytes, Metabolism and Endocrine

(NCM103)Pain

Pain

Words to Remember: Nociceptors Is a free nerve ending that is a receptor for painful (noxious) stimuli

Nociception A system that carries information about inflammation and damage in tissue to thespinal cord and brain

Pain Threshold Lowest intensity of a painful stimuli that is perceived by a person as pain

Pain Tolerance The duration and intensity of pain that the person is willing to endure

WHAT IS PAIN?? International Association for the Study of Pain (IASP)

o An unpleasant sensory and emotional experience associated with actual /

potential tissue damage

Whatever the patient says it is, existing whenever he says it does Margo McCaffery

Pathway for Pain Perception and Response

Sensory Impulse(Pain Fibers)

Dorsal Root Motor Impul

Gate Control Theory Pain impulses can be blocked / regulated by a gating mechanism

o LARGE Fiber Stimuli = GATE IS CLOSED!

o SMALL Fiber Stimuli = GATE IS OPEN!

Suggests that psychological factors play a role in the perception of pain

Guided response in pain management

OPENING and CLOSEING The GATE

PATTERNS of PAIN Acute Pain

o Caused by activation of nociceptor

o Short duration (less than 6 months)

o Immediate onset

o Limited and often predictable duration

FACTOR OPENS CLOSES

Physical Injury

Agitation

Medication

Emotional AnxietyStress

Frustration

Depression

Tension

RelaxationOptimism

Happiness

Behavioral

(Cognitive)

Rumination

Boredom

Enjoyable activities

Complex Tasks

Distraction

Social Interaction


2/6

Allodynia Pain due to

a stimulus that does not

normally provoke pain

o Usually reversible / controllable with adequate treatment

Chronic Pain

o Usually lasts more than 6 months

o Has no foreseeable end unless it is associated with very slow healing process

o May have been obscure that the person does not know when it is first developed

o Course of chronic pain includes months to yearso Client complains of fatigue, sleep disturbance and limited function

o Evidence of depressive mood is present and exhibits behavior of chronically ill people

SOURCES of PAIN Cutaneous (Superficial) Pain

Abrupt onset and a sharp / stinging quality

Slower onset and a burning quality

Well-defined localized pain of short duration

Somatic Pain

Originates from ligaments, tendons, bones, blood vessels and nerves

Somatic receptors are sparse; pain is dull and poorly localized Poorly localized pain may produce nausea and can be associated with sweating and BP

changes

Pain from deep structure frequently radiates from the primary site

Inflammation is an important component of somatic pain

Inflammatory process produces vasodilation, redness, swelling and heat

The edematous tissue distends Stretching the sensitive tissue Further increasingpain

Visceral Pain

Originates from the body organs

Pain is usually more aching and longer in duration

It is difficult to localize, several injuries to visceral tissues exhibitReferred Pain

Often manifested as sweating, restlessness, nausea, emesis, pallor and agitation

Abdominal pain will occur when body organs are perforated and their contents drain into

the peritoneal cavity

Referred Pain

Felt in an area distant from the site of the stimulus

Pain sensation may be intense and there may be little or no pain at the point of noxious

stimuli

Often baffling, warranting careful assessment

Neuropathic Pain

Caused by damage / injury to nerve fibers in the periphery or by damage to the CNS

Noxious *defined* impulses are generated at the site of the injury

Pain is felt as numbness, burning, stabbing needles and electric shock

Breakthrough Pain

A transient increase in pain of moderate to severe intensity that occurs against a

background of persistent pain of mild to moderate intensity that has been controlled

Kinds of Breakthrough Pain

Incident Pain

Predictable and occurs quickly within minutes

(Administer short acting medications may avoid flare ups and allow

clients to participate more fully in therapy)


3/6

It can occur with movement, coughing and increased activity

Idiopathic / Spontaneous Pain

It can occur randomly, and unpredictably; with little or no warning

It can be unrelated to activity level / adequacy of the persistent pain

function

Phantom Limb Sensation

- A client may continue to experience sensations in the part amputated as if that part were

still present / attached

- Abnormal sensations perceived as presence of the limb paresthesia / pain (Nerve fibersthat served the past, continue to extend to the periphery ending at the incision site)

Psychogenic Pain

It is not caused by Nociception but by psychological factors

Some mental / emotional problems can cause increased prolonged pain

Usually the patient will report pain that does not exist

Common types of psychogenic pain are headache, muscle pain, back pain and stomachpain

Usually diagnosed when other causes of pain are ruled out

It is treated with psychotherapy antidepressants and non-narcotic analgesics

FACTORS AFFECTING PAIN Perception of Pain

o Perception and interpretation is an important component of pain experience

o Both physical stimuli and psychosocial factors can influence our experience of pain

o Anxiety, experience, attention, expectation and the meaning of the situation in which

injury occurs affect pain perception

o Pain perception does not depend solely on the degree of physical damage, it is also

influenced by ones tolerance of pain

Tolerance

Sociocultural Function

o Race, culture, and ethnicity are factors that can influence all sensory response to pain

o People from different cultures may handle pain in various ways

o The nurse should recognize the patients way of dealing with pain and must accept it

o Health care providers must be sensitive to the contribution of cultural factors and

language barriers in order to facilitate adequate pain management

Age

o Age may change a perception and expression of pain

o Adults may not report pain for it may mean weakness, failure / loss of control

o Older people may think pain is simply something to be endured as a normal part of aging

process

o Pain would also be seen as a sign..

Gender

o Men report less pain than women regardless of ethnicity

o Health care providers who value bearing pain without complement may say women as

complainers and may ignore / ** their pain experience

Meaning of Pain

o If the cause of pain is known, the person may be better able to interpret the meaning and

to deal with the experience


4/6

o If the meaning of pain is negative, then the pain may be perceived more intensely

Anxietyo The degree of anxiety experienced by the client may also influence the response to pain

o Anxiety intensifies pain perception

o If the cause is unknown, anxiety is likely to be higher and the pain worsens

Past Experiences with the Pain

o Past experiences with pain affects the way that the current pain is perceivedo Negative experiences with pain as children can have difficulty managing pain

o Patients with miserable experiences in the past may perceive the next episode intensely

even though the medical conditions may be similar

ASSESSMENT OF PAIN Intensity = Patient self Report of pain rating

Location = Ascertained by verbal description / by pointing the location

Quality = Descriptive adjective like Stabbing like a knife! or Throbbing

Duration = Time of onset, interval and duration of pain

Aggravating / Alleviating Factor = What makes it worse / better?

Distress = Emotional component may intensify pain

Tools for Assessing PAIN Visual Analogue Scale (VAS)

o A horizontal 10-cm line with anchors (ends) indicating the extremes of pain

o The person is asked to place a mark indicating where the current pain is

Faces Pain Scale

o This instrument has SEVEN faces depicting the range from contented to obvious distress

o The patient is asked to point to the face that most closely resembles the pain intensity felt

Physical Interventiona. Comfort Measures Clean, smooth sheets, soft support pillows, warm blankets and soothingenvironment

b. Position Changes Movements are pain relieving interventions (Moving the body relievesmuscle spasms and provide a degree of pain relief)

c. Massage Back rub is particularly relaxing at bedtime and may block pain so as to promotecomfort sleep (Foot massage is particularly helpful and cost effective)

d. Heat and Cold Application

Heatis an excellent means of pain reduction of relief that is amenable to nursing

autonomy

Cold Application also brings pain reduction or relief

(Ice may also be used to prevent / reduce edema and inflammation)

e. Transcuteneous Electrical Nerve Stimulations (TENS)- Delivers electrical bursts through the skin to superficial and deep nerves

- Used with clients with chronic pain such as muscle pain from arthritis

f. Acupressure A non-invasive method of pain reduction or relief based on principles ofacupuncture (Pressure, massage, or other Cutaneous stimulation such as heat / cold application is

applied over acupuncture sites)

Cognitive/Behavioral Interventions


5/6

> These groups do not cause

physical dependence or tolerance

> The site of action is at the

periphery at the receptor site where

they serve as an anti-inflammatory

function and prevent the productionof prostaglandin

a. Deep Breathing It is for relaxation and is easy to learn; it also contributes to pain reliefby reducing muscle tension and anxiety

b. Progressive Relaxation Gradually tightens and deeply relaxes various muscle groupsproceeding systematically from one area of the body to the next (It also decreases anxiety

and excessive muscle contraction)

c. Rhythmic Breathing It is both relaxation and distraction. It can be combined with

rhythm such as music / ticktocking clock. Concentration is necessary in this type ofintervention (It focuses attention away from pain but focuses on the breathing and therhythm)

d. Music It can be relaxing distraction, releases endogenous opioids or dissociation- Physiologic response to relaxation

e. Guided Imagery

Helps patients visualize a pleasant experience this kind of intervention

This kind of intervention uses distraction which increases pain tolerance

f. Distraction Attention is directed away from the painful sensations or the negativeemotional arousal associated with the pain episode (Interventions include watching

movies, doing crafts, interacting with others and reading books / magazines)

g. Meditation Focuses ones attention away from pain

Provides energy and peace to the person who is meditating

Communicates with spiritual being

h. Hypnosis

Based on suggestive dissociation and the process of focusing ones attention

The Hypnotherapist must be skilled and informed and must avoid negative

effects

i. Humor

It has been postulated that humor elevates endogenous opioids or endorphins

It increases the number of natural killer cells of the immune system

It makes people feel better relaxed, and in less pain

MEDICAL MANAGEMENT OF PAIN GOAL:

a. Diagnosis of painful condition

b. Reduction of the severity and intensity of pain to tolerable levelsc. Observation of the psychological consequences of pain

ANESTHESIA

- Pharmacologic substances that abolishes pain generally causes loss of

feeling and sensation- TYPES:

1. General2. Local

3. Regional (Nerve Block)ANALGESICS

- Medications developed to provide pain relief

- Two Types

1. Non Opioid Analgesic

a. Aspirin

b. Salicylate Saltsc. Acetaminophen

d. NSAIDS


6/6

2. Opioid Analgesia

- Derived from natural opium alkaloids and their synthetic

derivations

- Added to medication regimen when pain is moderate tosevere

1st lecture pain (ncm103)

Documents