Download - Chapter 20 Pain Management
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Chapter 20
Pain Management
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
PainPain
• Definition of pain
• The process of pain
– Transduction
– Transmission
– Perception
– Modulation
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Phases of PainPhases of Pain
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QuestionQuestion
•Is the following statement true or false?
C-fibers carry impulses rapidly at a rate of approximately 5 to 30 meters per second.
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AnswerAnswer
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.
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Pain (cont’d)Pain (cont’d)
• Pain theories
– Endogenous opioids
o Endorphins
o Dynorphins
o Enkephalins
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Mechanism of Pain Transmission and Interference
Mechanism of Pain Transmission and Interference
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Pain (cont’d)Pain (cont’d)
• Types of pain
– Cutaneous
– Visceral
– Neuropathic
– Acute
– Chronic
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QuestionQuestion
•Phantom limb pain belongs to which of the following categories of pain?
a. Cutaneous
b. Visceral
c. Neuropathic
d. Acute
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AnswerAnswer
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.
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QuestionQuestion
•Is the following statement true or false?
Somatic pain is discomfort that originates at the skin level.
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AnswerAnswer
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.
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Pain Assessment Standards Pain Assessment Standards
• Pain: the fifth vital sign
• JCAHO standards
• Compliance with established standards of care
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JCAHO Components of a Comprehensive Pain Assessment
JCAHO Components of a Comprehensive Pain Assessment
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Pain Assessment Data Pain Assessment Data
• Components of brief or basic pain assessment
• Questions to be asked during admission assessment
• Underassessed and undertreated clients
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Components of Pain AssessmentComponents of Pain Assessment
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Pain Intensity Assessment Tools Pain Intensity Assessment Tools • Four types of pain assessment
tools
– Numeric scale
– Word scale
– Linear scale
– Picture scale
• Different scales for different ages
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Pain Intensity Assessment Tools (cont’d)
Pain Intensity Assessment Tools (cont’d)
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Pain Management Pain Management
• Treatment biases
• Pain management techniques
• Drug therapy
– Nonopioid drugs
– Opioid drugs
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World Health Organization Analgesic Ladder
World Health Organization Analgesic Ladder
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Pain Management (cont’d) Pain Management (cont’d)
• Opioid drugs (cont’d)
– Patient-controlled analgesia
– Intraspinal analgesia
• Adjuvant drugs
• Botulinum toxin therapy
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Pain Management (cont’d)Pain Management (cont’d)
• Surgical approaches
– Rhizotomy
– Cordotomy
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Client and Family Teaching: Pain and Its Management Client and Family Teaching: Pain and Its Management
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Pain Management (cont’d)Pain Management (cont’d)
• Nondrug/nonsurgical interventions
– Education
– Imagery
– Meditation
– Distraction
– Relaxation
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Pain Management (cont’d)Pain Management (cont’d)
• Nondrug/nonsurgical interventions (cont’d)
– Heat and cold
– Transcutaneous electrical nerve stimulation
– Acupuncture and acupressure
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Pain Management (cont’d)Pain Management (cont’d)
• Nondrug/nonsurgical interventions (cont’d)
– Percutaneous electrical nerve stimulation
– Biofeedback
– Hypnosis
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Percutaneous Electrical Nerve Stimulation
Percutaneous Electrical Nerve Stimulation
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Nursing ImplicationsNursing Implications
• Various nursing diagnoses
• Addiction
• Placebos
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General Gerontologic ConsiderationsGeneral 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
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General Gerontologic Considerations (cont’d)
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
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General Gerontologic Considerations (cont’d)
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
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QuestionQuestion
•Is the following statement true or false?
Older adults are less sensitive to pain stimuli.
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AnswerAnswer
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.