Pain

Pain Is the sensation of physical or mental hurt or suffering that causes emotional agony to the one experiencing it

An unpleasant sense caused by signals from some sense nerve endings. It is a basic symptom of inflammation and is an important clue to the cause of many disorders.

Pain may be mild or severe, chronic, acute, cutting, burning, dull, or sharp, exactly or poorly located, or referred Subjective response to physical and psychologic stressors

Considered as the 5th vital signKey Concepts

Subjective Protective ResponseRelevant Concepts

1. There are receptors that detect tissue injury, they are called nociceptors2. There are neurotransmitters involved in the processing of pain perception.These are:

Serotonin- Also called 5-hydroxytryptamine. A substance found naturally in the brain and intestines. Serotonin is released from certain cells when the blood vessel walls are damaged. It acts as a strong vessel-narrowing substance.

Histamines a compound, found in all cells, produced by the breakdown of histidine. It is released in allergic reactions and causes widening of capillaries, decreased blood pressure, increased release of gastric juice, and tightening of smooth muscles of the bronchi and uterus.

Bradykinins A chemical made by the body that widens the blood vessels. (vasodilator) Prostaglandin One of several strong hormonelike fatty acids that act in small amounts on certain organs.

They are made in tiny amounts and have many different effects. Prostaglandins given by nasal spray, in tablets, or dissolved in liquids cause changes in smooth muscle tone, hormone functions, and in the autonomic and central nervous systems.

Prostaglandins are used to end pregnancy and to treat asthma and too much stomach acid.

3. There are Polypeptides that binds with receptors in the brain and Spinal cord which has morphine-like characteristics Enkephalins

one of two pain-relieving substances made in the body.

found in the pituitary gland, brain, and stomach and bowels.

It is believed that enkephalins can slow nerve activity through the central nervous system. They slow nerve signals to indicate pain, which reduces the mental and physical sensation of pain Endorphins

Endorphins are composed of amino acids. They are made by the pituitary gland and act on the nervous system to reduce pain. They produce effects like that of morphine

Types of Pain General ClassificationI. Acute Pain

1. Somatic Pain

Originates from the superficial structures like the skin and deeper structures like muscles, usually sharp and localized2. Visceral pain

Originates from the viscera (the internal organs held within a space in the body, mainly the stomach and intestines.) Usually accompanied by autonomic symptoms like vomiting

Usually poorly localized3. Referred Pain

Pain felt in areas other than those stimulated or pain perceived in an area distant from the site of the stimuli. It occurs in response to visceral injuryII. Chronic Pain- Prolonged pain usually more than 6 monthsCategories of Chronic Pain Recurrent Acute Pain

Characterized by relatively defined episodes of pin interspersed with pain free episodes. Example: migraine head aches

On going time limited pain

Identified by a defined time period. Examples are cancer pains, which ends with the control of the disease or death, or burn pain which ends with rehabilitation or death Chronic Non-malignant pain

Is a non threatening pain that nevertheless persist beyond the expected time for healing. Chronic lower back pain falls into this category Chronic intractable non malignant pain syndrome

Is similar to simple chronic nonmalignant pain, but is characterized by the persons inability to cope well with pain and sometimes by physical, social or psychologic disability resulting from painIII. Others Pains 4. Psychogenic Pain Pain that occurs with no physiologic basis

It originates in the mind of the patient5. Phantom Limb pain

Pain perceived that is occurring in an extremity that has been amputated

6. Central Pain

Related to a lesion in the brain that may spontaneously produce high frequency burst of impulses that are perceived as pain

A vascular lesion, tumor , trauma or inflammation may cause this

Example: Thalamic painTerms to remember Trigeminal Neuralgia- Neuritis of the trigeminal (fifth cranial) nerve, characterized by severe pain in the face occurring in sudden paroxysms. Tic douloureux. Causalgia- A burning sensation in the palms, soles or digits, thought to be due to irritation or disease in the nerves supplying these areas. Neuralgia- Pain along the route of a nerve. this is a result of damage to the peripheral nerve caused by infection or disease Dystrophies- characterized by continous severe burning pain. These conditions follow peripheral nerve damage and present the symptoms of pain, vasospasm, muscle wasting and vaso motor changes( vasodilation followed by vasoconstriction) Hyperesthesias- are conditions of oversensitivity to tactile and painful stimuli. This results in diffuse pain that is usually increase by fatigue and emotional lability Myofascial pain syndrome- common condition by injury or disease of muscle or fascial tissue results fro muscle spasm, stiffness and collection of acid in the muscleTheories of Pain1. Pattern Theory Contends that pain results from combined results from intense stimulus and interpreted in the dorsal horns of the spinal cord

States that pain is perceived if the stimulus is intense enough2. Specificity Theory States that there are specific nerve recptors for a particular stimulus

Nociceptors for pain; Thermoreceptors for heat and cold

3. Gate Control Theory Contends that pain and pain perception result from the interplay of three systems: 1) Substancia Gelatinosa,[dorsal horn of the spinal cord] 2) Thalamus ( the Central Control), 3) peripheral nerves [transmission] Also contends that pain impulses are transmitted by2 types of nerve fibers

1. A-delta fibers (myelinated)2. C- Fibers (unmyelinated)

Proposes that a gate mechanism in the substancia gelatinosa can be closed completely or partially to block the pain impulse.Assessment of PainSubjective Data Characteristics and description of pain as to site severity, duration,, intensity and type Measures to relieve pain]

Factors that worsens pain]

Coping strategies

Medications being taken

Interference with the ADL, social, job and family

Objective Data Physiologic

Vital signs, pallor,diaphoresis, dilated pupils, muscle tension, nausea and vomiting Behavioral Restlesness, clenched teeth and fist, rigid body posture, crying ,moaning and frowning Nursing Care

1. Assist the client to find positions to relieve pain or that provide comfort

a. There is frequent change of position

b. Moving the patient gently]

c. The use of pressure relieving aids

d. Backrub

2. Assist the patient with hygiene

3. Maintain comfortable temperature in the environment

4. Utilizes distraction to relieve pain