1 Chapter 20 Pain Management. pain Pain is The major cause of physical distress among clients. An unpleasant sensation usually associated with disease.

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Chapter 20

Pain Management

painPain is

The major cause of physical distress among clients.An unpleasant sensation usually associated with disease or injury.

The process of pain1.Transduction-Phase:

Conversion of chemical information at the cellular level into electrical impulses that move toward the spinal cord.

2. Transmission-Phase : During which stimuli move from the peripheral nervous

system to the brain

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3. Perception-Phase: Conscious experience of discomfort when the pain threshold is

reached.

4. Modulation-Phase: Brain interacts with the spinal nerves in a downward fashion to

alter the pain experience

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Phases of Pain

Pain theoriesEndogenous opioids: (naturally produced

morphine-like chemicals) e.g., endorphins.

When it is released, they bind to sites on the nerve cell’s membrane that block the transmission of pain impulses.

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Mechanism of Pain Transmission and Interference

TYPES OF PAIN1. Cutaneous pain:

Discomfort that originates at the skin level

2. Visceral pain : Discomfort arising from internal organs Referred pain:

Discomfort perceived in a general area of the body, usually away from the site of stimulation ( appendicitis )

3. Neuropathic pain: Pain with atypical characteristics also called functional

pain Example : phantom limp pain

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TYPES OF PAIN (cont’d)4. Acute pain:

Lasts a few seconds to less than 6 months Associated with tissue trauma, surgery, or recent

identifiable etiology. Gradual reduction in pain promotes coping

5. Chronic pain Discomfort that lasts longer than 6 months Physical and emotional distress Depression

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PAIN ASSESSMENT STANDARDS Pain is the fifth vital sign Should be assessed with temperature, pulse, respirations,

and blood pressure Pain should be regularly assessed throughout the healthcare

delivery Healthcare workers should be educated on pain Clients and families should be educated on effective pain

management Client’s choices regarding pain management is respected

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PAIN ASSESSMENT DATA1. Onset :

Time under which the pain became apparent ( e.g. after surgery)

2. Quality: Degree of suffering ( e.g. throbbing, crushing)

3. Intensity:Magnitude of pain ( e.g. mild ,moderate, severe) (numeric

scale from 0-10) 4. Location

Anatomic site ( e.g. chest, abdomen) 5. Duration

Time span of pain ( e.g. continuous, intermittent, weeks)

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NONVERBAL PAIN INDICATORSMoaning CryingGrimacingGuarded positionIncreased vital signsReduced social interactionsIrritabilityDifficulty concentratingChanges in eating and sleeping

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PAIN MANAGEMENT TECHNIQUES1. DRUG THERAPY:

1. Nonopioids (non-narcotic drugs). e.g. Aspirin, acetaminophen, NSAIDS ibuprofen, naproxin

2. Opioids (narcotic drugs), e.g. Morphine sulfate, Codeine sulfate

3. Adjuvant drugs that assist in accomplishing the desired effect of a primary drug (e.g. antidepressant, anticonvulsant)

2. SURGICAL APPROACHES Intractable pain - Pain unresponsive to other methods

of pain management p. 42712

3. Nondrug/ Nonsurgical interventions:1. Education:

Educate client about pain and methods for pain management

2. Imagery: Intentional daydreaming

3. Meditation: (Spiritual)Concentrating on a word or idea that promotes tranquility,

4. Distraction:Intention diversion of attention to switch focus from unpleasant

sensory experience

5. Relaxation:Technique for releasing muscle tension and quieting the mind

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6. Heat and Cold:Thermal therapy for pain relief

7. Acupuncture:Pain management technique in which long, thin needles are

inserted into the skin

8. Acupressure:Technique that involves tissue compression rather than needles to

reduce pain

9. Hypnosis:Therapeutic technique in which a person enters a trance-like state

10. Transcutaneous electrical nerve stimulation

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Nursing Implications-Nursing Diagnoses1. Acute pain

2. Chronic pain

3. Anxiety

4. Fear

5. Ineffective Coping

6. Deficient Knowledge: Pain Management

Placebo : an inactive substance sometimes prescribed as a substitute for analgesic drugs

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trance  (trăns)n.1. A hypnotic state.2. Detachment from one's physical

surroundings, as in contemplation or daydreaming.

3. A semiconscious state, as between sleeping and waking; a daze.

in which ability to function voluntarily may be suspended.

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