Pain Module (E) Lecture Cont

Pain Management

Module E (Lecture)

Objectives

Identify types and categories of pain to location,etiology, and duration

Identify subjective and objective data to collect and analyze when assessing pain

Identify examples of nursing diagnosis for clients with pain

State outcome criteria by which to evaluate a clients response to interventions for pain.

Objectives

Identify barriers to effective pain management

Describe non-pharmacologic pain control interventions

Describe pharmacologic interventions for pain

Nature of Pain

“An unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage” (International Association for the Study of Pain, 1979).

Types of Pain Acute Pain- pain lasting only through

the expected recovery period.

Chronic Pain- lasts beyond the usual course for recovery (six months duration).

Continued Pain can be categorized according to

its origin: Cutaneous Deep somatic Visceral

Continued Radiating Referred Intractable Neuropathic Phantom

Pain Syndromes Central Pain Syndromes

Trigeminal neuralgia Peripheral Pain Syndromes

Post-herpetic Neuralgia Phantom Limb Pain

Pain with Underlying Pathology Syndromes Headache- common somatic pain either

intracranial or extra-cranial. Cancer Pain Syndrome – Progressionof the disease or from efforts to cure or

control disease. Myofacial Pain Syndrome

Concepts Associated with Pain

Pain Threshold Pain Sensation Pain Reaction Pain Tolerance

Gate Control Theory According to theory, peripheral nerve

fibers carrying pain to the spinal cord can have their input modified at the spinal cord level before transmission to the brain.

Continued Ascending Modulation

Large diameter sensory fibers, message, heat and cold applications

Transcutaneous electrical nerve stimulation (TENS) unit, electrical stimulation is applied to skin

Descending modulation

Factors Affecting the Pain Experience

Ethnic and Cultural Values

Developmental Stage

Environment and Support People

Continued Past Pain Experience

Meaning of Pain

Anxiety and Stress

Why clients may be reluctant to report pain Unwillingness to trouble staff Fear of injectable route of analgesic

administration Belief that pain is to be expected as

part of recovery Concern about addiction

Continued Fear about cause of pain or that reporting

pain will lead to further tests and expenses Concern about unwanted side effects,

especially of opioid drugs Difficulty expressing personal discomfort

Pain Assessment Accurate pain assessment is essential

for effective pain management. Pain is subjective and experienced uniquely by every individual, nurses need to assess all factors affecting the pain experience.

Pain History Previous pain treatment and

effectiveness When and what analgesics were last

taken Allergies to medications, other

medications being taken

Continued Location (abdomen) Intensity (scale of 0-10)See figures 43-

7 and 43-8, pgs 1090-1091) Quality (perceiving like a knife) Pattern (onset, duration, and

recurrence of intervals without pain.

Continued Precipitating Factors (Environmental factors,

heat or cold) Alleviating factors (herbal teas, rest, t.v., prayer) Associated Symptoms (N/V, dizziness, diarrhea) Effects on ADL’S (Sleep, appetite,

concentration, school, work, driving, walking)

Continued Coping resources (prayer or other

religious practices) Affective Responses (nurse to explore

feelings) Observation of Behavioral and

Physiologic Responses

Barriers to Pain Misconceptions and biases Clients respond to pain based on their culture,

personal experiences and the meaning the pain has for them.

Clients may not report pain because they expect nothing to be done, they think it is not severe enough, or because they feel it would distract or prejudice the healthcare provider.

Key Factors in Pain Management

Acknowledging and accepting Assisting Support Persons Reduce misconceptions about pain Reducing fear and anxiety Preventing Pain

Individualizing Care for Clients with Pain Establish a trusting relationship Consider the clients ability and willingness

to participate actively in pain relief measures

Use a variety of pain relief measures Provide measures to relieve pain before it

becomes severe.

Continued Use pain relieving measures that the client

believes are effective Base the choice of pain relief measure on

the client’s report of he severity of the pain If a pain relief measure is ineffective

encourage the client to try it once or twice before abandoning it

Continued Maintain an unbiased attitude about

what might relief the pain Keep trying Prevent harm to the client Educate the client and support people

about pain.

Pharmacologic Pain Management Involves the use of opioids (narcotics) Nonopioids/NSAIDS (nonsteroidal

antiinflammatory drugs) Adjuvants or Coanalgesic Drugs (See box

on pg 1098)

Opioid Analgesics Opium derivatives (M.S., and Codeine) Relieve pain and provide a sense of

euphoria binding to opiate receptors and activating endogenous pain suppression in the CNS.

MU, Delta, and Kappa receptors (opiate receptors)

Types of Opioids Full agonist- MS, Demerol, Codeine,

Darvon, Dilaudid- their doses can be increased to relieve pain.

Mixed agonist-antagonist Partial agonists

NONPHARMOCOLOGIC PAIN MANAGEMENT Physical Interventions-Provide Comfort Cutaneous Stimulation-Massage,

application of heat or cold, acupressure Contralateral Stimulation Immobilization Distraction (visual, auditory, tactile,

intellectual)

Transcutaneous Electrical Nerve Stimulation TENS is a method of applying low voltage

electrical stimulation directly over identified pain areas, at an acupressure point, along peripheral nerve areas that innervate the pain area, or along the spinal column.

Pain Evaluation The nurse and client must determine if

overall goals and outcomes are achieved. Flow sheet records and diaries are helpful

in this process, to evaluate the effectiveness of an analgesic.