Pain Management

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 11

PAIN MANAGEMENT

INTRODUCTION-

Pain is the fifth vital sign to emphasize its significance and to increase the awareness among
health care professionals of the importance of effective pain management. pain is a complex
phenomenon. Pain in different systems of the human body gives different experience to the
individual. pain experience with sharp instrument from a colicky pain of the alimentary system.
It is the most common reason for seeking health care. People from different countries and
different branches of medicines and paramedical tried to define pain.

DEFINITION- pain is defined as an unpleasant sensory and emotional experience arising


from actual or potential tissue damage.
( Merskey & bogduk 1994)

OR

Margo Mc caffery (1968) first defined pain as whatever the person experiencing says it is,
exciting it is whenever says it is.

CHARACTERISTICS OF PAIN-

Intensity: it is the severity of pain from no pain to excruciating pain.

Timing: onset of pain and duration.

Location: body area involved.

Quality: what the patient feels pain is burning, throbbing, aching or stabbing.

Personal meaning: how affects the persons daily life. (pain continue to work or study and
some others disabled by their pain.)

Aggravating and alleviating factor

SIGN AND SYMPTOMS OF PAIN:-

 Increased heart rate


 Increased respiratory rate
 Peripheral vasoconstriction
 Pallor
 Elevated BP
 Increased blood sugar level
 Diaphoresis
TYPES OF PAIN:

pain is categorized according to its duration, location, intensity and etiology. Three basic
categories of pain are generally recognized:

TYPES OF PAIN

Based on duration based on location based on intensity based on etiology

1. Based on duration:-

 Acute pain
 Chronic pain
 Chronic Cancer related pain
1. Acute pain:-
 usually of recent onset and commonly associated with a specific injury, acute pain
indicates that damage or injury has occurred.
 Acute pain is protective, has an identifiable cause , is of short duration and has
limited tissue damge and emotional response.
 It eventually resolves with or without treatment, after an injury area heals.
 Unrelieved acute pain can progress to chronic pain.

2. Chronic pain:-
 chronic pain may be defined as pain that lasts longer than 6 months and is constant
or reoccurring with mild to sever intensity.
 It does not always have an identifiable cause.
Eg. Arthiritic pain, headache, peripheral neuropathy.
 The possible unknown cause of chronic pain, combined with unrelenting nature
and uncertainly of its duration, frustrates a patient, frequently leading to
psychological depression.
 Associated symptoms of chronic pain: fatigue, insomnia, anorexia, weight loss,
hopelessness, anger.
3. Chronic Cancer related pain:-
pain associated with cancer may be acute or chronic. Most cancer pain is caused by
the tumor pressing on bones, nerves, or other organ in the body. Sometimes pain is due to
your cancer treatment e.g. chemotherapy.
2.Pain based on location:-
this is based on the site at which the pain is located
e.g. pelvic pain, headache, chest pain.
Reffered pain- pain due to problems in other areas manifest in different body parts.
Eg. Cardiac pain may be felt in the shoulders or left arms, with or without chest pain.

3.Based on intensity:-
 Mild
 Moderate pain
 Severe pain

 Mild pain: pain scale reading from 1-3 is considered as mild pain.
 Moderate pain: pain scale reading from 4-6 is considered as moderate pain.
 Sever pain: pain scale reading from 7-10 is considered as sevre pain.

4. Pain based on etiology:-

NOCICEPTIVE PAIN
NEUROPATHIC PAIN

SOMATIC PAIN PERIPHARAL PAIN

VISCERAL PAIN
CENTRAL PAIN

NOCICEPTIVE PAIN:-
 Is experienced when an intact, properly functioning nervous system send signals that
tissue are damaged requiring attention and proper care.
Eg. The pain experienced following a cut or broken bone alerts the
person to avoid further damage until it is properly healed.
 Once stabilized or healedthe pain goes away.

Somatic pain: this is the pain that is originated from the skin, muscles, bone
or connective tissue.
eg. The sharp sensation of a paper cut or aching of a sprained ankle.
Visceral pain: Is the pain that result from the activation of nociceptors of
the thorasic , pelvic, or abnormal viscera (organs)
Characterized by cramping, throbbing, pressing, or aching qualities.
Eg. Labour pain, angina pectoris or irritable bowel.

NEUROPATHIC PAIN:

 Neuropathic pain is associated with damaged or malfunctioning nerve due to illness,


injury or undetermined reason.
 Eg.
Diabetic peripheral neuropathy
Phantom limb pain
Spinal cord injury pain
 It is usually chronic
 It is describe as burning,electric shock, and or tingling , dull and aching.
 Neuropathic pain to be difficult to treat.

 There are two types of neuropathic pain-


-peripheral neuropathic pain: due to damge of peripheral system eg,
phantom limb pain.

-central neuropathic pain: results from malfunctioning nerves in the


CNS.
Eg. Spinal cord injury pain post post stroke pain.

PAIN THRESHOLD:- the pain threshold is the point at which a stimulus is perceived as pain. A patient
who is hyper reactive is considered to have a low pain threshold. On the other hand a patient with a high pain
threshold can tolerate pain.

The pain threshold is affected by:-


 Emotional status
 Fatigue
 Age
 Sex
 Fear & apprehension.

NEUROANATOMY OF PAIN-
Nervous system responsible for the sensation and perception of pain may be divided into three area:
1. Afferent pathway
2. CNS
3. Efferent pathway

Afferent pathway :- it is composed of :

a) Nociceptors (pain receptors)


b) Afferent nerve fibres
c) Spinal cord network

PATHOPHYSIOLOGY OF PAIN

1.Transduction
(noxious stimuli translated into electrical activity at sensory nerve endings)

2. Transmission
(propagation of impulses along spinothalamic pathway)

3.Modulation
(transmission is modified)

4.perception

PAIN ASSESSMENT:
Pain is often referred to as the “fifth vital sign” and should be assessed regularly and frequently. Pain is
individualized and subjective; therefore, the patient’s self-report of pain is the most reliable gauge of the
experience. If a patient is unable to communicate, the family or caregiver can provide input. Use of interpreter
services may be necessary.

Components of pain assessment include:


a) history and physical assessment;
b) functional assessment;
c) psychosocial assessment;
d) multidimensional assessment.

a) History and Physical Assessment:

The assessment should include physical examination and the systems in relation to pain evaluation. Areas of
focus should include site of the pain, musculoskeletal system, and neurological system. Other components of
history and physical assessment include:

• Patient’s self-report of pain


• Patient’s behaviors and gestures that indicate pain (e.g. crying, guarding, etc.)
• Specific aspects of pain: onset and duration, location, quality of pain (as described by patient), intensity,
aggravating and alleviating factors
• Medication history
• Disease or injury history
• History of pain relief measures, including medications, supplements, exercise, massage, complementary and
alternative therapies.

b)Functional and Psychosocial Assessment

Components of the functional and psychosocial assessment include:

• Reports of patient’s prior level of function


• Observation of patient’s behaviors while performing functional tasks
• Patient or family’s report of impact of pain on activities of daily living, including work, self-care, exercise,
and leisure
• Patient’s goal for pain management and level of function
• Patient or family’s report of impact of pain on quality of life
• Cultural and developmental considerations
• History of pain in relation to depression, abuse, psychopathology, chemical or alcohol use
• Impact of pain on patient’s cognitive abilities.
Common Pain Scales:-
There are a variety of pain scales used for pain assessment, for patients from neonates through advanced ages.
The three most common scales recommended for use with pain assessment are:
• The numeric scale
• The Wong-Baker scale (also known as the FACES scale)
• The FLACC scale

The Numeric Scale


The numeric scale is the most commonly used pain scale with adult patients, rating pain on a scale of 0-10.
Many nurses ask for a verbal response to the question. Use of this scale with the visual analog can provide a
more accurate response. This scale is appropriate with patients aged nine and older that are able to use numbers
to rate their pain intensity .
Wong-Baker Scale
The Wong-Baker FACES Scale uses drawn faces for patients to express their level of pain. The faces are
associated with numbers on a scale ranging from 0 to 10. This scale is most commonly used with children, and
is appropriate to use with patients ages three and older. Adults who have developmental or communication
challenges may benefit from using this scale.

FLACC Scale
FLACC is the acronym for Face, Legs, Activity, Cry, and Consolability. This scale is based on observed
behaviors, and is most commonly used with pediatric patients less than three years of age. The behaviors that
are described are associated with a number; each component is totaled for a number ranging from 0 to 10. This
scale is also appropriate with patients who have developmental delays or are non-verbal
PAIN MANAGEMENT:-
Pain management refers to the appropriate treatment and interventions developed in relation to pain assessment,
and should be developed in collaboration with the patient and family. Strategies are developed based on past
experiences with effective and non-effective treatments to meet the patient’s goal for pain management.
Considerations include type of pain, disease processes, risks, and benefits of treatment modalities. Pain
management strategies include pharmacological and non-pharmacological approaches.

Non-Pharmacological Treatment :-

There are a variety of approaches for decreasing pain in adult and pediatric patients that are non-
pharmacological. These types of strategies are often over-looked, but can be effective for alleviating pain when
used either alone or in combination with other non-pharmacological or pharmacological measures.

Non-pharmacological interventions may include:


• Heat or cold (as appropriate)
• Massage
• Therapeutic touch
• Decreasing environmental stimuli (e.g. sound, lighting, temperature)
• Range of motion or physical therapy
• Repositioning
• Immobilization
• Relaxation techniques and imagery
• Distraction
• Psychotherapy or cognitive behavioral therapy
• Biofeedback
• Music therapy Material protected by copyright
• Aromatherapy
• Acupressure or acupuncture
• Transcutaneous electrical stimulus (TENS)

Pharmacological Treatments:-
The use of medications to treat pain can be complex. Multiple factors must be considered including age, current
medications, patient medical and substance use history, type of pain (such as neuropathic versus nociceptive),
etc. Pharmacological treatments include:
• Analgesic: Acetaminophen (Tylenol®) is a common analgesic used for mild pain, or in a combination with
opioids for moderate pain. There must be caution taken in the amount of acetaminophen used per day, which
can result in hepatic toxicity.

• Non-steroidal anti-inflammatories (NSAIDs): Common examples include salicylates, ibuprofen (Advil®),


naproxen (Aleve®), and ketorolac (Toradol®). These are used to reduce inflammation which can decrease pain.
NSAIDs can be used for mild pain, or in combination with opioids for moderate pain. Caution is needed with
dosages for pediatric and elderly patients, and is contraindicated in patients with hepatic or renal impairment,
bleeding disorders, or gastrointestinal ulcers.
• Tricyclic antidepressants (TCAs): Examples include amitriptyline (Elavil®), nortriptyline (Aventyl®), and
desipramine (Norpramin®). TCAs can be effective in treating neuropathic pain, and can provide a mild
analgesic effect. Caution should be taken with pediatric and elderly patients.

• Selective serotonin reuptake inhibitors (SSRIs): Common examples include fluoxetine (Prozac®),
paroxetine (Paxil®), serotonin, and sertraline (Zoloft®). SSRIs can be used as adjunct therapy for depression
and neuropathic pain. Caution is required with pediatric and elderly patients, as there is a risk of suicidal
thoughts.

• Anticonvulsants: Examples include carbamazepine.


Anticonvulsants can provide sedation and a graded analgesic effect.

• Topical agents: Common examples include creams that have analgesic or local anesthetic agents. Topical
agents may be used with neuropathies or arthritis.

• Anesthetics: Anesthetics can be used for epidurals or nerve blocks to assist with acute or chronic pain. These
are temporary, and may be effective up to three or four months. Risks and benefits must be evaluated prior to
performing a block.

• Opioids: Common examples of mild opioids include codeine, oxycodone, and hydrocodone. Common
examples of more potent opioids are morphine, fentanyl, and hydromorphone, used for moderate to severe pain.
Opioids can be used with both acute and chronic pain.
CONCLUSION-

Pain management is a vital component of patient care, and can be complex. It is important to individualize plan
of care for each patient. Nursing responsibilities include:

• Pain assessment: The nurse must adequately and completely assess the patient’s pain.

• Pain rating: The nurse will appropriately identify a pain rating scale matched to the patient’s needs.

• Patient and family involvement in pain management: The nurse must include the patient and family in
development of the pain management plan of care.

• Physician communication: The nurse will notify the physician of any new pain, and/or pain that is not
managed adequately.

• Medication administration: The nurse must administer medication in an appropriate and safe manner.

• Patient and family involvement in non-pharmacological pain interventions: The nurse will involve the
patient and family, and provide appropriate instructions.

• Patient and family education: The nurse will instruct the patient and family on the correct administration
and management of medications and side effects, and provide them with pain management resources.
MAYO COLLEGE OF NURSING
BHOPAL

SUBJECT- ADVANCE NURSING PRACTICE


AN ASSIGNEMENT ON -
PAIN MANAGEMENT

SUBMITTED TO SUBMMITED BY

MS.VINCY VARGHESE MS. BHARTI RAI

LECTURER M.SC NURSING 1 YEAR

DATE OF SUBMISSION-

12/09/20

BIBLIOGRAPHY

 Basheer, S.P. & KHAN S.Y.(2012).A Concise Text Book of Advanced Nursing Practice. Bangalore,
India: EMMESS Medical Publishers.1st edition, page no. -145 to 159
 Soni, S. (2013).TEXTBOOK OF ADVANCE NURSING PRACTICE. New Delhi, India: JAYPEE
BROTHERS MEDICAL PUBLISHERS (P) LTD. Page no.134-168
 Sethi, N. (2014). NURSING PRINCIPLES AND PRACTICE.Jalandir city, India: LOTUS
PUBLISHERS.3RDedition, volume-1, Page no.474
 PARK, K.(2011). PARK’S TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE. Jabalpur,
India:M/s BANARSIDAS BHANOT.21ST edition, page no. 456-460
 Swarnkar, K. (2011). COMMUNITY HEALTH NURSING. Indore, India: N.R Brothers. 3rd edition,
page no. 125-130.
 Retrieved at 2013, May,01. From https://www.slideshare.net>Dr.JayeshPatidar.
Retrieved a t 2013, April, 27.From https://www.slideshare.net

You might also like