Pain

NURSING CARE
OF PATIENT WITH PAIN

DEFINITIONS
+“PAIN” is defined as an unpleasant sensory and emotional experience

arising from actual or potential tissue damage
+“PAIN is complex multifactorial phenomenon which includes an

emotional experience associated with actual as potential”
+ TRANSDUCTION
+ TRANSMISSION
+ PERCEPTION
+ MODULATION
ASSESSMENT OF PAIN
Assessment of pain includes
A. SUBJECTIVE
B. OBJECTIVE
A. SUBJECTIVE ASSESSMENT
1. PAIN HISTORY
+While taking pain history, nurse must provide an opportunity for clients to
express in their own words, how they view it and their situation
+This will help the nurse to understand means of pain to client and how the
client is coping with it.
2. ONSET AND DURATION OF OCCURRENCE:
+ - When did pain begin?
+- How long has it lasted?

+- Does it occur at same time each day?
+- How often does it occurs?
3. LOCATION
+In which area it is felt?
+Do the area differ under different circumstances?
+If several parts of body are painful, do pain occur simultaneously?
+Is pain unilateral / bilateral?
+Ask the individual to point site of discomfort

4. INTENSITY
+Use of pain intensity scale is an easy and reliable method of determining the
clients pain intensity
+Most scales are either 0 to 5 or 0 to 10

Currently used scales are:
+• Numerical scale
+• Descriptive scale
+• Visual analog scale
PAIN ASSESSMENT SCALE
1. NUMERICAL RATING SCALE

+A numerical rating scale with the range of 0 to 10 is another type of pain scale
that is used
+ The word “no pain” appear by “0” and “worst pain possible” is found by “10”
+ Patient are asked to choose a number from 0 to 10 that best reflects his/her
level of pain
1. NUMERICAL RATING SCALE
2. VERBAL RATING SCALES
+Verbal pain scales as name suggests, use words to describe pain.
+Word such as No Pain, Mild Pain, Moderate Pain & Severe Pain are used to
describe pain levels.
3. VISUAL ANALOGUE SCALES:
+ VSA use a vertical or horizontal line with words that convey “no pain” at one
end and “worst pain” at opposite end
+ Patient is asked to place a mark along line that indicates his/her level of pain.
4. WONG-BAKER FACES PAIN RATING SCALE
With the Wong-Baker Pain Scale, six faces are used that are numbered 0 to 5
underneath
+ Face 0 is a happy face
+ Face 2 is still smiling
+ Face 4 is not smiling or frowning
+ Face 6 is starting to frown
+ Face 8 is definitely frowning

B. OBJECTIVE ASSESSMENT
1. BEHAVIORAL EFFECTS:
+Assess verbalization, vocal response, facial and body movements & social
interaction
+Facial expression is often 1st indication of pain & may be only one
manifestation
+Vocalization like moaning, groaning, crying, grunting, screaming are

associated with pain
B. OBJECTIVE ASSESSMENT
2. PHYSIOLOGICAL RESPONSES:
+ It vary with the origin and duration of pain
+Early in onset of acute pain, the sympathetic nervous system is stimulated

results in increased blood pressure, pulse rate, respiration, pallor, diaphoresis
and pupil dilation
P – Q – R – S - T FORMAT
EFFECTS OF PAIN
+ Increased Heart Rate
+ Diaphoresis
+ Increased Blood Glucose Levels
+ Dilatation Of Pupils
+ Decreased GI Motility
+ Increased Muscle Tension
+ Increased Respiratory Rate

PAIN MANAGEMENT
Pain management strategies include both
+• PHARMACOLOGIC INTERVENTIONS
+• NON-PHARMACOLOGIC INTERVENTIONS
PHARMACOLOGIC INTERVENTIONS
+Paracetamol (acetaminophen), or a non steroidal anti-inflammatory drug

(NSAID) such as ibuprofen or aspirin.
+Opioid medications can provide a short, intermediate or long acting

analgesia depending upon the specific properties of the medication
+Opioid medications may be administered orally, by injection, via nasal

mucosa or oral mucosa, rectally, transdermally, intravenously, epidurally
and intrathecally eg. Oxycontin, Methadone
PHARMACOLOGIC INTERVENTIONS
+Muscle relaxants Orphenadrine and cyclobenzaprine
+Some antidepressant and antiepileptic drugs are used in chronic pain

management and act primarily within the pain pathways of the central nervous
system,
NON - PHARMACOLOGIC
+Non-pharmacological pain management is the management of pain without

medications.
+This method utilizes ways to alter thoughts and focus concentration to better
manage and reduce pain.
+Methods of nonpharmacological pain include

SUPERFICIAL HEAT
+Superficial heat can produce heating effects at a depth limited to between 1 cm

and 2 cm.
+It has been found to be helpful in diminishing pain and decreasing local muscle
spasm.
+Superficial heat, such as the hydrocollator pack, should be used as an adjunct to

facilitate an active exercise program. It is most often used during the acute phases
of treatment when the reduction of pain and inflammation are the primary goals.
CRYOTHERAPY
+Cryotherapy can be achieved through the use of ice, ice packs, or continuously via
adjustable cuffs attached to cold water dispensers.
+ Intramuscular temperatures can be reduced by between 3 °C and 7 °C, which

functions to reduce local metabolism, inflammation, and pain.
+Cryotherapy works by decreasing nerve conduction velocity, termed cold-induced

neuropraxia, along pain fibers with a reduction of the muscle spindle activity
responsible for mediating local muscle tone.
+ It is usually most effective in the acute phase of treatment

TENS and PENS
+TENS and PENS stand for Transcutaneous Electrical Nerve Stimulation and
Percutaneous Electrical Nerve Stimulation respectively.
+ Both procedures can be helpful in alleviating some of the more painful

symptoms of peripheral neuropathy
+But have to be used repeatedly to sustain the benefits.
+During TENS procedures, a small battery operated device is worn by the patient
and electrodes are typically placed on the surface of the skin, over the area
where the pain is felt. Low level electrical current is then applied for usually
about thirty minutes, several times throughout the day.
PENS
+The PENS procedure is similar in concept to TENS.
+The main difference is that instead of using the surface electrodes seen in TENS
devices, PENS uses needle probes as electrodes that are inserted through the
skin.
+ These needle probes are typically placed next to the nerve causing painful
neuropathy symptoms and then stimulated.
+PENS can be used in people who do not get sufficient pain relief from TENS
ACUPUNCTURE
+ Traditional Chinese acupuncture involves the insertion of extremely fine
needles into the skin at specific "acupoints." This may relieve pain by
releasing endorphins, the body's natural painkilling chemicals.
+ Acupuncture is generally quite safe, and the complication rate appears

to be quite low. A review of acupuncture-related complications reported
in medical journals found that the most
+ Serious problem was accidental insertion of a needle into the internal

organ
+ Mild complications are bleeding, soreness, or bruising at the site of

needle insertion
ACUPRESSURE
 Acupressure points (also called potent points) are places

on the skin that are especially sensitive to bioelectrical
impulses in the body and conduct those impulses readily.
 Stimulating these points with pressure, needles, or heat
triggers the release of endorphins, which are the
neurochemicals that relieve pain.
 As a result, pain is blocked and the flow of blood and
oxygen to the affected area is increased.
 This causes the muscles to relax and promotes healing.
Placebo therapy
+ A placebo is a substance or treatment which is designed to have

no therapeutic value
+ To achieve the effect of placebo it is essential degree of the

suggestions of the person who prescribe a placebo, and the degree of
belief of the person receiving the placebo.
+ Expected effect of placebo is to achieve the same effect as the right

remedy.
+ If a substance is presented as harmful, it may cause harmful effects,

called 'nocebo" effect.
+ Placebo effect is not equal in all patients, same as the real effect of
the drug is not always equal in all patients.
OTHER THERAPIES
+CUTANEOUS STIMULATION AND MASSAGE
+DISTRACTION
+RELAXATION TECHNIQUES.
o It reduces pain by relaxing tense muscles that contribute the pain.
Techniques consists of abdominal breathing at a slow, rhythmic rate.
+BED REST
+TRACTION
+ ANALGESIA AND SEDATION IN CRITICALLY
+ ILL PATIENTS
+ • In critically ill patients, adequate analgesia and
+ sedation increase comfort, reduce stress
+ response and facilitate diagnostic and
+ therapeutic procedures. Analgesia and sedation
+ may also have a beneficial impact on morbidity,
+ particularly by reducing pulmonary complications
+ such as atelectasis and pneumonia, and
+ delirium or agitation with subsequent accidental
+ extubation. The method and depth of analgesia
+ and sedation should be adapted to the needs of
+ the individual patient. While evaluation of
+ analgesia and sedation is important, technical
+ tools for assessment are generally unreliable

Pain

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NURSING CARE

OF PATIENT WITH PAIN

+“PAIN” is defined as an unpleasant sensory and emotional experience

+“PAIN is complex multifactorial phenomenon which includes an

Assessment of pain includes

+- How long has it lasted?

+In which area it is felt?

+Do the area differ under different circumstances?

+If several parts of body are painful, do pain occur simultaneously?

+Is pain unilateral / bilateral?

+Ask the individual to point site of discomfort

+Most scales are either 0 to 5 or 0 to 10

1. NUMERICAL RATING SCALE

3. VISUAL ANALOGUE SCALES:

4. WONG-BAKER FACES PAIN RATING SCALE

+ Face 2 is still smiling

+ Face 4 is not smiling or frowning

+ Face 6 is starting to frown

+ Face 8 is definitely frowning

+Vocalization like moaning, groaning, crying, grunting, screaming are

+Early in onset of acute pain, the sympathetic nervous system is stimulated

+ Increased Blood Glucose Levels

+ Increased Muscle Tension

+ Increased Respiratory Rate

+Paracetamol (acetaminophen), or a non steroidal anti-inflammatory drug

+Opioid medications can provide a short, intermediate or long acting

+Opioid medications may be administered orally, by injection, via nasal

+Muscle relaxants Orphenadrine and cyclobenzaprine

+Some antidepressant and antiepileptic drugs are used in chronic pain

+Non-pharmacological pain management is the management of pain without

+Methods of nonpharmacological pain include

+Superficial heat can produce heating effects at a depth limited to between 1 cm

+Superficial heat, such as the hydrocollator pack, should be used as an adjunct to

+ Intramuscular temperatures can be reduced by between 3 °C and 7 °C, which

+Cryotherapy works by decreasing nerve conduction velocity, termed cold-induced

+ It is usually most effective in the acute phase of treatment

+ Both procedures can be helpful in alleviating some of the more painful

+But have to be used repeatedly to sustain the benefits.

+ Acupuncture is generally quite safe, and the complication rate appears

+ Serious problem was accidental insertion of a needle into the internal

+ Mild complications are bleeding, soreness, or bruising at the site of

 Acupressure points (also called potent points) are places

+ A placebo is a substance or treatment which is designed to have

+ To achieve the effect of placebo it is essential degree of the

+ Expected effect of placebo is to achieve the same effect as the right

+ If a substance is presented as harmful, it may cause harmful effects,

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