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NOTES ON PAIN AND PAIN MANAGEMENT-MSN I

✔

Pain-

an unpleasant sensory and emotionalexperience associated with actual or potential tissuedamage or described in terms of such damage,sensation of physical or mental suffering.

A sensation of physical or mental hurt or suffering that causes distress or agony to theone experiencing it.

Is subjective in nature, only the personexperiencing it may describe it.

Is protective in nature because it provideswarning signal for tissue injury. It helpsminimize injury and is often a protective injury-protection mechanism.

✔

Pain-

is whatever the experiencing person say it is,existing whenever he say does-Mc-Caffery

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Persistent pain-

a pain that contributes insomnia,weight gain, constipation, etc.

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Severe pain-

an emergency situation deservingattention and professional treatment.

✔

Comfort-

implies renewal amplification of power.



Types of Comfort:

Relief-

experience of having a specific need tomeet

Ease-

state of calm

Transcendence-

state in which client ease above.



Theories of Pain:

Pattern Theory-

states that pain is perceivedwhenever stimulus is intense enough.

Specificity Theory-

It states that there is a specificnerve receptor for particular stimuli. E.g.Nociceptor-noxious stimuli, Thermoreceptor-heat/cold, Mechano receptor- pressure,Chemoreceptor-Chemicals

Gate Control Theory-

There is a gate in the spinalcors called substantia gelatinosa. When the gateis open, pains stimulus is transmitted, thus pain isperceived. When the gate is closed, stimulus isblocked thus, no pain is perceived. This isintroduced by Melzack and Wall

Affect Theory-

It avers that pain is emotional. Theintensity of pain perceived depends on the valueof the organ affected to the individual.

Parallel Processing Model-

Physiologic or neurologic decipheringof pain sensation andcognitive emotional properties occur alongdifferent nerve fibers.



Types of Pain:

A.By Location

✔

Referred pain-

appear to arise in differentareas.

✔

Visceral pain-

pain arise from organ or hollowviscera.

B.By Duration

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Acute pain-

it has a sudden/slow onset andregardless of its’ intensity.

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Chronic pain-

is prolonged, usuallyrecurring/persisting over 6 months or longer. It is mildto severe, constant or recurring w/o anticipated or predictable end.

✔

Cancer pain-

may result from direct effect of thedisease and its treatment may be unrelated to diseaseand its treatment with cancer.

✔

HIV/AIDS pain

- malignant pain which tend to betreated more aggressively.

By Intensity

✔

Mild-

pain ranging from1-3

✔

Moderate-

pain ranging from 4-6

✔

Severe-

pain ranging fro, 7-10 w/ worst outcome

By Etiology

✔

Physiological pain-

pain when an intact,properly functioning nervous system sends signals thattissues are damaged.

✔

Somatic-

originates in the skin, muscles, bonesand connective tissues.

✔

Cutaneous pain-

occurs over body surface or skin.

✔

Radiating pain-

felt at a source and extends tosurrounding tissues.

✔

Visceral pain-

results from activation of painreceptor or hollow viscera; tends to be poorly locatedand may have a cramping quality and feeling sick.

✔

Neuropathic pain-

experienced by people whohave damaged/malfunctioning nerves, abnormal dueto illness and abnormal nerves in PNS or CNS. It istypically chronic, burning, tingling and electric shocklike pain.

✔

Peripheral neuropathic pain-

follows damageand or sensitization of peripheral nerves.

✔

Central neuropathic pain-

results frommalfunctioning nerves in the CNS.

✔

Sympathetically maintained pain-

occursoccasionally when abnormal connections betweenpain fibers and SNS. Perpetuate problems with boththe pain and sympathetically controlled functions.

RAZEL G. CUSTODIO, BSNS III-3

NOTES ON PAIN AND PAIN MANAGEMENT-MSN I



Pain Concepts:

✔

Pain threshold-

least amount of stimuli needed for aperson to label a sensation as pain.

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Pain tolerance-

maximum amount of pain stimulithat a person is willing to withstand without seekingavoidance of pain relief.

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Hyperalgesia/hyperpathia-

a heightened responseto a painful stimuli or increased sensation of pain.

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Allodynia-

sensation of pain from a stimuli normallynot producing pain. It is also skin sensitivity to pain.

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Dysesthesia-

unpleasant abnormal sensation,imitates the pathology of central neuropathic paindisorder.

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Nociceptive pain-

pain directly related to tissuedamage and may be somatic.

✔

Sensitization-

an increased sensitivity of a receptor after repeated activation by noxious stimuli or nociceptor.

✔

Wind-up

-progressive increase in excitability andsensitivity of spinal cord neurons leading topersistent increased pain.

✔

Pain perception

- actual feeling of pain.

✔

Bradykinin

-universal stimulus for pain.



Clinical Manifestations of Pain:

✔

Postherpetic neuralgia-

a case of herpes zoster typically erupts decades after a primary infection.Has vesicular rash with burning and electric shockpain.

✔

Phantom pain –

feeling that a lost body part ispresent.

✔

Phantom limb pain-

feeling that a lost body part ispresent after limb amputation.

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Postmastectomy pain-

feeling that a lost breast ispresent.

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Trigeminal neuralgia-

intense stab like pain that isdistributed by 1 or more branches of trigeminalnerve.

✔

Headache-

caused by intracranial or extracranialproblem.

✔

Fibromyalgia-

a chronic disorder characterized bywidespread musculoskeletal pain, fatigue and multi-tender points.

✔

Psychogenic pain-

due to emotional factors

✔

Intermittent-

pain stops and starts again.



Pain Pathway:Stimuli→

Nociceptor→ A Delta Fiber or CFiber→Ganglion→Dorsal horn→Spinothalamaictract→Thalamus

(center of awareness of pain

)→Cerebral cortex

(center for interpretation of pain)

→Responses



Pain Physiology:

✔

Primary sensory neurons-

specialized to detectmechanical, thermal and chemical conditionassociated with potential tissue damage.

✔

Nociception-

physiologic processes related to painperception.

✔

Nociceptors-

specialized pain receptor that can beexcited by mechanical, thermal, and chemical stimuli.

Transduction phase-

noxious stimuli trigger torelease of biochemical mediators and causemovement of ions across cell membrane excitingnociceptors.

Transmission phase-

includes 3 segments:

segment-

pain impulsivetravels from the PNfibers to spinal cord.

✔

Substance P

-serves as aneurotransmitter, enhancing themovement of impulses across nervesynapse.

✔

Dorsal horn-

pain signal is mediated andmodified by modulating factors beforeamplified or damped signal viaspinothalamic tract

segment-

transmission from spinal viaspinothalamic tract to brainstem and thalamus.

segment-

transmission of signals betweenthalamus to somatic sensory cortex.

Modulation phase-

descending system, occurswhen neurons in the thalamus and brainstemsend signals back down to dorsal horn of spinalcord.

✔

Excitatory glial cell amino acids-

tendsto persist or amplify pain.

Perception phase-

final phase. It is when clientbecomes conscious to pain

✔

Pain perception-

sum of complexactivities in CNS that may character painand its intensity.

RAZEL G. CUSTODIO, BSNS III-3

NOTES ON PAIN AND PAIN MANAGEMENT-MSN I



GATE CONTROL Theory Concepts

✔

Substantia gelatinosa-

milieu of CNS. Mayimbalanced in an excitatory or inhibitory direction-opens/closes the gate.

✔

Ion channels-

located on the pre or post synapticgate and also serve as a gate.

✔

A delta nerve fibers-

typically send messages of touch/warm or cold temperature. It has inhibitoryeffect to sustantia gelatinosa.



Factors Affecting pain:

Ethnic/CulturalNorms, Sex, Developmental stage, ageEnvironment or support people, Past painexperience, Meaning of pain, etc.



Responses to Pain:

✔

Involuntary-

Physiologic mediated by ANS or SNS.In SNS-mild while in PNS-severe

✔

Voluntary-

Behavioral or emotional response.



3 Stages of Pain Response:

✔

Activations-

Begins with perception of pain. Afight/flight response initiated by SNS.

✔

Rebound-

Intense but brief initiated by PNS.

✔

Adaptation-

it is due to endorphins counteractingpain when pain last for many hours /days.



Pain Assessment and tools:CHARACTER-

sensation

ONSET-

when the pain started

LOCATION-

where

DURATION-

constant vs intermittent

EXACERBATION-

factors making it worst

RELIEF-

factors making it better

RADIATION-

pattern of shooting

✔

Wong-Baker Faces Rating Scale-

for preverbalchildren.

✔

FLACC Scale-

has been validated in children from2mos-7yrs.

✔

Legmut Facial Expression-

cry, activity andconsolability.



Pharmacologic Pain Management:

✔

Rational Polypharmacy-

demands that Hprofessionals should be aware of all ingredients of medications that alleviate pain and use combinationsto reduce the need for high doses.

✔

Multimodal therapy-

uses nondrug approaches likeheat relaxation.



WHO 3 STEPS APPOACH FOR OPIODS

STEP 1-

Non-opiod analgesics is theappropriate starting pt.

STEP 2-

A weak opioid or combinationof opioid or combination of opioid/nonopioid with or w/o analgesicmeds

STEP 3-

strong opiates are administeredand titrated.

✔

Ceiling effect-

Once the maximum analgesicsbenefit is achieved more drug will not produce moreanalgesia.

✔

Equianalgesia-

refers to the relative potency of various opioid analgesics compared to a standarddose of parenteral morphine

✔

Placebo-

any medication including surgery thatproduces an effect in the client because of itsimplicit/ explicit effect and not because of its specificphysical or chemical property.



TYPES OF OPIOIDS

✔

Full agonist-

bind tightly to Mu receptor sitesproducing maximum pain inhibition, an agonisteffect, has no ceiling effect

✔

Mixed Agonist-

Are antagonists-agonists-antagonists analgesics-act like opioids and relievepain, block and inactivate other opioid analgesics,block Mu receptor but activates Kappa receptor site.

✔

Partial agonist-

have ceiling effect in contrast to fullagonist; block Mu receptor or are neutral receptor but bind with kappa receptor site, good analgesicpotency, most popular



TYPES OF COANALGESICS

✔

Coanalgesic/adjuvant-

a medication that is notclassified as a pain medication but may reduce painspecifically Neuropathic pain.

✔

Tricyclic antidepressant-

useful for centralneuropathic pain, burning, stinging quality.

✔

Anticonvulsant-

particularly useful into peripheralneuropathic conditions that often present w/stabbing, shooting and electric shock pain.

✔

Lidoderm-

alleviate neuropathic as well as other types of pain particularly allodynia.



OTHER PHARMACOLOGIC MGT.

✔

Epidural Space-

most commonly use in Intraspinalroute of administration of pain med. It is because ithas the durameter that acts as protective carrier.

✔

Continuous Local Anesthetics-

continuoussubcutaneous administration of long acting local

RAZEL G. CUSTODIO, BSNS III-3

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thanks!!!

sure! :)

Pain Notes

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Category:	Research > Health & Medicine
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Upload Date:	07/16/2009
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Tags:	medicalsurgical nursing i pain and pain mgt. medicalsurgical nursing i pain and pain mgt. (fewer)