Chapter 9

Nursing Care of
Patients in Pain
 Pain

• is whatever the experiencing person says it

is, existing whenever the experiencing
person says it does.

Margo McCaffery, 1999

 Pain

• is an unpleasant sensory and emotional

experience associated with actual or
potential tissue damage or described in
terms of such damage.

IASP, 1979
 Suffering

• Is the state of severe distress associated with

events that threaten the intactness of the
person.

AHCRQ, 1994
 Terms to Know
• Opioid
• Physical Dependence
• Psychological Dependence
• Tolerance
 Mechanisms of Pain Transmission

• TRANSDUCTION
• TRANSMISSION
• PERCEPTION
• MODULATION
 Types of Pain

• Acute
• Cancer
• Chronic Nonmalignant
Referred Pain
 Pain Treatment
• Analgesics
– Opioids
– Nonopioids
– Adjuvants
• Other Treatments
– Steroids
– Benzodiazepines
– Tricyclic antidepressants
– Anticonvulsants
WHO Ladder
 Placebos

• Administered Inactive Substitutes for

Analgesics
• Not Justified in the Treatment of Pain
 Analgesic Routes
• Oral
• Rectal
• Inhalation
• Transdermal
• Intramuscular
 Analgesic Routes (cont’d)
• Intravenous
– PCA
• Subcutaneous
• Intraspinal
 Nondrug Therapies
• Cognitive-Behavioral
– Education
– Relaxation
– Imagery
– Distraction
– Biofeedback
 Nondrug Therapies (cont’d)
• Physical Agents
– Heat
– Cold
– Massage
– Exercise
– Immobilization
– TENS
 Pain Assessment: WHAT’S UP?
• Where Is the Pain?
• How Does It Feel?
• Aggravating and Alleviating Factors?
• Timing
• Severity on 0-10 Scale
• Useful Other Data
• Patient’s Perception
Pain Scales