PAIN (WEEK 1)

Definitions of Pain
By: (IASP) International Assoication for Study of Pain
 Pain is an unpleasant sensory and emotional experience associated with actual or
potential tissue damage.

By: Stenback
 A personal private sensation of hurt.
 A harmful stimulus that signal current or impending tissue damage.
 A pattern of responses to protect the organism from burn.

By: Mc Caffery (1979)

 Whatever the experiencing person says it is existing whenever the person say it is.  Hyperalgesia
Excessive sensitivity to pain
II. Misconceptions and Myths of Pain  Pain Threshold/Sensation
1. Pain is a part of aging  the amount of pain stimulation a person requires before feeling pain
2. If a person is asleep, they are not in pain  least level of pain that the patient is able to detect
3. If pain is relieved by non-pharmaceutical pain relief techniques, the pain was not real
anyway  Pain Reaction
4. Real pain has an identifiable cause Includes the ANS and behavioural responses to pain
5. It is better to wait until a client has pain before giving medications Types:
6. Very young or very old people do not have as much pain ANS Response
7. Some clients lie about the existence or severity of their pain  autonomic reaction of the body that often protect the individual from further harm.
8. Addiction occurs with prolonged use of morphine or morphine derivatives (automatic withdrawal of hand from hot object.)
9. The same physical stimulus produces the same pain intensity, duration and distress in Behavioural response
different people  is a learned response used as a method of coping with pain.
10. Clients experience severe pain only when they have had major surgery.
11. The nurse or other health care professionals are the authorities about a client’s pain  Pain Tolerance
12. Visible or physiologic or behavioral signs accompany pain and can be used to verify its  maximum amount and duration of pain that an individual is willing to endure
existence.  greatest level of pain that the patient is able to tolerate

TERMINOLOGIES  Pain Perception

Pain Related Terms  the point which the person becomes aware of the pain
 Radiating pain
perceived at the source of the pain and extends to the nearby tissues  Triad of Pain Perception
 Referred pain 1. Pain Receptor
felt in a part of the body that is considerably removed or far from the tissues causing the 2. Pain Stimuli
pain 3. Pain Fibers

Nociceptors
 pain receptors
 Free nerve ending in the skin that respond only to intense, potentially damaging  Emotional
stimuli.  Behavioral factors
induced by:
The Pain Stimulus  social rejection, broken heart, grief, love sickness, or other such emotional events.
1. Mechanical
2. Thermal  Psychogenic Pain
3. Chemical S/S:
 Headache,
Pain Fibers  back pain
There are two separate pathways that transmit pain impulses to the brain:  stomach pain
1. Type A-delta fibers
are associated with fast, sharp, acute pain and  Neurologic Pain
2. Type C fibers Damage PNS & CNS Nerve Fibers
are associated with slow, chronic, aching pain Main Problem:
 Neorologic System

What causes neuropathic pain?

 Alcoholism
 Amputation
 Back, leg, and hip problems
 Chemotherapy
 Diabetes
 Facial nerve problems
 HIV infection or AIDS
 Multiple sclerosis
 Spine surgery

Two common areas of neuralgia

Pain Syndromes
3. Referred Pain
4. Radiating Pain
5. Psychogenic Pain
6. Neurologic Pain
7. Phantom Limb Pain
8. Intractable Pain

Psychogenic Pain
 no pathologic cause

Caused:
 Mental
 PATHOPHYSIOLOGY OF PAIN
Phantom Limb Pain
 Painful perception perceived in a missing body part or in a body part paralyzed from a Physiology of Pain
spinal cord injury 1. Transduction
2. Transmission
3. Perception
4. Modulation

Phantom Pain

Perception
 cerebral cortex
 Somato sensory cortex
 association cortex
 limbic system

Modulation
 endogenous opioids (endorphins & enkephalins
Intractable Pain  chemical substances
 This type of pain is a chronic pain that is resistant to cure or relief. - spinal and medullary dorsal horn
- periaqueductal gray matter
- hypothalamus
- amygdala in the CNS)
 serotonin 5HT
 norepinephrine
 gamma amino butyric acid (GABA)

TYPES OF PAIN
Categories of pain according to its
1. Origin
2. Onset
3. Cause or etiology
According To Location/origin
Superficial Cutaneous Pain Tissue ischemia Blocked artery
 occurs over body surface or skin segments.
Deep Somatic Pain
 occurs in the skin, muscles and joints (musculoskeletal – muscle, bone, periosteum, Stimulation of pain receptors
cartilage, tendons, deep fascia, ligaments, joints, blood vessels and nervous)
Visceral Pain
 pain from body organs accumulation of lactic acid

Types of PAIN (Onset) GATE CONTROL THEORY (Melzack and Wall)

 Acute pain
following acute injury, disease or some type of surgery
 Chronic
 malignant pain
associated with cancer or other progressive disorder
 nonmalignant pain
in the persons whose tissue injury is non progressive or healed

Factors influencing reaction to pain

 Psychological
 Physiological
 Cultural

Age (Physiological)
 Infant:
Types of PAIN (Cause/Basis)
perceive pain and respond to its increasing sensitivity
Mechanical
 Toddler:
 trauma
respond by crying and anger because they perceive it as a threat to security or sense that
 blockage of body duct
pain is a punishment
 tumor
 School age:
 muscle spasm
try to be brave and not to cry or express much pain so parents and nurse will not be angry
with them
Thermal or cold
 extreme heat
 Adolescent:
Chemical
may not want to report pain in front of peers because they perceive complaints of pain as  A drug delivery system which is a safe method for post operative, trauma & obstetrics,
weakness burns, terminal care pediatrics and cancer pain management
 Adult:  Involves self IV drug administration
may not report pain for fear that it indicates poor diagnosis. Nurse may mean weakness and  Goal : to maintain a constant plasma level of analgesic so that the problems of client
failure with needed dosing (PRN) are avoided
 Client preparation & teaching is important
PAIN MANAGEMENT  Check IV line & PCA device regularly
Pharmacologic Treatment

Pharmacologic Pain Relief Interventions

 Analgesics:
 Non opioids/ non- narcotic analgesics
 NSAIDs
 Narcotic analgesics / opioids
 Adjuvants / co- analgesics
 Local anesthesia
 Patient controlled analgesia
 Epidural analgesia
Advantages of PCA
1 . Non – Narcotic Analgesics  Easy access for clients for medication
Ex.  Allows self administration with no risks
 Acetaminophen acetyl salicylic acid  Pain relief without depending on nurses
2. NSAIDs  Small doses of medications at short intervals for sustained pain relief
Ex :  Stabilized serum drug levels
 Ibuprofen  Decreased anxiety
 Naproxen
 Indomethacin Disadvantages of PCA
 Piroxicam  Patient becomes dependent on PCA
 Ketoralac  If mobility is contraindicated, client may move due to decreased or no pain by PCA
4. Narcotic Analgesics/Opioids  Respiratory depression
Ex:  Side effect may be constipation
 meperidine  Mechanical failure of pump
 methylmorphine  Relatives may press button for client
 morphine sulphate  Wrong programming parameters
 Fentanyl  Incorrect placing of syringe can cause infusion of excessive drug doses
5. Adjuvants  Costly & if client may not understand the system
Sedatives, anti-anxiety agents, muscle relaxants
Ex: OTHERS: (Anesthesia)
 Amitriptyline 7. Local
 Hydroxyzine 8. Spinal anesthesia
 Diazepam 9. Epidural anesthesia
6. Patient Controlled Analgesia (PCA)
Surgical Treatment 3. Binders, Chiropractic

 Dorsal Rhizotomy 1. Acupressure/Acupuncture

 Cordotomy or Spinothalamic Tractotomy

2. Cutaneous Stimulation

3. Binders

Non-Pharmacologic Interventions
A. Cognitive Behavioral Approaches:

1. Distraction
2. Reducing Pain Perception
3. Bio-feed back
4. Guided Imagery 4. Rest and Sleep
5. Chiro-practic
B. Physical Approaches
Goals:
 to provide comfort
 to correct physical dysfunctions
 to alter physiological responses
 to reduce fears associated with pain related immobility
Examples:
1. Acupressure / acupuncture
2. Cutaneous stimulation (massage, heat application, TENS) 6. Use of Placebos
PAIN HISTORY
 Location: “Where is your pain?”
 Intensity: