PAIN

MANAGEMENT
NIKKI S.A. VILLAHERMOSA
 TABLE OF CONTENTS

Classification Assessment
01 Different classification
of pain
Assess pain and
document
03

Pathophysiology Management
02 Chemical Mediators
Natural Pain Relievers
WHO Guidelines 04
Fiber Tract
 TABLE OF CONTENTS

Adverse Effects
05 Adverse effects of
unrelieved pain
WHAT IS PAIN?
an unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage
“Pain as the fifth vital sign.”
—American Pain Society (ASP), 1996
 CLASSIFICATION
Based on
Based on
Duration 01 02 Location

PAIN
Based on Based on
Intensity 04 03 Etiology
 Based on Duration

Acute Pain Chronic Pain

Short Duration Longer Duration (>6mos)
Identifiable Pathology Unclear Pathology
Predictable Prognosis Unpredictable Prognosis
Treated with Analgesics Multidisciplinary Treatment
 Based on Location

Where?
Site at which the
pain is located Visceral Pain
Pain from the
Visceral Organs
Referred pain
Pain due to problems
in a different area
manifesting in
another.
 Based on Location

Where?
Site at which the
pain is located Visceral Pain
Pain from the
Visceral Organs
Referred pain
Pain due to problems
in a different area
manifesting in
another.
 Based on Intensity

Severe Pain 7-10

Moderate Pain 4-6

Mild Pain 1-3

 Based on Etiology
ETIOLOGY

NOCICEPTIVE NEUROPATHIC

SOMATIC VISCERAL CENTRAL PERIPHERAL

 Nociceptive Pain
SOMATIC VISCERAL PAIN
Cutaneous, Muscle, Bone, CT Organs and linings of body cavities
Well-localised, constant ,achy Poorly localised, diffuse, deep,
cramping & splitting

Examples: Examples:
Incisional Pain, Insertion Sites, Chest tubes, Bladder Distension,
Bone metastases, Peripheral Pancreatitis, Liver Metastasis
Vascular Disease
 Neuropathic Pain
CENTRAL PERIPHERAL
Malfunctioning nerves in the Damage of the Peripheral
Central Nervous System Nervous System

Examples: Examples:
Spinal Cord injury Phantom limb pain
Post-Stroke Pain
 Psychogenic Pain

- No organic structures affected

- Mental, emotional or
behavioural factors
- Variable, Numerous
 PATHOPHYSIOLOGY

Natural Pain
Relievers

01 02 03
Chemical Fiber Tract
Mediators
 Chemical Mediators of Pain

Histamine 01 02 Bradykinin
Basophils, Platelets, Mast Cells Vasoactive Peptides: Kininogens
Vasodilation & ↑Vascular Vasodilation, Pain, Bronchoconstriction,
Permeability ↑Vascular Permeability

Serotonin 03 04 Substance P
Vasoactive Amine by Platelets Neurotransmitter for Slow Pain
↑Vascular Permeability Substantia Gelatinosa of Rolando
 Chemical Mediators of Pain

Glutamate 05 06 Protaglandin
Neurotransmitter of A Delta Fast
Endoperoxides from Arachidonic
pain fibers
Acid

PGE2 - pain and fever

PGE2, PGD2, PGF2 - vasodilation
PGI2 - vasodilation, inhibition of
platelet aggregation
 Natural Pain Relievers
of the Body

- β-Endorphins, Met-Enkephalins,
leu-enkephalins, and dynorphins
Raphe magnus nucleus

Serotonin enkephalins
Fiber Tracts for Pain Transmission

01 02
Neospinothalamic Paleospinothalamic
Tract Tract
Fast Type Aδ Fibers Slow-Chronic Type C Fibers
Mechanical and Acute Thermal pain Substance P
Glutamate
Fiber Tracts for Pain Transmission
 ASSESSMENT
O - Onset
L - Location
D - Duration

C - Characteristic
A - Aggravating/Alleviating Factors
R - Radiation
T - Timing
S - Severity
 ASSESSMENT
Facial
Expression
Facial Body
Grimacing, Movement
frowning
Guarding
Resistance
Vocalisation
Crying, Moaning
Monitoring Sheet
WHO GUIDELINES for Pain Relief

CLOCK

LADDER

MOUTH
WHO GUIDELINES for
Pain Relief
Descending Analgesic Ladder
World Federation of Societies of Anesthesiologists (WFSA)
Descending Analgesic Ladder
World Federation of Societies of Anesthesiologists (WFSA)
 PHARMACOLOGIC TREATMENT

Aspirin Acetaminophen NSAIDs

COX-2 Inhibitors Opioids/Narcotics Adjuvants

 ADVERSE EFFECTS OF
UNRELIEVED PAIN
PHYSIOLOGIC PATHOLOGIC

↑ Heart Rate Unstable Angina

↑ Blood Pressure Myocardial Infarction
CARDIOVASCULAR
↑ Myocardial Demand DVT
Hypercoagulation PE

Atelectasis
↓Lung Volumes
Pneumonia
RESPIRATORY ↓Cough
Hypoxemia
Splinting

Constipation
↓Gastric Emptying
GASTROINTESTINAL Anorexia
↓Bowel Motility
Ileus
 ADVERSE EFFECTS OF
UNRELIEVED PAIN
PHYSIOLOGIC PATHOLOGIC

Hyperglycemia
Weight loss/Muscle
Altered release of multiple
NEUROENDOCRINE Wasting
hormones
Impaired wound healing
Impaired immune function

Immobility
Muscle Spasm
Weakness
MUSCULOSKELETAL Impaired muscle mobility
fatigue
and function

Sleep Deprivation
Anxiety
PSYCHOLOGICAL Impact on Coping
Fear
PTSD
THANK YOU!
References:
● Goodman and Gilman’s The Pharmacological Basis of Therapeutics 13th Ed
● Guyton and Hall Textbook of Medical Physiology 13th Ed
● "Pain Management". 2020. https://www.slideshare.net/ainnasultana/pain-management-82770535.
● Principles of Pain Management Lecture
● WHO Guidelines for Pain Relief

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