MODULE 7

INTRODUCTION

TERMINOLOGIES

1. ACUTE PAIN
- Abrupt onset and lasting a short time.
2. NEUROPATIC PAIN
- Occurs from an abnormal processing of sensory stimuli by the central or peripheral nervous system
3. NOCICEPTIVE PAI
- Arises from mechanical, thermal, or chemical noxious stimuli, can be somatic or visceral
4. PERSISTENT PAIN
- Chronic pain that has been present for 3 months or longer

COMFORT

- Comfort is an important concept and a fundamental value of nursing. It is a key component for providing nursing care to older
adults.
- Providing comfort is a complex act that goes beyond assuring pain relief and feeding. It also includes paying attention to
manifestations of stress, taking into account all dimensions of the human being and providing measures to alleviate suffering.

PAIN A COMPLEX PHENOMENON

- The greatest threat to comfort

- Fifth vital sign
- An unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Prevalence of Pain in Older Adults

Pain is one of the most widely cited symptoms underlying disability among older adults. For instance, in a population-based
cohort of moderately-to-severely disabled women, pain was the most commonly endorsed cause of disability in basic activities of daily
living (ADLs) (e.g., bathing), instrumental ADLs (e.g., housework), and mobility function (e.g., walking a quarter of a mile). Although
these findings have been observed in other community-based studies of older adults, the epidemiology of pain in older adults is not
well established. For example, the overall prevalence of pain estimated in previous studies ranges considerably from 24% to 72%
Further, the age pattern of pain is not well characterized as some studies suggest an increased prevalence with advancing age while
others report a flat or decreasing prevalence. Much of the variance in prevalence estimates can be attributed to inadequate sampling of
the oldest-old in the community and in residential care settings, and to differences in survey methods and case definitions. The effects
of dementia status and cognitive function of respondents on prevalence estimates is unclear and the role of proxy respondents has not
been investigated. In addition to the uncertainties in pain prevalence among older adults, the impact of pain has primarily been
assessed with self-reported functional outcomes. Relatively few studies have examined the impact of pain using objective, physical
performance measures that can capture a wide range of function and that are now used in geriatric patient assessment.

TYPES OF PAIN

- The sensation of pain involves communication between your nerves, spinal cord, and brain. There are different types of pain,
depending on the underlying cause.
- We all feel pain in different ways, so you may find it difficult to describe the type of pain you’re feeling to others. You can also
experience more than one type of pain at a time, which only adds to the difficulty.
- Understanding the different types of pain can make it easier for you to talk to your doctor and describe your symptoms. Read
on to learn about some of the main types of pain and how they feel.
- NOCICEPTIVE PAIN
o Nociceptive pain is a medical term used to describe the pain from physical damage or potential damage to the body.
Examples might be the pain felt from a sports injury, a dental procedure, or arthritis.
o Nociceptive pain is the most common type of pain people experience. It develops when the nociceptive nerve fibers
are triggered by inflammation, chemicals, or physical events, such as stubbing a toe on a piece of furniture.
- NEUROPATIC PAIN
o Neuropathic pain is a medical term used to describe the pain that develops when the nervous system is damaged or
not working properly due to disease or injury.
o It is different from nociceptive pain because it does not develop in response to any specific circumstance or outside
stimulus.
o In fact, individuals can suffer from neuropathic pain even when the aching or injured body part is not actually there.
This condition is called phantom limb pain, which may occur in people after they have had an amputation.
o Neuropathic pain is also referred to as nerve pain and is usually chronic.
o Many different conditions and diseases cause neuropathic pain, including:
 Diabetes
 Multiple sclerosis
 Stroke
 Cancer
 Cytomegalovirus
 Amputation
- ACUTE PAIN
o Acute pain is short-term pain that comes on suddenly and has a specific cause, usually tissue injury. Generally, it
lasts for fewer than six months and goes away once the underlying cause is treated.
o Acute pain tends to start out sharp or intense before gradually improving.
o Common causes of acute pain include:
 Broken bones
 Surgery
 Dental work
 Labor and childbirth
 Cuts
  Burns
- CHRONIC PAIN
o Pain that lasts for more than six months, even after the original injury has healed, is considered chronic.
o Chronic pain can last for years and range from mild to severe on any given day. And it’s fairly common, affecting an
estimated 50 million Trusted Source adults in the United States.
o While past injuries or damage can cause chronic pain, sometimes there’s no apparent cause.
o Without proper management, chronic pain can start to impact your quality of life. As a result, people living with
chronic pain may develop symptoms of anxiety or depression.
o Other symptoms that can accompany chronic pain include:
 Tense muscles
 Lack of energy
 Limited mobility
 Some common examples of chronic pain include:
 Frequent headaches
 Nerve damage pain
 Low back pain
 Arthritis pain
 Fibromyalgia pain

PAIN PERCEPTION

- Chronic pain in the older population has a widespread impact on a variety of problems, including activity restrictions, sleep
issues, and mood.
- Physical changes in older adults can influence the perception of pain. Recent research findings confirm that aging is associated
with changes in the structure, function, and chemistry of the nervous system that directly impact the perception of pain. One
example of change pointed out that the density of unmyelinated fibers in the peripheral nervous system decreases with age.
This reduction in density will result in a slowing of nerve conduction.

EFFECTS OF UNRELIEVED PAIN

- The consequences of chronic pain are far-reaching and go beyond physical sensations of ongoing discomfort. Research shows
that unrelieved pain negatively impacts patients in every way – socially, physically and financially.
- Fortunately, research also shows us that when effectively treated, brain effects related to chronic pain may be reversible.
Therapists can help manage symptoms of chronic pain through many approaches, including acupressure, electromodalities,
manual therapy techniques, joint range of motion and mobility and strengthening exercises. The goals of pain management
intend to address each aspect of chronic pain.

PAIN ASSESSMENT

- Pain is often referred to as the “fifth vital sign,” and should be assessed regularly and frequently. Pain is individualized and
subjective; therefore, the patient’s self-report of pain is the most reliable gauge of the experience. If a patient is unable to
communicate, the family or caregiver can provide input. Use of interpreter services may be necessary. Components of pain
assessment include: a) history and physical assessment; b) functional assessment; c) psychosocial assessment; and d)
multidimensional assessment.
- History and Physical Assessment. The assessment should include physical examination and the systems in relation to pain
evaluation. Areas of focus should include site of the pain, musculoskeletal system, and neurological system. Other components
of history and physical assessment include:
o Patient’s self-report of pain
o Patient’s behaviors and gestures that indicate pain (e.g. crying, guarding, etc.)
o Specific aspects of pain: onset and duration, location, quality of pain (as described by patient), intensity,
aggravating and alleviating factors
o Medication history
o Disease or injury history
o History of pain relief measures, including medications, supplements, exercise, massage, complementary and
alternative therapies
- Functional and Psychosocial Assessment. Components of the functional and psychosocial assessment include:
o Reports of patient’s prior level of function
o Observation of patient’s behaviors while performing functional tasks
o Patient or family’s report of impact of pain on activities of daily living, including work, self-care, exercise, and leisure
o Patient’s goal for pain management and level of function
o Patient or family’s report of impact of pain on quality of life
o Cultural and developmental considerations
o History of pain in relation to depression, abuse, psychopathology, chemical or alcohol use
o Impact of pain on patient’s cognitive abilities
- Multidimensional Assessment. Many tools are available for an in-depth, multidimensional pain assessment. This is
particularly important with patients that have chronic pain, mixed pain (both acute and chronic), or complex situations (such
as multiple disease processes). Common examples of these tools include:
o Brief Pain Inventory: Provides patient input in describing pain and effects, including psychosocial components.
o McGill Pain Questionnaire: Patients can use descriptors for their pain, which provides information about the
experience and intensity.

COMPLEMENTARY THERAPIES

- Complementary therapy is known by many different terms, including complementary medicine, alternative therapy, alternative
medicine, holistic therapy and traditional medicine.
- A wide range of treatments exists under the umbrella term ‘complementary therapy’, which makes it difficult to offer a blanket
definition. Complementary therapies are used alongside conventional medicines or treatments.
- Alternative therapies are sometimes grouped with complementary therapies, but they refer to different concepts. Alternative
therapies are used in place of conventional medicines or treatments.
 - There is evidence to support the use of some complementary therapies, but alternative therapies are typically unproven or
have been shown to be ineffective.
- There is no scientific or medical evidence for some complementary therapies and many alternative therapies, and they may be
unsafe or cause harmful side effects.
- Complementary therapies tend to share a few core beliefs, including:
o Illness occurs if the body is out of balance.
o The body can heal itself and maintain a healthy state if given the right conditions.
o The whole person should be treated, not just the disease or the symptoms.
o The gentlest therapies must be tried first before harsher ones.
o There is no quick fix, since healing and balance take time.
o Natural products are preferable to synthetic ones.
o Examples of complementary therapies
o Some of the more popular complementary therapies include:
 Acupuncture
 Alexander technique
 Aromatherapy
 Herbal medicine
 Homeopathy
 Naturopathy
 Reiki
 Yoga

DIETARY CHANGES AND MEDICATION

COMFORTING NURSING CARE

The success of dedicated professionals depends, in part, on an environment that nurtures and fosters their well-being. A
nonsupportive environment often results in employees who have a lack of engagement with their work and a sense of disconnection
with the organization's goals and mission. The resulting disassociation may lead to instability of the organization because poor morale,
increased stress, and burnout in some employees will eventually erode organizational effectiveness.

Historically, the primary focus of nursing has been meeting the needs of patients by providing care or comfort to the patient.
Comfort is a term that's been equated to care. Comfort is a major aspect of patient care; reference to comfort is evident in nursing
literature as early as Nightingale's Notes on Nursing. The specific instructions in Nightingale's book were directed to the nurse to assist
the patient in achieving optimal health through improving or enhancing the patient's physical and mental comfort. There was no
mention of ways to ensure or enhance nurse comfort. As such, the needs and support or comfort of the nurse are often overlooked.

Nurses deserve the same comfort and care that they provide to their patients. They also deserve the comfort of a professional
environment in which to work. Traditionally, nurses have looked to their administrators for the comfort of a good working environment
with appropriate compensation, professional development opportunities, and autonomy. Nurses must find ways to nurture themselves
even in undesirable conditions if they're going to fully combat the negative consequences of burnout.