Pain As the 5th Vital Signs

Pain is*"an unpleasant sensory and emotional experience associated with actual or potential tissue
damage, or described in terms of such damage" (American Pain Society [APS], 2003; Gordon, 2002).
 A noxious stimulation of actual or threatened / potential tissue damage

CATEGORIES OF PAIN ACCORDING TO ORIGIN

 1) Cutaneous
 Skin
 2) Deep Somatic
 Tendons, ligaments
 Bones
 Blood Vessels
CATEGORIES OF PAIN BASED ON CAUSE
 1) Acute
 Due to trauma or surgery
 Persists for less than six (6) months
 2) Chronic Malignant Pain
 Related to cancer
 On and off
 Persists for more than six (6) months
 3) Chronic Non-malignant Pain
 Persists for more than six (6) months

CATEGORIES OF PAIN ACCORDING TO WHERE IT IS EXPERIENCED

 1) Radiating Pain
 Felt on the source and is extending to nearby tissues
 2) Referred Pain
 Felt on other parts detached from the source
 Example:
 Pain on a lacerated liver may be felt on the right shoulder and not on the right
upper quadrant
 3) Intractable Pain
 Highly resistant to pain-relief methods
 4) Phantom Pain
 Pain that is felt on a MISSING BODY PART or a PART THAT IS PARALYZED by SPINAL
CORD INJURY.
PAIN THRESHOLD
 Amount of pain stimulation that is required in order to feel pain
PAIN TOLERANCE
 Maximum amount of pain and duration that a person is willing to endure
PAIN MANAGEMENT STRATEGIES
 1) Pharmacologic Methods
 Narcotics
 NSAIDs
 Adjuvants or Co-analgesics
 
 2) Non-Pharmacologic Methods
  Physical Interventions
 Cognitive / Behavioral Interventions
NON-PHARMACOLOGIC PHYSICAL INTERVENTIONS TO PAIN
 1) Cutaneous Stimulation
 1A) Massage
 Effleurage
 Soft massage
 Gentle stroking
 1B) Petrissage
 Hard massage
 Large and quick pinches
 Also done by striking
 1C) Application of Counter-Irritant

 Menthol
 Omega Pain Killer
 Flax Seeds
 Poultices
 1D) Heat and Cold Application
 Nursing Alert!
 Rebound Phenomenon
 When you apply heat (usually done for 20 minutes),
vasodilation is produced
 If heat is applied for more than 20 minutes, there is
vasoconstriction
 This is an inherent defense mechanism from burning of tissues
 1E) Cold Application
 Maximum vasoconstriction is reached when skin reaches 15°C
 If there is further drop in temperature, there is vasodilation (skin becomes
reddish)
 This is the inherent defense mechanism from being frozen

 1F) Accupressure
 Pressure on certain points of the body
 Stimulates release of endorphins, which have natural analgesic effects
 This started in Ancient China
 ) Accupuncture
 Insertion of long slender needles on certain chemical pathways
 Origin is also Ancient china
 1G) Contralateral Stimulation
 Example: Injury on left side and massage is done on the right side
 Useful when patient cannot be accessed:
 For patients in a cast
 For patients with burns
 For patients with phantom pain
 2) Immobilization
 Application of splints
 3) Transcutaneous Electrical Nerve Stimulation
  Composed of electrodes
 Operated by battery
 Electrodes are applied on painful site or over the spinal cord
 4) Administration of a Placebo
Relieves pain because of its intent and not because of physical or chemical properties

COGNITIVE AND BEHAVIORAL

NON-PHARMACOLOGIC INTERVENTIONS TO PAIN
 Purpose:
 To alter pain perception
 To alter pain behavior
 To provide client with a greater sense of control over the pain
COGNITIVE AND BEHAVIORAL
NON-PHARMACOLOGIC INTERVENTIONS TO PAIN
 1) Distraction
 Purpose is to divert attention from pain
 Slow Rhythmic Breathing
 Stare at a certain object
 Take deep breath slowly
 Release or exhale slowly
 Concentrate on breathing
 Picture a peaceful scene
 Establish a rhythmic pattern
 2) Massage and Rhythmic Breathing
 3) Rhythmic Singing and Tapping
 Key Concept!
 Faster beat music is more preferable
 4) Guided Imagery
 Imagine that you are walking along a peaceful shore
 Eyes are closed and suggestions are given
 5) Hypnosis
 The success of hypnosis depends on the ability of the patient to concentrate and the
capacity of the hypnotist to suggest
 Based on suggestion
 Progressive relaxation

Types of Pain - Pain may be described in terms of :

 Location, - headache, stomach ache, chest pain
 Duration- acute pain, Chronic pain, Cancer pain
 Intensity - mild, moderate, severe
 Etiology. Physiological pain, Neuropathic pain

Mnemonic for Pain Assessment: COLDERR

 Character: describe the sensation (e.g., sharp, aching, burning),
 Onset: when it started, how it has changed,
 Location: where it hurts (all locations),
 Duration: constant versus intermittent in nature,
  Exacerbation: factors that make it worse,
 Relief: factors that make it better (medications and other factors), and
 Radiation: pattern of shooting/spreading/location of pain away from its origin.

The Wong- Baker faces pain rating scale

Explain to the person that each face is for a person who feels happy because he has no pain
(hurt) or sad because he has some or a lot of pain.

 Face 0 is very happy because he doesn't hurt at all.

 Face 1 hurts just a little bit.
 Face 2 hurts a little more.
 Face 3 hurts even more.
 Face 4 hurts a whole lot.
 Face 5 hurts as much as you can imagine, although you don't have to be crying to feel this bad.

Numerical Pain Scale

A numerical pain scale allows you to describe the intensity of your discomfort in numbers
ranging from 0-10 ( or greater depending on the scale ) Rating the intensity of sensation is one way of
helping your doctor determine treatment.

Verbal Pain Scale

Describes the degree of discomfort by choosing one of the verbal lines that most corresponds to
the intensity of pain you are feeling. This is a good way to explain early post - operative pain which is
expected to diminish overtime. This scale is used to determine if your recovery is progressing in a
positive direction.