BASIC HUMAN NEED PAPER

“PHARMACOLOGICALLY AND NON PHARMACOLOGICALLY PAIN

MANAGEMENT”

Arranged by :

Ibi Yulia Setyani (P 1337420617032)

I Made Arya Putra (P 1337420617044)

Damar Darmawan (P 1337420617061)

Shalsabila Wanda Briliyanti (P 1337420617080)

Dinda Khoirunisa Hana (P 1337420617084)

BACHELOR OF APPLIED SCIENCE NURSING

HEALTH POLYTECHNIC OF HEALTH MINISTRY SEMARANG

2017/2018
 FOREWORD

Thank God to the presence of God Almighty over the abundance of His grace and
grace so we can finish this paper entitled "Pharmacologically and Non-Pharmacologically
Pain Management" well. Writing this paper to fulfill one of the tasks of first semester’s Basic
Human Needs Subject, Bachelor of Applied Science Nursing program given by lecturer
Sudiarto, MN of Basic Human Need Subject.
This paper is written from the results of the preparation of the data that we have
received from guidebooks and the internet related to the theme of papers that we made, as
well as information from other media, surely we want to say thank to:
1. God Almighty because of His grace we can finish this paper
2. Sudiarto, MN, as the lecturer of the Basic Human Needs Subject for any
guidance and advice that has been given during the making of this paper.

In compiling this paper, we handle some difficulties and obstacles, but thanks to
guidance, help and encouragement from various parties, we are able to complete this paper.
We hope that by reading this paper can benefit all of us, in this case it can add to our insights
on Pharmacology and Non Pharmacology, especially for us, the authors. Indeed this paper is
still far from perfect, so we expect criticism and suggestion from the better for the sake of the
results.

Semarang, September 14th, 2017

 CHAPTER 1
PRELIMINARY

Pain, a short and simple word, but when discussed will produce a long and interesting
study to decipher. One word that is often a complaint of someone who is treated in health
services, one annoying word, disturbing one's comfort. Its uniqueness makes each other
different in interpreting and feeling its coming.
Pain complaints are the most common we find when we are doing our duty as part of
the health team, whether in the outpatient and inpatient settings, which because of the
frequent complaints we find sometimes we often think of it as a matter of course so the
attention we give is not enough to give satisfactory results in the eyes of the patient.
The real pain involves not only the perception of a sensation but also the
physiological, psychological, social, cognitive, emotional and behavioral responses, so in
handling it requires serious attention from all elements involved in the health service, for
that understanding of pain and handling is a must for every health worker, especially
nurses who within 24 hours a day interact with patients.

1.1 Background
Making a paper about this pain in order to complete the task given in the Basic
Human Needs course.
Pain is a feeling of discomfort, both light and heavy. The only thing that can be
felt by the individual can not be perceived by others, including patterns of thought,
one's activities directly, and changes in one's life. Pain is an important sign and
symptom that can indicate the occurrence of physiological disorders.

1.2 Problem Restrictions

This paper discusses the causes and kinds of pain. And discuss about how to
overcome it.
By paying attention to the background, so in this writing the authors obtain the
desired results, then the author will discuss about pain. The things the author will be
talking about are:
 Definition of pain
  Type of pain
 Characteristics of pain
 Factors that cause pain
1.3 General Purposes
The objectives of this paper are:
 To fulfill the task of Basic Human Needs subject
 To increase knowledge about pain
 To know the characteristics of pain
 To know the factors causing and how to overcome the pain
 To know the type of pain

1.4 Writing Method

In making this paper, using the method of literature. Review the literature on
library materials appropriate to the issues raised in this paper. As a reference also
obtained from the internet website that discusses about Pain.
 CHAPTER 2
CONTENT

2.1 Definition of Pain

Pain is a feeling of discomfort, both light and heavy. The only thing that can
be felt by the individual can not be perceived by others, including mind pattern, one's
activities directly, and changes in one's life. Pain is an important sign and symptom
that can indicate the occurrence of physiological disorders.

According to some figures or sources:

 IASP 1979 (International Association for the Study of Pain) pain is "an
unpleasant sensory and emotional experience, related to actual tissue damage
or potentially causing tissue damage", from the above definition it can be
concluded that pain is subjective where the individual learns what pain is,
through experience directly related to injury (injuri), which begins from the
beginning of his life.
 Tamsuri (2007) Pain is defined as a state that affects a person and his
extension is known when someone has experienced it
 McCaffery (1979) says pain as a personal explanation of pain when he says
about pain "whatever is said about pain and exists wherever he says it exists"

2.2 Type of Pain

In 1986, the National Institutes of Health Consensus Conference on Pain

categorized pain into three types: Acute pain is the result of an acute injury, disease or
surgery, non-malignant chronic pain associated with tissue damage in the healing or
non-progressive and chronic malignancy is a pain associated with cancer or other
progressive disease processes.

2.3 Response to Pain

The response to pain includes physiological responses and behavioral
responses. For acute phonological reponal pain is an increase in blood pressure
(early), increased pulse rate, increased respiration, dilated pupils, and cold sweat,
behavioral response is anxiety, inability to concentrate, fear and dis- tress. Whereas in
chronic pain the physiological response is normal blood pressure, normal pulse,
normal respiration, normal pupil, dry skin, and behavioral response in the form of
immobilization or physical inactivity, withdrawal, and despair, as no symptoms and
signs are present chronic pain is the task of the health team, the nurse in particular
becomes not easy to be able to identify it.

2.4 Causes of Pain

 Trauma
 Mechanical
Pain arising from free nerve endings damaged, for example due to collision,
friction, injury and others.
  Thermis
Pain arises because the end of the receptor nerve gets stimulation due to
heat, cold, eg due to fire and water.
 Khemis
Arising from contact with acidic or strong base chemicals
 Electric
Arising due to the influence of strong electric current about pain receptors
that cause muscle spasms and burns.
 Neoplasm
 Benign
 Malignant
 Inflammation
Pain occurs due to damage to the ends of the receptor nerve due to
inflammation or squeezed by swelling. For example: abscess
 Impaired blood circulation and abnormalities of blood vessels
 Psychological trauma

2.5 Factors that affect the pain response

 Age
The child has not been able to express the pain, so the nurse should
examine the pain response in the child. In adults sometimes report pain if it is
pathological and malfunctioning. In the elderly tend to harbor the pain experienced,
because they think pain is a natural thing that must be lived and they are afraid if
they have severe illness or die if pain is checked.

 Gender
Gill (1990) reveals that men and women do not differ significantly in
response to pain, more influenced by cultural factors (ex: inappropriate if men
complain of pain, women may complain of pain).

 Culture
People learn from their culture, how they should respond to pain such as an
area believes that pain is a result to be accepted because they make mistakes, so
they do not complain when there is pain.

 Meaning of pain
It relates to how one experiences pain and how to overcome it.

 Caution
The degree to which a client focuses his attention on pain can affect the
perception of pain. According to Gill (1990), increased attention is associated with
increased pain, whereas distraction attempts are associated with a decreased pain
 response. Relaxation techniques, guided imagery is a technique to overcome the
pain.

 Anxiety
Anxiety increases perception of pain and pain can cause anxiety.

 Past experience
Someone who has successfully overcome pain in the past, and now the
same pain arises, it will be easier to overcome the pain. Easy or not someone
overcome pain depending on past experience in overcoming pain.

 Coping pattern
Adaptive coping patterns will make it easier for someone to cope with pain
and instead a maladaptive coping pattern will make it difficult for someone to cope
with pain.

 Family and social support

Individuals who experience pain often rely on family members or close
friends for support and protection

2.6 How to overcome the Pain

Pharmacologically pain management

Generally pain is reduced by pharmacological therapy. Pain is overcome by

blocking the transmission of pain stimulant for perceptual alteration and by reducing
cortical response to pain

The drugs used for pain therapy are:

1. Narcotic Analgesics

Opiates are the most common drug used to treat pain in the client, for
moderate to severe pain. The influence varies greatly depending on the physiology of
the client itself. Very young and very old clients are sensitive to these analgesics and
require only very low doses to relieve pain (Long, 1996).

Narcotics can lower blood pressure and depressive depression in other vital
functions, including respiratory depression, bradycardia and drowsiness. Part of this
reaction is beneficial for example: hemorrhage, a slight decrease in blood pressure is
needed. But in patients with hypotension will cause shock due to excessive doses.

2. Local Analgesics

Analgesics works by blocking the conduction of nerves when given directly to

the nerve fibers.

3. Client-controlled analgesics

The client-controlled analgesic system consists of a prescribed narcotic-filled

infusion, fitted with a regulator of the intravenous injection hole. Analgesic control by
the client is pressing a number of keys to enter a number of narcotics. This method
requires special tools to prevent entry of the drug at an unspecified time. This client-
controlled analgesic uses less than the standard way, ie intramuscularly. The use of
client-controlled narcotics is used on clients with post-surgical pain, cancer pain, cell
crisis.

4. Nonsteroidal drugs

Non-inflammatory nonsteroidal drugs work primarily against inhibition of

prostaglandin synthesis. At low doses these drugs are analgesic. At high doses, the
drug is anti-inflammatory in addition to analgesic properties. The working principle of
this drug is to control the moderate pain of dysmenorrhea, arthritis and other
musculoskeletal disorders, postoperative pain and migraine. NSAIDs are used to treat
mild to moderate pain.

Non pharmacologically pain management

According to Tamsuri (2006), in addition to pharmacological measures to

overcome pain there are also nonpharmacological measures to overcome pain
consisting of several acts of penaganan based on:

1. Physical handling / physical stimulation include:

Skin Stimulation (Cutaneus)

Warm compresses

• Can be done by attaching a rubber bag filled with warm water or a towel that has
been soaked in warm water, to the body part of the pain.

• Should be followed by movement or massage exercises.

• The physiological effects of warm compresses are the softening of fibrous tissue,
making the muscles of the body more relaxed, decreasing or relieving the pain, and
facilitating the supply of blood flow.

 Cold compress

Used is a bag containing ice cubes (cold pack), can also be a towel dipped in cold
water.

The physiological effects are vasoconstriction (blood vessel stemming) and

metabolic reduction, helping to control bleeding and swelling due to trauma, reduce
pain, and decrease nerve end muscle activity.

Doing compress should be careful because it can cause skin tissue experiencing
necrosis (cell death). For that it is recommended to do cold compress no more than 30
minutes.
 Massage

Skin massages provide an effect of decreased anxiety and muscle tension. This
muscle massage stimulation is believed to stimulate large-diameter fibers, thus able to
block or decrease pain impulses

 Electric stimulation (TENS)

The workings of this system are still unclear, one thought is this way can release
endorphins, so it can block the stimulation of pain. Can be done with massase, hot
bath, compress with ice bags and transcutaneous electrical nerve stimulation (TENS /
transcutaneous electrical nerve stimulation). TENS is a stimulation of the skin by
using a light electric current which is delivered through the outer electrode.

 Acupuncture

Acupuncture is a treatment that has long been used to treat pain. Small needles
inserted in the skin, aimed at touching certain points, depending on the location of the
pain, which can block the transmission of pain to the brain.

 Plasebo

Placebo in Latin means I want to please is a substance without pharmacological

activity in a form known by the client as a "medicine" such as caplet, capsule,
injection fluid and so on.

2. Intervention of cognitive behavior include:

 Intervention

In general interventions that can be done to overcome the pain is divided into 2
major sections, namely:

 Non Pharmacologic intervention: Distraction, Relaxation, Cutaneous

Stimulation
 Pharmacology Intervention :

 Relaxation

Relaxed skeletal muscle is believed to reduce pain by relaxing muscle

tension that supports pain. Relaxation techniques may need to be taught
bebrapa times to achieve optimal results. With relaxation the patient can
change the perception of pain.

 Biological feedback
 Behavioral therapy is done by giving the individual information about
the physiological pain response and how to train the volunteer's control over
the response. This therapy is effective to overcome muscle tension and
migraine, by installing electrodes on the temples.

 Hypnosis

Helps to change the perception of pain through the influence of

positive suggestion.

 Distraction

Distract attention to pain, effective for mild to moderate pain. Visual

Distraction (viewing TV or ball game), audio distraction (listening to music),
touch distraction (massase, holding toy), intellectual distraction (puzzle, chess
playing)

 Guided Imagery (Guided imagination)

Asking the imagination to imagine the fun, this action requires a calm
atmosphere and room and concentration of clients. If clients experience anxiety,
action must be stopped. This action is done when the client feels comfortable and not
acute pain.
 CHAPTER III
CONCLUSION

3.1 Conclusions

Pain management should use a holistic / holistic approach, this is because pain affects the
whole aspect of human life, therefore we should not only be fixated on one approach but also
using other approaches that refer to aspects of human life that is biopsikososialkultural and
spiritual , nonpharmacologic approaches and pharmacological approaches will not work
effectively when used alone, they should be integrated and complementary in order to overcome /
manage the patient's pain.

Patients are different individuals who respond differently to pain, so that handling can not be
equated between individuals with each other.

Appropriate, accurate assessments of pain are necessary in order to find the right solution to
deal with, for which assessment should always be done on an ongoing basis, in an effort to find
the most recent picture of the pain felt by the patient.

3.2 Suggestions

 The need to develop other ways of handling the pain.

 Socializing about pain should be increased again for the people of Indonesia understand
well with the real sense of pain.
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