PAIN MANAGEMENT

I. Definition of Terms
● Acute Pain – abrupt onset and lasting a short time
● Neuropathic Pain – occurs from an abnormal processing of sensory stimuli by the central or
peripheral nervous system
● Nociceptive pain – arises from mechanical, thermal, or chemical noxious stimuli; can be
somatic or visceral
● Persistent pain – chronic pain that has been present for 3 months or longer
II. Pathophysiology of Pain
- The pathophysiology of pain is a complex process that varies according to duration (eg, acute,
chronic) or type (eg, nociceptive, neuropathic, psychogenic). Perioperative nurses should
understand the pathways that lead to pain to better assist in managing patients' pain symptoms.
Approaching pain from a patient-centered stance includes acknowledging that pain is defined
entirely by the subjective experience of the patient, which may not be proportional with the level
of tissue damage.
III. The Art and Science of Pain Relief
Pain is the most common reason why people consult a doctor, but also the most common
symptom indicating the onset of an illness. Pain is the oldest evolutionary reaction of an
organism to any kind of attack or destruction. Is pain a signal, a symptom, an emotion or an
illness? Why do we feel pain? The cause can be physical, psychological, social, or spiritual.
Today, we are witnessing many innovations in prevention, diagnosis, treatment, and
rehabilitation of patients with chronic pain, and it is not easy to imagine what the future
diagnostic and therapeutic advances will bring. Pain is a dominant public health problem in the
world, which requires a multidisciplinary approach. Modern science and clinical practice already
enable us to significantly reduce pain and suffering regardless of the cause and kind of pain. Pain
is a subjective feeling and it is not easy to measure it. Since no two people are the same, no two
reactions to pain are the same. It is difficult, almost impossible to compare biologically caused
pain with emotional, social, or spiritual pain, but all of them can cause great suffering.
IV. Pharmacological Management
• Opioid Analgesics- Older patients are generally more sensitive to opioid analgesics,
start low go slow.
• Adjuvant drugs- Relieve discomfort, potentiate the effect of the pain medication,
decrease dosage of opioid required for adequate pain control, reduce side effects
associated with higher doses of opioids.
Medications used as adjuvants
 Antidepressants
 Topical analgesics
 Anti-anxiety medications
 Opioid Analgesics
• Chronic pain- oral dosing is preferred route, most effective when it is administered
around the clock, long-acting or sustained- release forms of medication improve control.
• Opioid Analgesics
• Acute pain- Breakthrough pain relief should be available, IV or IM is preferred route,
patient control analgesia(PCA) is less effective in elderly and especially those who are
cognitively impaired.
V. Nonpharmacological Methods to Manage Pain in the Older Person.
1.Pain education programs
2. Socialization or recreational therapies (movies, art therapy, therapeutic use of music)
3. Behavior modification (imagery, hypnosis, relaxation)
4. Physical therapy (massage, ultra-sound, exercise, and hot or cold packs)
5. Neuro stimulation (acupuncture, transcutaneous nerve stimulation)
VII. Consequences of Unrelieved Pain
- Unrelieved pain can result in a patient limiting the movement of the thoracic and abdominal
muscles in a bid to reduce pain. This may cause some degree of respiratory dysfunction with
secretions and sputum being retained because of a reluctance to cough. Atelectasis and
pneumonia may follow (Macintyre and Ready, 2001).