PAIN

Pain
 Is unpleasant sensory and emotional
experience associated with actual and
potential tissue damage.
 It is considered the fifth vital sign.
 It is one of the human body defense
mechanisms that indicates the person is
experiencing problem.
 Sources of Pain
 Nociceptive: pain that is usually transmitted
after normal processing of noxious stimuli
– Cutaneous (superficial): usually involves the
skin or the subcutaneous tissue
– Somatic: is diffuse or scattered and originates in
tendons.
– Visceral: is poorly localized and originates in
body organs
 Neuropathic: results from injury or abnormal
functioning of peripheral nerves or CNS
 Psychogenic: unknown physical cause
 PHYSIOLOGY OF PAIN

SOURCES
Injury, Inflammation Chemical/Thermal Heat, Cold

PAIN RECEPTORS
(Nociceptors)
Histamine, Bradykinin, Serotonin, E-prostaglandin

DISCHARGE IMPULSES

Electrical Activity to spinal cord and onto the Brain

BRAIN = Electrical activity becomes the

experience of

PAIN
 Duration of pain
 Acute pain: generally rapid in onset, varies
in intensity from mild to severe, lasts from
brief period to less than 6 months
 Chronic pain: may be limited, intermittent or
persistent but lasts for 6 months or longer
and interferes with normal functioning.
– Remission: when the pain present but the
patient does experience symptoms
– Exacerbation: reappear of symptoms
– Intractable pain: resistant pain to therapy, and
persists despite a variety of interventions
 Origin of Pain
 Physical cause — cause of pain can be
identified
 Psychogenic — cause of pain cannot be
identified
 Referred — pain is perceived in an area
distant from its point of origin
 Perception of Pain
 Pain threshold: is the lowest intinsity of
stimulus that causes the subject to
recognize pain
 Adaptation
 Modulation of pain
– Neuromodulators
– Endorphins, dynorphins enkephalins
 Common Responses to Pain
 Physiologic: ↑BP, ↑HR,↑RR, pupil dilation,
muscle tension and tension rigidity, pallor,
↑adrenaline level, ↑blood glucose
 Behavioral: moving from painful stimuli,
grimacing, moaning, crying, restlessness,
protecting painful area
 Affective: exaggerated weeping, withdrawal,
anxiety, depression, fear, anger, anorexia,
fatigue, hopelessness, powerlessness.
 Factors Affecting Pain
Experience
 Culture
 Ethnic variables
 Family, gender, and age variables
 Religious beliefs
 Environment and support people
 Anxiety and other stressors
 Past pain experience
 General Assessments of Pain
 Patient’s verbalization and description of pain
 Duration of pain
 Location of pain
 Quantity and intensity of pain
 Quality of pain
 Chronology of pain
 Aggravating and alleviating factors
 Physiologic indicators of pain
 Behavioral responses
 Effect of pain on activities and lifestyle
Pain Assessment Tools
 Pain assessment tools
WILDA Scale
– Words that describe the pain
– Intensity of pain
– Location of pain
– Duration of pain
– Aggravating or alleviating factors
 Diagnosing Pain
 Type of pain
 Etiologic factors
 Behavioral, physiological, affective response
 Other factors affecting pain process
 Nursing Interventions for Pain
 Establishing trusting nurse-patient
relationship
 Initiating nonpharmacologic pain relief
measures
 Considering ethical and legal responsibility
to relieve pain
 Teaching patient about pain
 Manipulating Pain Experience
Factors
 Remove or alter cause of pain
 Alter factors affecting pain tolerance
 Initiate nonpharmacologic relief measures
Nonpharmacologic Pain Relief Measures
 Distraction
 Humor
 Music
 Imagery
 Relaxation
 Cutaneous stimulation
 Acupuncture
 Hypnosis
 Therapeutic touch
 Pharmacologic Pain Relief
Measures
 Analgesic administration
 Nonopiod analgesics e.g. NSAIDs
 Opioids or narcotic analgesics
 Adjuvant drugs e.g. anticonvulsants,
antidepressants, ..
 Why clients may be reluctant to
report pain:
 Unwillingness to trouble staff who are perceived as
busy
 Fear of injectable route of analgesic administration
 Belief that pain is to be expected as apart of the
recovery process
 Belief that pain is a normal part of aging
 Belief that expression of pain reveal weakness
 Concerns about side effects and risks especially of
opioid drugs
 Additional Methods for
Administering Analgesics
 Patient controlled analgesia
 Epidural analgesia
 Local anesthesia