ASSESSIN

Pain
G

KARELLE CUSTODIA
THERESA GALIVO
Pain
An unpleasant sensory
and emotional experience
which we primarily
associate with tissue
damage or describe in
terms of such damage.
Sensory Nerve Receptor (Pain
Receptor)
• mechanical ( pressure,
swelling, abscess,
incision tumour growth)
• thermal (burn, scald)
• chemical (excitatory
neurotransmitter, toxic
substance, ischaemia,
infection)
Pathophysiology of pain
-are associated with the central and
peripheral nervous system.

Nociceptors – transmits the

sensations to the central nervous
system.
Physiologic process of pain
1. Transduction – begins when the free nerve endings (nociceptors) of C-
fibres and A-delta fibers of primary afferent neurones respond to noxious
stimuli.
• Nociceptors – noci=harmful – are exposed to noxious stimuli when tissue
damage and inflammation occurs as a result of trauma, surgery,
inflammation, infection and ischemia.
• Nociceptors are distributed in the:
• -somatic structures (skin, uscles, connective tissue, bones and joints;
• -visceral structures (visceral organs such as liver, gastro-intestinal tract)
• -the C fibre and A-delta fibres are associated with different qualities of
pain.
2. TRANSMISSION the process occurs in three stages. The pain
impulse is transmitted:
-from the site of transduction along the nociceptor fibres to the dorsal
horn in the spinal cord
-from the spinal cord to the brain stem
-through connections between the thalamus, cortex and higher levels
of the brain.

3. PERCEPTION Is the end result of the neuronal activity of

pain transmission and where pain becomes a conscious
multidimensional experience. Studies shown that Emotional status
affects directly the level of pain perceived and thus reported by the
clients.
4. MODULATION Changing or
inhibiting transmission of pain impulses
in the spinal cord.
Pathways for trasmitting pain
Types of pain
1. Acute vs. Chronic
2. Nociceptive vs. Neuropathic
3. Somatic vs. Visceral
4. Referred
5. Somatogenic vs. Psychogenic
 ACUTE PAIN CHRONIC PAIN

Sudden onset Persistent – usually lasting more than six

months

Temporary (disappears once stimulus is Cause unknown – may be due to neutral

removed) stimulation

Can be Somatic, Visceral, or Referred Physiological responses are less obvious

especially with adaptation

Physiological responses to acute pain Physiological responses may include

include increased RR, HR, BP and depression
reduction in gastric motility – sympathetic
response
NOCICEPTIVE NEUROPATHIC
Pain results from Pain results from direct
activation of injury to nerves in the
nociceptors (Pain peripheral nervous
receptors) system. (Alcoholism,
diabetic neuropathy,
post-herpetic neuralgia,
etc…)
 SOMATIC VISCERAL
- Superficial: stimulation - Stimulation of receptors
of receptors in skin in internal organs,
- Deep: stimulation of abdomen, and skeleton
receptors in muscles, - Often poorly localised as
joints and tendons fewer receptors located
in viscera
- Visceral pain can be
referred.
 REFERRED PAIN

- Pain experienced at a point

distant to its point of origin
- Area of referred pain is supplied
by same spinal segment as
actual site of pain
- Brain misinterprets signals as
coming from somatic regions.
 SOMATOGENIC PSYCHOGENIC
- Pain is pain originating - Pain is pain for which
from an actual physical there is no physical cause.
cause e.g. trauma, IT is not however
ischaemia, etc. imaginary pain and can be
as intense as somatic pain.
Areas of Referred Pain
Factors affecting Pain

• Age
• Sex
• Medical Condition
• Genes
• Emotions
What data to collect?
• Location
• Intensity
• Quality
• Pattern
• Precipitating factors
• Emotional responses
Tips for Collecting Data
• Maintain a quiet and calm environment
• Maintain the client’s privacy
• Ask the questions in an open-ended format
• Listen carefully to the client’s verbal
descriptions
• Watch the client’s facial expressions
• Do not put words in the client’s mouth
• Ask the client about past experiences with
pain
• Believe the client’s expression of pain.
TOOLS for
ASSESSING
PAIN
Visual Analog Scale (VAS)

A measurement instrument that tries to measure a

characteristic or attitude that is believed to range
across a continuum of values and cannot easily be
directly measured.
Numeric Rating Scale
Simple Descriptive Pain Intensity
Wong-Baker FACES Pain Rating Scale