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Sunday, February 11
, 2024
 Meher Institute Of Nursing And
Allied Health Science
2
Generic BS Nursing 1st year 2nd
Semester.

Prepared by: Ashfaque Laghari

Sunday, February 11
, 2024
 Objectives:

• At the end of presentation you will be able to….

3 • Define the process of pain .( Physiological changes).

• Define the different theories of the pain.
• Define the non prhamacological intervention on pain
management.
• Define the phramacologial intervention for pain management.
• Define acute and chronic pain.
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Pain
 Pain occurs when something hurts, causing an
uncomfortable or unpleasant feeling.
 The presence of pain often means that something is
wrong.
 The best judge of your pain is you
 Pain is a signal in your nervous system that something
may be wrong.

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Process of pain
 A pain message is transmitted to the brain by specialized
nerve cells known as nociceptors, or pain receptors.
 When pain receptors are stimulated by temperature,
pressure or chemicals, they release neurotransmitters
within the cells.
 Neurotransmitters are chemical ‘messengers’ in the
nervous system that facilitate communication between
nerve cells.
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Changes occur during pain

 Physiological changes:
 Increse in
 Heart rate
 Blood pressure
 Respiratory rate
 Oxygen consumption
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8 Pain theories
 Gate control theory.
 Intensive theory
 Specificity theory
 Strong’s theory
 Pattern theory
 Central summation theory
 The fourth theory of pain
 Sensory interaction theory
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 Gate control theory
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(neural pathway of pain)

 This theory was proposed by two Scientis Melzack and wall in

1960.
 The gate control theory states that “ There are gates On the spinal
cord and those gates will allow some pain signals to travel
through to the brain, but other signals do not pass through or
greatly dimilished.

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Continue
 There are two types of cells:
 Type (A): which carry the information of touch,
temperature and pressure.
 These cells are mylenated and all the cells are longer in
diameter also carry fast impulse to the brain.
 Type (C): which carry the information about pain.
 These cells are unmylenated and these cells carry slow
impulses than type A cells.
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11 Continue…
 When signals that are carried on larger type A of Fibres
reach a specific cell types will stimulate the projection of
Neurons, allowing the signal to go through to the brain.
 These same signals will also stimulate the Inhabitory
interneurons, that will block the signals coming from the c
fibres , thus “ closing the gate “ to the pain, as the signals
will not go through to the brain.

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12 Gate control theory

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13

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 Differentiate between acute pain and
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chronic pain
Acute pain
 Acute pain usually comes on suddenly
and is caused by something specific.
 It is sharp in quality.
 Acute pain usually doesn’t last longer
than six months.
 It goes away when there is no longer an
underlying cause for the pain.
Chronic pain
 Chronic pain is pain that is ongoing and
usually lasts longer than six months.
 This type of pain can continue even
after the injury or illness that caused it
has healed or gone away.
 Pain signals remain active in the
nervous system for weeks, months or
years.
 Some people suffer chronic pain even
when there is no past injury or apparent
body damage
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15 continue
Acute pain Chronic pain

Chronic pain is linked to

Causes of acute pain
conditions that include:
include:
 Headache.
 Surgery.
 Arthritis.
 Broken bones.
 Cancer.
 Dental work.
 Nerve pain.
 Burns or cuts.
 Back pain.
 Labor and childbirth.
 Fibromyalgia. Sunday, February 11
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17 Non pharmacologic intervention for pain
management

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18 Non pharmacologic intervention for pain
management

 Non-pharmacological therapies are ways to decrease pain

without medicine.
 Non-pharmacological therapies may help decrease your
pain or give you more control over your pain.
 This can improve your quality of life.
.

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 Continue..
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some common therapies to help control pain are:
 Heat: helps decrease pain and muscle spasms. Apply heat to the area for 20 to 30
minutes every 2 hours for as many days as directed.
 Ice: helps decrease swelling and pain. Ice may also help prevent tissue damage.
Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel and place
it on the area for 15 to 20 minutes every hour, or as directed
 Massage therapy: may help relax tight muscles and decrease pain.
 Physical therapy: teaches you exercises to help improve movement and
strength, and to decrease pain.

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ContInue…
 Relaxation techniques can help you relax, relieve stress, and
decrease pain. Common relaxation techniques include any of the
following:
 Aromatherapy: is a way of using scents to relax,
relieve stress, and decrease pain. Aromatherapy uses
oils, extracts, or fragrances from flowers, herbs, and
trees. They may be inhaled or used during massages,
facials, body wraps, and baths.
 Deep breathing can help you relax and help decrease
your pain. Take a deep breath in and then release it
slowly. Do this as many times as needed. Sunday, February 11
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21 conti..

 Tense your muscles and then relax them. Start with the muscles
in your feet then slowly move up your leg. Then move to the
muscles of your middle body, arms, neck and head.
 Meditation and yoga may help your mind and body relax. They
can also help you have an increased feeling of wellness.
Meditation and yoga help you take the focus off your pain.

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22 Conti..

 Guided imagery teaches you to imagine a picture in your mind.

You learn to focus on the picture instead of your pain. It may help
you learn how to change the way your body senses and responds to
pain.
 Music may help increase energy levels and improve your mood. It
may help reduce pain by triggering your body to release endorphins.
These are natural body chemicals that decrease pain. Music may be
used with any of the other techniques, such as relaxation and
distraction

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 Pharmacologic management of pain
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3 step ladder, Originally developed by the World Health Organization

(WHO) to improve management of pain.
1. Non-opioid medications: Step 1 - WHO Analgesic ladder Mild to
Moderate pain.
 Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin,
ibuprofen, naproxen, diclofenac weaken and reduce the levels of
chemical mediators.
 Paracetamol also known as acetaminophen. Although it is the
most widely used pain relieving medication
 Aspirin also known as acetylsalicylic acid (ASA)
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24 Conti..
2. Compound analgesics: Step 2 on the WHO analgesic ladder –
mild to moderate pain
Compound analgesics are a combination of drugs in a single tablet
usually including codeine (a weak opiate) and aspirin or paracetamol.
3.Opioid medications: Step 3 on the WHO analgesic ladder –
severe pain
Medications derived from morphine (or synthetic analogs) mimic the
body’s own analgesic system and are strongest and most effective
painkillers currently available
Opioid medications include morphine, oxycodone, codeine, tramadol,
buprenorphine, fentanyl and diamorphine (heroin)
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25 Conti..

 Topical analgesics
Topical analgesics include rubefacients, topical NSAIDs and local
anesthetics
Topical capsicum may be prescribed for chronic pain conditions such
as post herpetic neuralgia and diabetic neuropathy
Topical NSAIDs ( including ibuprofen, naproxen and diclofenac ) are
used in acute and chronic pain conditions

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31 References
 Brennan T., Joo T., Kehlet H., Mekhai N., & Woolf C. (2016). Unraveling the
Mechanisms and Clinical Consequences of Pain: Recent Discoveries and the
Implications for Pain Management: A Case-Based Interactive Expert Forum.
WebMD LLC. (accessed 28/12/2021).
 Kaye V. & Brandstater M. (2015). Transcutaneous Electrical Nerve Stimulation.
WebMD LLC. (accessed 28/12/2021).
 Middleton, C. (2003). Understanding the physiological effects of unrelieved pain.
Nursing Times. (accessed 28/12/2021).
 Snell, R. (2010). Clinical Neuroanatomy (7th ed.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.Standring, S. & Gray, H. (2008).
 Gray's Anatomy. [Edinburgh]: Churchill Livingstone/Elsevier.

Sunday, February 11
, 2024