Chapter 20 Pain Management

pain Pain is The process of pain The major cause of physical distress among clients. An unpleasant sensation usually associated with disease or injury. The process of pain Transduction-Phase: Conversion of chemical information at the cellular level into electrical impulses that move toward the spinal cord. Transmission-Phase : During which stimuli move from the peripheral nervous system to the brain

Perception-Phase: Modulation-Phase: Conscious experience of discomfort when the pain threshold is reached. Modulation-Phase: Brain interacts with the spinal nerves in a downward fashion to alter the pain experience

Phases of Pain

Pain theories Endogenous opioids: (naturally produced morphine-like chemicals) e.g., endorphins. When it is released, they bind to sites on the nerve cell’s membrane that block the transmission of pain impulses.

Mechanism of Pain Transmission and Interference

TYPES OF PAIN Cutaneous pain: Visceral pain : Neuropathic pain: Discomfort that originates at the skin level Visceral pain : Discomfort arising from internal organs Referred pain: Discomfort perceived in a general area of the body, usually away from the site of stimulation ( appendicitis ) Neuropathic pain: Pain with atypical characteristics also called functional pain Example : phantom limp pain

TYPES OF PAIN (cont’d) Acute pain: Chronic pain Lasts a few seconds to less than 6 months Associated with tissue trauma, surgery, or recent identifiable etiology. Gradual reduction in pain promotes coping Chronic pain Discomfort that lasts longer than 6 months Physical and emotional distress Depression

PAIN ASSESSMENT STANDARDS Pain is the fifth vital sign Should be assessed with temperature, pulse, respirations, and blood pressure Pain should be regularly assessed throughout the healthcare delivery Healthcare workers should be educated on pain Clients and families should be educated on effective pain management Client’s choices regarding pain management is respected

PAIN ASSESSMENT DATA Onset : Quality: Intensity: Location Duration Time under which the pain became apparent ( e.g. after surgery) Quality: Degree of suffering ( e.g. throbbing, crushing) Intensity: Magnitude of pain ( e.g. mild ,moderate, severe) (numeric scale from 0-10) Location Anatomic site ( e.g. chest, abdomen) Duration Time span of pain ( e.g. continuous, intermittent, weeks)

NONVERBAL PAIN INDICATORS Moaning Crying Grimacing Guarded position Increased vital signs Reduced social interactions Irritability Difficulty concentrating Changes in eating and sleeping

PAIN MANAGEMENT TECHNIQUES DRUG THERAPY: Nonopioids (non-narcotic drugs). e.g. Aspirin, acetaminophen, NSAIDS ibuprofen, naproxin Opioids (narcotic drugs), e.g. Morphine sulfate, Codeine sulfate SURGICAL APPROACHES Intractable pain - Pain unresponsive to other methods of pain management p. 427

Nondrug/ Nonsurgical interventions: Education: Educate client about pain and methods for pain management Imagery: Intentional daydreaming or pleasant memories Meditation: (Spiritual) Concentrating on a word or idea that promotes tranquility Distraction: Intention diversion of attention to switch focus from unpleasant sensory experience Relaxation: Technique for releasing muscle tension and quieting the mind

10. Transcutaneous electrical nerve stimulation (TENS) Heat and Cold: Thermal therapy for pain relief Acupuncture: Pain management technique in which long, thin needles are inserted into the skin Acupressure: Technique that involves tissue compression rather than needles to reduce pain Hypnosis: Therapeutic technique in which a person enters a trance̊-like state 10. Transcutaneous electrical nerve stimulation (TENS) Delivers electricity to the skin and underlying nerves (15 to 30 minutes) 11. Placebo : an inactive substance sometimes prescribed as a substitute for analgesic drugs

Nursing Implications-Nursing Diagnoses Acute pain Chronic pain Anxiety Fear Ineffective Coping Deficient Knowledge: Pain Management Placebo : an inactive substance sometimes prescribed as a substitute for analgesic drugs

̊trance  (trăns)n. 1. A hypnotic state. 2. Detachment from one's physical surroundings, as in contemplation or daydreaming. 3. A semiconscious state, as between sleeping and waking; a daze. in which ability to function voluntarily may be suspended.