Chapter 20 Comfort

Pain—A Complex Phenomenon Pain relies on the patient’s perception and report. Four out of ten people experience pain on a daily basis. The elderly are more likely to experience pain than younger adults and will suffer moderate to severe pain twice as long as younger persons. Pain can be both under and over reported by the elderly.

Types of Pain Nociceptive pain –Arises from mechanical, thermal, or chemical noxious stimuli to the A delta and C afferent nociceptors. Found in fasciae, muscles, joints, and other deep structures. Activation causes a transduction of painful stimuli along the primary afferent fiber of the dorsal horn of the spinal column.

Types of Pain (cont.) Neuropathic pain –Associated with diabetic neuropathies, postherpetic neuralgias, and other insults to the nervous system. Sharp, stabbing, tingling, or burning pain with a very sudden onset of high intensity. Lasts a few seconds or lingers for a longer period.

Types of Nociceptive Pain Somatic Pain –Characteristic of pain in the bone and soft tissue masses. –Well localized and described as throbbing or aching. Visceral Pain –Associated with disorders that can cause generalized or referred pain. –Described as deep and aching.

Complications of Unrelieved Pain in the Elderly Limited mobility –Pressure ulcers, pneumonia, and constipation Poor appetite –Malnutrition and dehydration Depression, hopelessness, spiritual distress

Effective Pain Management Qualitative and quantitative assessment of symptoms. –Inquiries into the presence of pain –Description of pain through questioning Physical examination to offer additional insights into patients’ pain –Ongoing assessment

Pain Management Variables Role of aging on pain Assessing patients with cognitive deficits Cultural factors

Pain Assessment Instruments Numeric rating scale: Asks the patient to rate pain on a scale from 1 to 10. Visual Analogue Scale: Uses a horizontal line with “no pain” on the left end and “pain as bad as it can possibly be” on the right end. McGill Pain Questionnaire: Contains 78 words categorized into 20 groups, a drawing of the body, and a Present Pain Intensity (PPI) scale.

Underlying Factors in Pain Management Poor positioning or posture Inactivity Emotional issues Adverse drug reactions

Examples of Alternative Therapies for Pain Management Acupressure Acupuncture Aromatherapy Biofeedback Chiropractic Electrical stimulation Exercises Guided imagery Heat and cold therapies Herbal medicine Homeopathic remedies Hypnosis Naturopathy Osteopathy Prayer Progressive relaxation

Diet Influences on Pain Persons with inflammatory conditions should eliminate arachidonic acid from diet. Omega-3 fatty acids can reduce inflammation. Antioxidants offer protection from inflammation.

Opioids of Choice for Pain Management Moderate to Severe Pain –Codeine –Oxycodone –Hydrocodone Severe Pain –Morphine –Fentanyl

Areas of Concern with Drug Use Propoxyphene and pentazocine are not advised for use with the elderly. Ongoing evaluation of responsiveness to drugs and possible adverse effects is important. –Adverse reactions can develop from drugs used for a long time that have not presented problems before.

Comfort Measures Giving the patient undivided attention regardless of the length of the interaction. Listening attentively. Explaining. Touching. Perceiving.

Source Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN ).