1. PAIN and its MANAGEMENT
Lecture 09
Genalin L. Taguiam

2. Course Outcome
At the end of the week’s activity, the students should be able to:
Differentiate the types of pain
Describe four processes involved in nociception
Describe non-pharmacologic pain control interventions
Provide psychological care/support according to client’s/patient’s age

3. PAIN
Nociception
The activation of specialized nerve fibers that signal the occurrence of tissue damage

4. PAIN
Unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage

5. PAIN
Highly subjective
“Whatever the experiencing person says it is, existing when the person says it does.”
(Mc Caffery)

6. According to Duration ACUTE PAIN Types of Pain
Pain that lasts only through the expected recovery period
Either sudden or slow onset regardless of intensity

7. According to Duration CHRONIC PAIN Types of Pain
Prolonged, usually recurring or persisting over 6 months or longer
Interferes with functioning

8. According to Location CUTANEOUS PAIN DEEP SOMATIC PAIN Types of Pain
Originates in the skin or subcutaneous tissue
DEEP SOMATIC PAIN
Arises from ligaments, tendons, bones, blood vessels and nerves

9. Types of Pain According to Location VISCERAL PAIN RADIATING PAIN
Results from stimulation of pain receptors in the abdominal cavity, cranium and thorax
RADIATING PAIN
Perceived at the source of pain and extends to nearby tissue

10. REFERRED PAIN According to Location Types of Pain
Pain in a part of the body that is considerably removed from the tissues causing pain

11. MILD PAIN MODERATE PAIN SEVERE PAIN Types of Pain
According to Intensity
MILD PAIN
pain is in 1 – 3 range
MODERATE PAIN
pain is in the 4 – 6 range
SEVERE PAIN
pain is in the 7 – 10 range
0 – no pain
10 – worst pain

12. Types of Pain
INTRACTABLE PAIN
Pain that is highly resistant to relief

13. Types of Pain According to Etiology PHANTOM PAIN PHYSIOLOGICAL PAIN
experienced when an intact, properly functioning nervous system sends signals that tissues are damaged
NEUROPATHIC PAIN
experienced by people who have damaged or malfunctioning nerves
PHANTOM PAIN
A painful sensation is perceived in a body part that is missing

14. According to Etiology Types of Pain PSYCHOGENIC PAIN
Physical pain that is caused, increased, or prolonged by mental, emotional or behavioral factors

15. Common Terms Associated with Pain
PAIN THRESHOLD
Amount of pain stimulation a person requires in order to feel pain
HYPERALGESIA
Excessive sensitivity to pain

16. Common Terms Associated with Pain
PAIN TOLERANCE
The maximum amount and duration of pain that an individual is willing to endure

17. NOCICEPTORS TYPES OF PAIN STIMULI
PHYSIOLOGY OF PAIN
NOCICEPTORS
Receptors that can transmit pain sensation
TYPES OF PAIN STIMULI
Mechanical
Thermal
Chemical

18. Pain Stimuli Mechanical Thermal Chemical Trauma to body tissue
Alterations in body tissue
Blockage of a body duct
Tumor
Muscle spasm
Thermal
Extreme heat or cold
Chemical
Tissue ischemia
Tissue ischemia – stimulation of pain receptors because of accumulated lactic acid

19. TRANSDUCTION NOCICEPTION Release of biochemical mediators
prostaglandins, bradykinin, serotonin, histamine, substance P
Movement of ions across cell membranes
Stimulation and sensitization of nociceptors

20. NOCICEPTION
TRANSMISSION
Pain impulse peripheral nerve fibers spinal cord spinothalamic tracts brain stem and thalamus somatic sensory cortex

21. NOCICEPTION
TRANSMISSION

22. MODULATION PERCEPTION “Descending System”
NOCICEPTION
MODULATION
“Descending System”
Release substances which can inhibit the ascending noxious impulses into the dorsal horn
PERCEPTION
clients become aware of the pain

23. GATE CONTROL THEORY
Peripheral nerve fibers carrying pain to the spinal cord can have their input modified at the spinal cord level before transmission to the brain (Melzack and Wall)

24. Substantia gelatinosa cells in the dorsal horn of the spinal cord
GATE CONTROL THEORY
Substantia gelatinosa cells in the dorsal horn of the spinal cord
gating mechanism
Small diameter nerve fibers
Carry painful stimuli

25. Large diameter nerve fibers
GATE CONTROL THEORY
Large diameter nerve fibers
Inhibit the transmission of pain impulses

26. Physiologic Response Proprioceptive Reflex Fight or Flight Reaction
RESPONSES TO PAIN
Physiologic Response
Fight or Flight Reaction
Proprioceptive Reflex
Proprioceptor
**sensory receptor found chiefly in muscles, tendons, joints

27. Behavioral Response Altered sleep Loss of appetite
RESPONSES TO PAIN
Behavioral Response
Altered sleep
Loss of appetite
Withdrawal and Isolation
Crying, moaning
Proprioceptor
**sensory receptor found chiefly in muscles, tendons, joints

28. Factors Affecting Pain Experience
Ethnic and Cultural Values
Behavior related to pain is part of socialization process
Affect the level of pain is willing to tolerate
Pain maybe part of the ritualistic process
Tolerance of pain signifies strength and endurance

29. Factors Affecting Pain Experience
Developmental Stage
Tolerance and response to pain differs from one stage to another

30. Factors Affecting Pain Experience
Pain experiences
Alter a client’s sensitivity to pain
Success or lack of success of pain relief measures influences a person’s expectations for relief and future response to interventions

31. Factors Affecting Pain Experience
Meaning of Pain
Client’s interpretation of its significance
Environment and support people
Can affect the perception of and response to pain

32. Character – describe the sensation
Assessment
Character – describe the sensation
Onset – when it started, how it has changed
Location – where it hurts
Duration – constant versus intermittent in nature
Exacerbation – factors that make it worse
Relief – factors that make it better
Radiation – pattern of shooting/ spreading/ location of pain away from its origin

34. KEY STRATEGIES IN PAIN MANAGEMENT
Acknowledging and accepting client’s pain
Acknowledge the possibility of pain
Listen attentively
Discuss emotional reactions
Attend to the client’s need

35. KEY STRATEGIES IN PAIN MANAGEMENT
Assisting support persons
Provide accurate information
Disease and medication
Nondrug pain relief measures
Access to resources

36. KEY STRATEGIES IN PAIN MANAGEMENT
Reducing misconceptions about pain and its treatment
Reducing fear and anxiety
Preventing pain

37. PHARMACOLOGIC PAIN MANAGEMENT Use of medicine/drugs in treating pain
Examples
Opiod Analgesics (Narcotics)
NSAIDS
Proper analgesia with the intensity of pain
Use of placebo

38. NONPHARMACOLOGIC PAIN MANAGEMENT
Target domain of Pain Control - BODY
Physical Interventions
To provide comfort
Cutaneous Stimulation
Massage, application heat and cold, contralateral stimulation, accupressure

39. NONPHARMACOLOGIC PAIN MANAGEMENT
Target domain of Pain Control - BODY
Immobilization/Bracing

40. NONPHARMACOLOGIC PAIN MANAGEMENT
Target domain of Pain Control – MIND
Relaxation, Imagery
Distraction
Reducing fear, anxiety, stress
Facilitating coping

41. NONPHARMACOLOGIC PAIN MANAGEMENT
Target domain of Pain Control – SPIRIT
Prayer
Meditation
Self-reflection
Meaningful rituals

42. NONPHARMACOLOGIC PAIN MANAGEMENT
Target domain of Pain Control – SOCIAL INTERACTIONS
Functional restoration
Improved communication
Support groups

43. reference
Berman, A., Snyder, S., Kozier, B., & Erb, G. (2008). Kozier and Erb's Fundamentals of Nursing 8th Edition. (pp ) New Jersey, USA: Pearson Education Inc.