1. Chapter 43-Pain Management Part I
Ouch! That hurts! I’m hurting! OMG! It’s killing me. I can’t live any longer! Can’t you do anything?

2. The Concept for this unit is
com·fort  (k m f rt) tr.v. com·fort·ed, com·fort·ing, com·forts 1. To soothe in time of affliction or distress.2. To ease physically; relieve.n. 1. A condition or feeling of pleasurable ease, well-being, and contentment.2. Solace in time of grief or fear.3. Help; assistance: 4. One that brings or provides comfort.5. The capacity to give physical ease and well-being.

3. Concepts related to Pain
Pain-symptom of disease
Pain-now considered a separate disease
Pain-subjective
Pain-highly individualized
Pain-highly feared. The fear of pain is second only to the fear of death

4. Causes of pain
Thermal
Chemical
Mechanical

5. Processes of Pain
Transduction
Transmission
Perception
Modulation

6. Transduction
Transduction-energy from stimuli converted to electrical energy
Begins in the periphery with stimulus
Pain impulse via nerve fibers
Transduction completed results in transmission

7. Transmission Transmission involves neurotransmitters
Intact pain fibers-ECF & Spinal Cord
Message received by cerebral cortex
Interpretation by CNS

8. Perception Message received-awareness
Limbic system determines how one feels about the pain

9. Modulation Message interpreted and received
Release of inhibitory neurotransmitters
Modulation is the inhibitory/analgesic effect

10. Gate-Control Theory p.1053 Emotional Cognitive Gate-keepers
Pain threshold
Pain tolerance

11. Types of Pain p.1055 Acute/Transient Chronic/Persistent
Chronic Episodic
Cancer
Idiopathic
Inferred

12. Misconceptions/Biases
The person experiencing the pain is the best indicator of the characteristics of pain
Assess pain
Believe the person

13. Factors Affecting Pain p. 1056-1060
Age
Culture
Gender
Genetic
Neurological functioning
Social
Spiritual

14. Nursing Assessment No pain meter available Must rely on patient
Nurse must ascertain subjective data
Expression of pain

15. Characteristics of Pain
Onset/Duration
Location
Quality
Pattern
Relief measures
Contributing symptoms
Behavioral effects
Effects on ADL’s

16. Pain Assessment Pain scales p. 1065 Oucher scale Wong-Baker
Pneumonic-P,Q,R,S,T
Assessment of pain is considered the fifth vital sign!

17. Questions/Statements R/T Pain
Be a reporter-who, what, when, where, why
Ask opened-ended questions
Avoid leading statements
Observe nonverbal cues
Congruent nonverbal actions and verbal comments
Remember to assess drug allergies