1. Pain Teresa V. Hurley, MSN, RN

2. Duration of pain  Acute Rapid in onset, varies in intensity and duration Protective in nature  Chronic May be limited, intermittent, or persistent Lasts for 6 months or longer Periods of remission or exacerbation are common

3. Gate Control Theory of Pain  Relationship between pain and emotions  Small and large diameter nerve fibers conduct and inhibit pain stimuli  Gating mechanism determines impulses that reach the brain

4. Factors Affecting Pain Experience  Culture  Ethnic variables  Family, gender, and age variables  Religious beliefs  Environment and support people  Anxiety and other stressors  Past pain experience

5. General Assessments of Pain  Client’s verbalization and description of pain  Duration of pain  Location of pain  Quantity and intensity of pain  Quality of pain  Chronology of pain

6. General Assessments of Pain (continued)  Aggravating and alleviating factors  Physiologic indicators of pain  Behavioral responses  Effect of pain on activities and lifestyle

7. Wilda Scale  Words that describe the pain  Intensity of pain  Location of pain  Duration of pain  Aggravating or alleviating factors

8. Nursing Interventions for Pain  Establishing trusting nurse-patient relationship  Initiating nonpharmacologic pain relief measures  Considering ethical and legal responsibility to relieve pain  Teaching patient about pain

9. Nonpharmacologic Pain Relief Measures  Distraction  Humor  Music  Imagery

10. Nonpharmacologic Pain Relief Measures  Relaxation  Acupuncture

11. Nonpharmacologic Pain Relief Measures  Hypnosis  Biofeedback  Therapeutic touch

12. Pharmacologic Pain Relief Measures  Analgesic administration  Nonopiod analgesics  Opioids or narcotic analgesics  Adjuvant drugs (enhance the action of main drug)

13. Numeric Sedation Scale  1 — awake and alert, no action necessary  2 — occasionally drowsy, but easy to arouse, no action necessary  3 — frequently drowsy, drifts off to sleep during conversation, reduce dosage  4 — somnolent with minimal or no response to stimuli, discontinue opiod, consider use of naloxone

14. Pain Management Regimens for Cancer or Chronic Pain  Give medications orally if possible.  Administer medications around the clock time rather than prn.  Adjust the dose to achieve maximum benefit with minimum side effects.  Allow client’s as much control as possible over the regimen.