1. 1 Marilyn Gripping Sept. 18, 2010

2. 2 Disclaimer The views and opinions I present today are entirely my own. They do not necessarily reflect the views of the Calgary Health Region, or either of Norquest or Bow Valley Colleges. My views and opinions should not be construed as an official explanation or interpretation.

3. 3 Disclosure I have no relationship that could be perceived as placing me in a real or apparent conflict of interest in the context of this presentation.

4. 4 What is Pain? “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” (Jovey, page 9)

5. 5 “Whatever the person experiencing it says it is and exists whenever he says it does.” (Linton, 202)

6. 6 Factors Influencing Pain Experience Pain Threshold Pain Tolerance Age Physical Activity Nervous System Integrity

7. 7 Surgery/Anesthesia Culture Religious Beliefs Past Experiences/Anxiety Situational Factors

8. 8 Perception of Pain Afferent pathways Nociceptors CNS Pain receptors Spinal cord Brain Efferent pathways Descending pathway

9. 9 Endorphins and Enkephalins Body’s natural opioid-like substances Block transmission of pain to spinal cord Individuals produce different amounts

10. 10 Decrease Endorphins Prolonged stress Pain Use of opioids Alcohol

11. 11 Increase Endorphins Brief stress Pain Laughter, Exercise Acupuncture Transcutaneous Electrical Nerve Stimulation (TENS) Massive Trauma Sexual Activity

12. 12 Gate-Control Theory Pain reflects both physical and psychosocial factors

13. 13 Gate-Control Theory

14. 14 Gate-Control Theory – con’t

15. 15 Gate-Control Theory – con’t

16. 16 Types of Pain Acute Subacute Chronic Baseline Pain Breakthrough Pain

17. 17 Categories of Pain Nociceptive Somatic Visceral Neuropathic CNCP (Chronic Non-Cancer Pain)

18. 18 Pain Severity Pain Scale Pain is rated on a scale of 0-10 where “0” is no pain and “10” is the worst pain imaginable or the worst pain the person has ever had.

19. 19 Statistics 1/3 of all people suffering with chronic pain are treated successfully with NSAIDs Chronic pain in elderly is very common and is often undertreated Risk of addiction is usually less than the need to control chronic pain

20. 20 The Treatment Continuum Most efficient use of locally available medical resources More available, less expensive, less invasive, fewer side effects Less available, more expensive, more invasive, more side effects

21. 21 Examples: Physical Psychological Pharmacological Invasive Therapies

22. 22 Prescribing of pain meds Dose to effect Exceptions: NSAIDS Antidepressants Anticonvulsants

23. 23 Analgesic Ladder

24. 24 Adjuvants Drugs primarily developed to treat other conditions

25. 25 Bibliography Dhalla, Irfan A, et al. (2009). Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ- JAMC, 181 (12), 891-896. Fischer, Benedikt, Rehm, Jurgen (2009). Deaths related to the use of prescription opioids. CMAJ-JAMC, 181 (12), 881-882. Jovey, Roman D. (Ed). (2008). Managing Pain – The Canadian Healthcare Professional’s Reference. (2008 Edition). City: Purdue Pharma. Kozier, B., Erb. G., Berman, A., Snyder, S., Bouchal, D.S.R., Hirst, S., et al. (2010). Fundamentals of Canadian Nursing: Concepts, process and practice (2 nd Canadian ed.) Toronto: Pearson Education Canada. Linton, A. (2007). Introduction to medical-surgical nursing (4 th ed.). Philadelphia, PA: Saunders.