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Pain and its management
Yuni Permatasari istanti
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What is Pain??
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Introductory Ideas
Sensation of the aected level of unpleasantness
Perception of actual or threatened damage
Perception based on expectations, pastexperience, anxiety, suggestions, cognitivefactors
Acute
Chronic
Pain is Subjective
Simple Spinal Reex Arc
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Significance of Pain
Pain
A clear example of the mindbody
!"PS# model !and most common problemassociated $ith going to %CP#
Adaptive as a biological $arning signal
!e&g&, congenital insensitivity to pain)
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The Physiology of Pain
'%o$ you (no$ that you stubbed yourtoe) handout Receptor
*& +ociceptor a speciali-ed neuron thatperceives and responds to painful stimuli
.& Special pain nerve /bers
A01elta 2ibers 00 3arge, myelinated !fast#
nerve /bers that transmit sharp, stinging pain C02ibers 00 Small, unmyelinated nerve /bers
that carry dull, aching pain
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The Physiology of Pain
'%o$ you (no$ that you stubbedyour toe) handout
4& 1orsal %orn pain5s 'arrival) to theC+S
6& "rain perception of pain& %eavilyinuenced by emotion, context,expectations, etc& !illustration nextslide#
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Pain Pathways
PAG area of midbrain (next slide)
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Pain Pathways
Peria7ueductal
8ray !PA8#midbrainregion00
activates adescendingneural pathwaythat uses
serotonin to'
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Gate Control Theory
Proposed by 9el-ac( : ;all !*#
A neural 'gate) in the spinal cord
regulates the experience of pain Pain is not the result of a straight0
through sensory channel
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The Gate Control Theory
of Pain
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The Biochemistry of Pain
Substance P !pain +?#
+?s !e&g&, serotonin# that alter 'gate)
@n(ephalins, endorphins, dynorphins!endogenous opioids#
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Psychosocial Factors in the
Experience of Pain
Stress
pain perception is inuenced by stress!emotionality and pain experience#
stress leads people to engage in behaviors!i&e&, grinding teeth, tensing muscles#, $hich inturn lead to pain
8ood ne$s Stress0Bnduced Analgesia !SBA# a stress0related increase in tolerance topain, mediated by the body5s endogenousopioids
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Psychosocial Factors in the
Experience of Pain
3earning
modeling
secondary gain reinforcement culturally learned 00 groups establish
norms for the degree to $hich sueringshould be openly expressed and theform that pain behaviors should ta(e
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Psychosocial Factors in the
Experience of Pain
Cognition
anticipation of pain is often $orse than
pain itself placebo and pain !e&g&, child $ho gets ear
examined feels better#
expectations of ability to cope !e&g&,
control and pain PCA morphine#
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Pain Management
Dvervie$
?he 2ifth Eital sign
"ody ?emp, Pulse, "P, Resp Rate, Pain
9easuring pain
Chronic pain issues
?reatment
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PI! SSESSME!T
http://pengukuran%20nyeri.ppt/http://pengukuran%20nyeri.ppt/5/19/2018 Pain Management
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Chronic Pain Management
Acute vs& Chronic pain
;ho becomes a chronic pain patientF
+ot necessarily related to pain intensity 9ore important are reactions
Physical !postural changes#
2unctional disability !pain interferes $ith life activities#
Reactions to pain episodes and to stress
?he toll of chronic pain !video clips from 'Psychology ofPain)#
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The toll of chronic pain
Dysfunction report high levels of pain, feel they have little
control over their lives, and are extremely inactive
Interpersonal distress perceive little social support and feel other people
in their lives don5t ta(e their pain seriously
often poor communication
sexual relationships deteriorate
Cost %uge medical bills
Gndergone many treatments !e&g&, multiplesurgeries# and rely on pain(illers
Hob lossdisability
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Treating Pain
Pharmacological ?reatments
Analgesic !pain0relieving# drugs are the
mainstay of pain control Bnclude 'central acting) opioid drugs
and 'peripherally acting) nonopioiddrugs
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"pioid nalgesics
2ormerly called narcotics
Agonists !excitatory chemicals e&g&,
morphine# act on receptors in thebrain and spinal cord
Patient controlled analgesia
addresses control andundermedication
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!onopioid nalgesics
+onsteroidal Anti0Bnammatory1rugs !+SAB1s#
Aspirin, ibuprofen 00 relieve pain andreduce inammation at the site ofinjured tissue
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"ther Medical Inter#entions
Counterirritation
Analgesia in $hich one pain is relieved by
creating another, counteracting stimulus ?ranscutaneous @lectrical +erve
Stimulation !?@+S#
A counterirritation form of analgesiainvolving electrically stimulating spinalnerves near a painful area
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Cogniti#e$Beha#ioral Therapy
Cognitive0"ehavioral ?herapy !C"?#
A multidisciplinary pain0management
program that combines cognitive,physical, and emotional interventions
used by I4J of clinicians $ho treat chronicpain
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Cogniti#e$Beha#ioral Therapy
Components Education and goal-setting component is
used to clarify client5s expectations
Cognitive interventionsto enhancepatients5 self0eKcacy and sense of controlover pain
Teaching new skillsfor responding to paintriggers
Promote increased eercise and activitylevels
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Cogniti#e$Beha#ioral
Inter#entions
!iofeed"ack # muscle relaation
Cognitive distraction
Imagery # virtual reality therapy $see %ciAmerican Aug &''()
ypnosis
Cognitive restructuring * tochallenge illogical beliefs andmaladaptive thoughts !next slide#
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%eshaping Pain Beha#ior
Bdentify the events !stimuli# thatprecede pain behaviors !responses#
as $ell as the conse7uences thatfollo$ !reinforcers#
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&hich pproach to Pain
Control &or's Best(
Bt depends on $hich type and aspect of pain
Dverall, the most eective programs aremultidisciplinary in nature, combining the
cognitive, physical, and emotionalinterventions of C"? $ith the judicious useof analgesic drugs
@ective programs also encourage patients
to develop !and rehearse# a speci/cpain-management program
+roup settings are pro"a"ly most e,ective
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!)%SI!G C%E P*!
Assessment
+ursing 1iagnosis
+DC dan +BC
http://nursing%20diagnosis.doc/http://nursing%20diagnosis.doc/5/19/2018 Pain Management
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C"!T"+ ,S)S
Seorang la(i0la(i 6>thdiba$a (e RSdengan (eluhan nyeri pinggang seja(
. bulan yang lalu& +yeri hilangtimbul, apabila nyeri datang pasientida( bisa bera(tivitas sama se(ali&
Ri$ayat pe(erjaan pasien sebagai(uli bangunan seja( .> tahun yanglalu&
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T)GS
"uat (elompo( dengan anggotama(simal > orang
"uat rencana asuhan (epera$atanpada pasien tersebut
?ugas di(umpul(an pada tanggal .L
9ei .L**