Chapter 42

Pain

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Pain

Pain is a universal experience. Pain is a state in which an individual

experiences and reports the presence of severe discomfort or an uncomfortable sensation.

Pain is a subjective experience.

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Pain

Nature of Pain• Can be a protective mechanism to prevent

further injury• Warning of potential tissue damage

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Nature of Pain

Common Myths About Pain• The nurse is the best judge of a client’s pain.• If pain is ignored, it will go away.• Clients should not take any measures to

relieve their pain until the pain is unbearable.• Most complaints of pain are purely

psychological.• Taking pain medication causes addiction.

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Types of Pain

Pain can be described in two basic ways:• Cause or origin• Description or nature

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Types of Pain

Cutaneous pain is caused by stimulation of the cutaneous nerve endings in the skin.

Somatic pain is nonlocalized and originates in support structures.

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Types of Pain

Visceral pain is discomfort in the internal organs.• Referred pain is pain originating from the

abdominal organ.

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Types of Pain

Acute pain is most frequently identified by sudden onset and relative short duration.

Recurrent acute pain is identified by repetitive episodes that may recur over a prolonged period of time or throughout the client’s lifetime.

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Types of Pain

Chronic Pain • Long-term, (lasting 6 months or longer),

persistent, nearly constant, or recurrent pain• Produces significant negative changes in

client’s life• May last long after the pathology is resolved

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Types of Pain

Chronic malignant pain occurs as a result of progressive tissue injury.

Chronic nonmalignant pain occurs in persons who do not have progressive tissue injury.

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Physiology of Pain

Nociceptive pain is the process by which an individual becomes consciously aware of pain.

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Physiology of Pain

Four principle processes are involved in nociception. • Transduction • Transmission • Perception• Modulation

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Nociceptive Pain

Transduction of pain involves the changing of noxious stimuli in sensory nerve endings to energy impulses.

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Nociceptive Pain

Transmission of pain involves the movement of impulses from site of origin to the brain.• Reflex arc

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Reflex Arcs

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Transmission of Pain

Gate Control Theory of Pain• Recognizes the psychological aspects of

pain.• A gate control system serves to block the

individual’s s perception of pain.

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Gate Control Theory: Blocking Transmission of Pain

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Nociceptive Pain

Perception of pain occurs when the pain impulse has been transmitted to the cortex and the person develops conscious awareness of the intensity, location, and quality of pain.

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Nociceptive Pain

Modulation of pain refers to activation of descending neural pathways that inhibit transmission of pain.

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Factors Affecting the Pain Experience

Age and gender Stress and anxiety Previous experience with pain Cultural norms and attitudes

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Pain Assessment

Data Collection• Intensity• Location• Quality (radiating, burning, diffuse)• Associated manifestations• Aggravating factors• Alleviating factors

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Pain Assessment

Data Collection• Pain threshold is the level of intensity at

which pain becomes appreciable or perceptible and varies with each individual and type of pain.

• Pain tolerance is the level of intensity or duration of pain the client is willing or able to endure.

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Data Collection

Assessment Tools• Initial Pain Assessment Tool• Pain Intensity Scales• Pain Diary• Psychosocial Pain Assessment

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Data Collection

Developmental Considerations• Infants, children and adolescents• Older clients

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Nursing Diagnoses

Acute Pain Chronic Pain

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Outcome Identification and Planning

Planning focuses on mutual goal-setting to reach realistic outcomes.

Both nonpharmacologic and pharmacologic interventions are used in planning strategies to control or maintain clients at desired levels of functioning and pain.

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Implementation

Nurse-Client Relationship• Trust• Client Education

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Implementation

Principles of Pharmacologic Pain Management• Combine analgesics• Maintain therapeutic serum levels• Choose appropriate routes of administration

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Implementation

Principles of Pharmacologic Pain Management• Pain Medications

- Nonsteroidal anti-inflammatory drugs (NSAIDS)- Opioid analgesics- Local anesthesia

• Tolerance, Physical Dependence, and Addiction

• Respiratory Depression

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Implementation

Treatment of Neuropathic Pain• Focus of treatment is optimizing functional

abilities.• Medications

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Implementation

Cognitive-Behavioral Interventions• Distraction• Reframing• Biofeedback• Cutaneous stimulation• Transcutaneous stimulation

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Implementation

Complementary and Alternative Therapies• Acupuncture and acupressure• Herbs• Nutrition• Physical stimulation• Relaxation techniques• Environment manipulation

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Evaluation

Client’s facial expression and posture Presence (or absence) of restlessness Vital sign monitoring Ongoing use of pain assessment tools