PAIN Assessmen

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Pain

“An unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of such damage, or both.”

Theories of Pain

Gate Control Theory• According to Melzack and Wall’s gate control theory,

small diameter peripheral nerve fibers carry signals of noxious stimuli to the dorsal horn, where these signals are modified when they are exposed to the substantia gelatinosa that maybe imbalanced in an excitatory or inhibitory direction. It conceptualizes that there is gate in the spinal cord the substantia gelatinosa. When the gate is open, pain stimulus is transmitted, thus, pain is perceived. When the gate is closed, stimulus is blocked thus, no pain is perceived.

Specificity Theory• It states that there are specific nerve

receptors for particular stimuli.According to Rene Decartes,specific pain system carried messages directly from pain receptors in the skin in the brain.It is considered as an independent sensation with specialized peripheral sensory receptors, which respond to damage and send signals through pathways in the nervous system to target centers of the brain.

Pattern Theory• Consider that the peripheral sensory

receptors,responding to touch,warmth and other non-damaging as well as to damaging stimuli, give rise to non-painful or painful experiences as aresult of differences in the pattern of the signals sent through the nervous system.

Affect Theory• It avers that the pain is emotional. The intensity of pain

perceived depends on the value of the organ affected to the individual.

Parallel Processing Model• It believes that the physiologic or neurologic

deciphering of the pain sensation and the cognitive emotional properties occur

TYPES OF PAIN

ACUTE PAIN

• Short duration(less than 6 months)• Has identifiable and immediate onset

“fast pain”• Limited predictable duration (self-

limiting)• Reversible or controllable• Elicits sympathetic

symptoms(tachycardia, diaphoresis, guarding, tachypnea and focus on pain

CHRONIC PAIN

• Long term(usually more than 6 months)

• Continual, persistent and recurrent• Has identifiable cause, has qualities

of slow pain• More difficult to treat• Has sympathetic adaptation

VISCERAL PAIN

• Results from stimulation of pain receptors in the abdominal cavity, cranium and thorax

RADIATING PAIN• Pain perceived at the source but extends to nearby tissue

REFFERED PAIN

• Pain felt in a part of the body that is considerably remote from the tissues causing the pain

INTRACTABLE PAIN•Pain that is highly resistant to relief

NEUROPATIC PAIN

• Long lasting unpleasant with episode of sharp, shooting pain resulting from damage to peripheral nerves or CNS

PHANTOM PAIN• Pain perceived in a body part that is missing (amputated)or paralyzed

Pain Location

Assessment ToolPQRST Method• P = Provokes– What causes pain?– What makes it better?– Worse?

• Q = Quality– What does it feel like?– Is it sharp?– Dull?– Stabbing?– Burning?– Crushing?

• R = Radiates– Where does the pain radiate?– Is it in one place?– Does it go anywhere else?– Did it start elsewhere and now localised to one spot?

• S = Severity– How severe is the pain on a scale of 1 - 10?

• T = Time– Time pain started?– How long did it last?

C.O.L.D.S.P.A.  C-haracter • Describe the sign and symptoms. How does it feel,

looks, sound, smell, and so forth.O-nset • When did it begin?  L-ocation• Where is it? Does it radiate? D-uration • How long does it last? Does it recur? 

S-everity•  How bad is it? P-attern• What makes it better? What make it worse? A-ssociated factors/ How it   Affects the client• What other symptoms occur with it? How

does it affect you?

Nursing ManagementIndependent Nursing Care of the Patient with Pain

1. Techniques that stimulate the skin (enhance secretion of serotonin, a neurotransmitter that blocks transmission of pain impulses).

>Therapeutic touch. >Contralateral stimulation. >Vibration .>Heat and cold application.>Counterirritants (e.g. liniments, plasters).>Acupuncture/acupressure.>TENS (Transcutaneous Electrical Nerve Stimulation)

2. Techniques that Distract Attention – to close the gate (SG) by acting on the thalamus.

>Staring>Slow, rhythmic breathing>Recite, sing>Describe something in detail>Listen to music>Conversation>Read, play games>Busy oneself (chores, hobbies)>Favorite toy

3. Techniques that Promote Relaxation.a. Conventional Methods>Relax muscles.>Listen to music.>Guided imagery. >Meditation, Yoga, Biofeedback.>Biofeedback is conscious control of the physiologic

response under the control of ANS (Autonomic Nervous System) e.g. heart rate, BP, RR.

>Autogenic Training. b. Analgesic. Administer analgesic at the start of pain. It

is no longer effective when pain reaches its peak.c. Placebo. A non-organic substance that satisfies the

patient’s request for analgesic. It requires physician’s order.

Dependent Nursing Care of the Patient with Pain

• IV opioid via PCA is more effective with higher client satisfaction than intermittent IV bolus for pain relief.

• No opioid is superior to others, but some clients respond better to different opioids; therefore, the opioid should be selected per client response rather than one set opioid for all clients as in a standard protocol.

• Subcutaneous PCA opioids are as effective IV PCA opioids.

• Acute neuropathic pain occurs after trauma and surgery.