Meeting the Special Needs of the Patient. Pain Management

2.  Pain is a unpleasant sensation.
 Nurse can neither feel nor see a client‟s
pain.
 Effective pain management is an important
aspect of nursing care.
 Pain presents both physiologic and
psychological dangers to health and
recovery.
 Severe pain is viewed as an emergency
situation.

3. "An unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage, or
described in terms of such
damage. {IASP}

4.  Pain is universal, subjective, and it is
one of the body‟s defense
mechanisms.
 Unrelieved pain possess both
physiologic and psycho logic dangers
to health and recovery.

5.  Pain may be described in terms of duration,
location and etiology,
 Acute pain / Chronic pain
 Cutaneous pain / Deep Somatic Pain/ Visceral
Pain.
 Radiating Pain / Referred Pain
 Intractable pain
 Neuropathic pain / Phantom pain

6.  Acute Pain – When pain lasts only
through the expected recovery period..
Whether it has sudden or slow onset and
regardless of the intensity.
 Chronic Pain – Is Prolonged, usually
recurring or persisting over 6 months or
longer, and interferes with functioning.
Chronic Pain
Chronic Malignant Pain / Chronic Non – Malignant Pain

7. Cutaneous Pain- Originates in the
skin or subcutaneous tissue. Eg.
Paper cut
Deep Somatic Pain – Arises from
ligaments, tendons, bones, blood
vessels, and nerves. Eg. Ankle sprain
Visceral Pain – Results from
stimulation of pain receptors in the
abdominal cavity, cranium and
thorax. Eg. Ischemia or Muscle
Spasm.

8. Radiating Pain – is perceived as
the source of the pain and
extends to nearby tissues. Eg.
Cardiac Pain
Refered Pain – is felt in a part of
the body that is considerably
removed from the tissues causing
the pain.
Intractable Pain – is a pain that is
highly resistant relief.

9. Neuropathic Pain – Is the result of
current or past damage to the
peripheral or central nervous
system and may not have a
stimulus such as tissue or nerve
damage, for the pain.
Phantom Pain – Which is a painful
sensation perceived in a body part
that is missing.

10.  3 Components of pain are Reception,
Perception and Reaction.
Cellular Damage (due to stimuli)
•Release of pain producing substances
Pain producing substances combines with receptor sites on
Nociceptors to initiate neural transmission associated with a pain

11. Nerve impulse travel through afferent nerve
• Nerve impulse travel from periphery to the dorsal horns of the
spinal cord
Excitatory neurotransmitter substance P is released
• Pain stimulus travel through spinothalamic tract, cross to
opposite side of the spinal cord and travels upto spinal cord
From spinal cord impulse is quickly send to higher
centers in the brain.

12. A Protective reflex
response with pain
reception.

13. Perception is the point at which a
person is aware of pain.
Reaction
The reaction to pain is the physiological and
behavioral responses that occur after pain is
perceived, eg. Crying or moving away from
the painful stimulus.

14.  Mc Lazack and Wall’s Gate Control
Theory (1965).

15.  Pain - an unpleasant sensory and emotional
experience associated with actual or potential
tissue damage.
 Analgesia - the selective suppression of pain
without effects on consciousness or other
sensations.
 Nociceptors - sensory receptor whose
stimulation causes pain
 Pain threshold: the point at which a stimulus is
perceived as painful.
 Phantom limb pain – feelings of pain in a limb
that is no longer there and has no functioning
nerves.
 Sensation – the process of receiving,
converting, and transmitting information from
the external and internal world to the brain.

16.  The three systems located in the spinal
cord act to influence perception of pain, viz;
1. The substantia gelatinosa in
the dorsal horn,
2. The dorsal column fibers, and
3. The central transmission cells.

17.  The noxious impulses are influenced by a
“gating mechanism.
 ” Stimulation of the large-diameter fibers
inhibits the transmission of pain, thus
“closing the gate.”
 Whereas, when smaller fibers are stimulated,
the gate is opened.
 When the gate is closed signals from small
diameter pain fibres do not excite the dorsal
horn transmission neurons.
 When the gate is open pain signals excite
dorsal horn transmission cells.
 The gating mechanism is influenced by nerve
impulses that descend from the brain.

18.  Gate is opened by
› Physical Factors - Bodily injury
› Emotional Factors - Anxiety & Depression
› Behavioural Factors - Attending to the injury and
concentrating on the pain
 Gate may be closed by:
› Physical Pain - Analgesic Remedies
› Emotional Pain - Being in a „good‟ mood
› Behavioural Factors - Concentrating on things
other than the injury

19.  Pain assessment is very essential since
pain is considered as a Fifth Vital Sign.
 Nurses needs to assess all factors
affecting the pain experience.
 Pain assessment varies according to the
client situation.
 Pain assessment consists of two main
components.

20. Pain History & Direct observation of
physiologic and Behavioral response of
the client are the two components of
pain assessments.
Pain History
Client must explain the pain in her own
words.

21. OLDCART
O – Onset
L – Location
D – Duration
C – Characteristics
A – Aggravating Factor
R – Radiation
T - Treatment

25.  Acute Pain related to physical injury,
reduction of blood supply, process of giving
birth
 Chronic Pain related to the malignancy
 Anxiety related to pain that is felt
 Ineffective individual coping
related to chronic pain
 Impaired physical mobility related to
musculoskeletal pain Risk for injury
related to lack of perception of pain

26. Increase knowledge
 Explain the causes of pain to the individual, if
known.
 Linking how long the pain will last, if known.
 Explain diagnostic tests and procedures in
detail with a connecting discomfort and
sensation will be felt, and the estimated
duration of pain occur.

27.  Provide accurate information to reduce
fear. Connect your acceptance of
individual response to pain.
› Recognizing the existence of pain.
› Listen with full attention on the pain.
› Shows that the pain you are because you
want to understand better (not to
determine if the pain is really there).

28.  Provide opportunities for individuals to rest
during the day and time of uninterrupted
sleep at night.
 Talk with individuals and families use
distraction therapy, along with other
methods to reduce pain.
 Teach methods of distraction for acute
pain, with regular breathing. Teach
noninvasive pain reduction

29. Give the individual the opportunity
to talk about fear, anger, and
frustration in place, difficulty
understanding the situation.
Give encouragement of
individuals to talk about the pain
experience.

30.  Use of Opioids {Narcotics}, Non-opioids /
Non-steroidal anti-inflamatory drugs
(NSAIDS)
 Opioids – e.g., Morphine Sulfate
 Non –Opioids – e.g., Diclofenac Sodium
 Adjuvants – e.g., Diazepam

31.  Physical Interventions – Massage,
Application of heat and Cold,
Accupressure etc.
 Immobilization
 Transcutaneous Electrical Nerve
Stimulation (TENS)
 Distraction -