Pain Management

1
Pain Management
2
What is pain?

• One of the most common reasons people seek
  healthcare
• One of the most widely under-treated health
  problems

3
Pathophysiology

• A sensation caused by some type of noxious
  stimulation
• A pattern of responses that function to protect
  the individual from harm
• Whatever the experiencing person says it is
  whenever he says it does

4
Components of Pain

• Physical
• Caused by some kind of noxious stimulant
• Emotional
• Results of combination of thoughts, feelings, and
  beliefs
• Behavioral
• Pattern of responses that function to protect the
  individual from further harm

5
Causes of Pain

• Cutaneous
• Direct stimulation to skin (cut)
• Somatic
• From musculo-skeletal system (sprained muscle)
• Visceral
• Arising from hollow organs (appendicitis)

6

• Neuropathic
• Damage to nervous system
• Referred
• Pain arising from someplace else in body

7
Descriptions of pain

• Chronic occurring over a long period of time
• Acute sudden, brief onset

8
Visual Analog Scale

• This is a line 10 cm. long (about 4 inches) that
  is divided into ten divisions. Patients are
  asked to show the amount of pain on a 1-10 scale.
• Researchers say that patients cannot function
  with a scale with more than ten points.

9
PQRST

• This mnemonic is devised to show the steps in
  pain assessment
• Provoking factors
• Quality
• Region/Radiation
• Severity/Symptoms
• Timing

10

• Provoking factors include what caused the pain
  and what might be making it worse
• Quality questions refer to how the pain feelslet
  the patient tell but offer suggestions if
  necessary, like sharp, dull, throbbing, burning,
  etc.

11

• Region.have patient point to area that hurts
• Severity can be measured with the pain rating
  scales
• Symptoms may accompany the pain.nausea,
  vomiting, etc
• Timing refers to when the pain started, how long
  it lasts

12
Be aware

• Just because a patient cannot respond to pain
  doesnt mean there is no pain
• Activities of daily living (ADLs) may be effected
• Neurological status will alter the response to
  pain

13
Pain Management

• Management must be timely,
• individualized,
• and bring the pain to an acceptable level of
  tolerance

14
Pharmacologic interventions

• Must be individualized
• Three main categories
• Non-opioids
• Opioids
• Adjuvants

15

• Non-opioids
• Acetominophen (Tylenol)
• Aspirin
• NSAIDs (Advil)
• Opioids
• Weak ? Strong
• Codeine ? Hydromorhone
• Oxycodone ? Morphine
• Vicodin ? Merperidine
• Adjuvants
• Primary function is not pain relief but provide
  relief
• May modify mood so patient feels better

16
Precautions to giving pain medications

• Medication choice may depend on practitioners
  preference, however
• Should not give two analgesics from same class at
  same time
• Must be aware of effects of medications
• Must watch for allergic reactions

17
Routes of medication administration

• Oral
• Injection
• Intravenous (includes PCA)
• Epidural
• Rectal
• Topical

18
WHO Pain Ladder
SEVERE PAIN Keep giving mild pain medication
and add a strong opioid such as morphine or
Fentanyl
MODERATE PAIN Keep giving mild pain medication
and add a mild Opioid such as codeine
MILD PAIN Aspirin, ibuprophen Acetominophen,
naprosyn
19
Concepts of WHO Pain Ladder

• By the mouth
• By the clock
• By the ladder
• For the individual
• With attention to detail

20
Placebos

• Controversial use of an inactive substance to
  satisfy the demand for medication

21
Non-pharmacologic interventions

• Pain control without using medications
• Alter the environment
• Relaxation and guided imagery
• Meditation
• Cutaneous stimulation
• Massage, acupressure, acupuncture, TENS
• Biofeedback
• Therapeutic touch
• Education

22
JCAHO Standards for Pain Management

• Address care at the end of life
• Assess and manage pain appropriately
• Assess pain in all patients
• Support safe medication ordering and
  administration

23

• Monitor patient during post-procedure period
• Rehabilitate for optimal level of function
• Educate about pain an managing pain
• Plan for discharge continued care if needed
• Collect data to monitor performance

24

• Nurses spend more time with patients than any
  other provider. They must stay informed in order
  to give the best care to their patients.

25

• References
• Falk. Kim Marie. Pain Management. National
  Center of Continuing Education. Catalog 98 TX.
• http//www.fxbcenter.org/caring/painladder.html
• http//www.harcourthealth.com/Mosby/Wong/fyi_03.ht
  ml