Concepts of Pain

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Concepts of Pain

• Mary Ellen Santucci DNSc, RN
• Nursing II
• Rutgers University

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Pain Tolerance

• Individuals ability to withstand a painful
  stimulus without demonstrating physical signs of
  pain.

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Components of the pain experience

• Stimulus
• Perception
• Response

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Responses to pain

• Histamine
• Sweating
• Heart Rate
• Blood Pressure
• Guarding
• Change in Mental Status

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Factors influencing perception and response to
pain

• Past Experience
• Culture
• Anxiety
• Depression
• Age
• Religious Beliefs

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Pain Threshold
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The Gate Theory of Pain Transmission

• Data suggests that when the large A neurons
  carrying skin tactile information are stimulated
  at the same time that the A and C fibers are
  transmitting painful stimuli, a lateral
  inhibition of the cells in the dorsal spine can
  occur producing some degree of analgesia.

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Types of Pain

• Acute
• Chronic
• Superficial/somatic
• Deep somatic/visceral
• Neurogenic
• Psychogenic
• Referred

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Acute Pain

• Characterized by increased heart rate, increased
  respirations,facial grimacing, withdrawal,
  crying, dilated pupils and sweating.
• Immediate and having a definite cause

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Chronic pain

• Associated with a return of heart and respiratory
  rate to normal.
• Pain without a definite cause lasting greater
  than 6 months.
• Depression and despair may develop

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Superficial/Somatic Pain

• Pain felt on the skin or in subcutaneous tissues
• Well localized over a dermatome a
• Transmitted rapidly

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Deep Somatic/Visceral

• Deep somatic pain is pain arising from bones,
  joints, tendons, skeletal muscle, blood vessels
  and deep nerve pressure. It is slow may and may
  radiate along a nerve route
• Visceral pain is pain in the abdominal and/or
  thoracic cavity. It is typically severe.

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Neurogenic Pain

• A type of chronic pain
• Can be numbing but can also be a burning
  sensation along a nerve pathway.
• Difficult to treat

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Psychogenic pain

• Caused by a psychiatric abnormality
• Occurs for no known reason but it seems to worsen
  during times of exacerabation of psychotic
  symptoms.
• It is real pain

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Referred Pain

• Pain perceived as coming from an area different
  from that in which the pathology is occurring.

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Care of the Client Experiencing Pain

• Assessment
• Subjective data
• Objective data

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Subjective Data

• The nature of pain is very subjective.
• Intensity
• Duration
• Quality
• Frequency
• Pain is what the client says it is!!!!!!!!!

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Objective Data

• Vital signs
• Guarding
• Facial Grimace
• Pallor
• Perspiration

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Planning and Interventions for Pain Relief

• Reducing anxiety and fear
• Planning for Rest
• Providing distraction
• Reducing Sensory Overload
• Decreasing noxious stimuli
• Relaxation techniques
• Guided imagery

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Planning Continued

• Therapeutic touch
• Referrals
• Pharmacotherapeutics
• Acupuncture
• Neurosurgical procedures
• Behavioral techniques
• Stimulation therapy

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Issues in Pain Management

• Problems of pain in children
• Assessment
• Interventions
• Problems of pain in adults
• Assessment
• Interventions