Pain Management

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Pain Management

• Module E (Lecture)

2
Objectives

• Identify types and categories of pain to
  location,etiology, and duration
• Identify subjective and objective data to collect
  and analyze when assessing pain
• Identify examples of nursing diagnosis for
  clients with pain
• State outcome criteria by which to evaluate a
  clients response to interventions for pain.

3
Objectives

• Identify barriers to effective pain management
• Describe non-pharmacologic pain control
  interventions
• Describe pharmacologic interventions for pain

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Nature of Pain

• An unpleasant sensory and emotional experience
  associated with actual or potential damage or
  described in terms of such damage (International
  Association for the Study of Pain, 1979).

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Types of Pain

• Acute Pain- pain lasting only through the
  expected recovery period.
• Chronic Pain- lasts beyond the usual course for
  recovery (six months duration).

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Continued

• Pain can be categorized according to its origin
• Cutaneous
• Deep somatic
• Visceral

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Continued

• Radiating
• Referred
• Intractable
• Neuropathic
• Phantom

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Pain Syndromes

• Central Pain Syndromes
• Trigeminal neuralgia
• Peripheral Pain Syndromes
• Post-herpetic Neuralgia
• Phantom Limb Pain

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Pain with Underlying Pathology Syndromes

• Headache- common somatic pain either intracranial
  or extra-cranial.
• Cancer Pain Syndrome Progression
• of the disease or from efforts to cure or
  control disease.
• Myofacial Pain Syndrome

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Concepts Associated with Pain

• Pain Threshold
• Pain Sensation
• Pain Reaction
• Pain Tolerance

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Gate Control Theory

• According to theory, peripheral nerve fibers
  carrying pain to the spinal cord can have their
  input modified at the spinal cord level before
  transmission to the brain.

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Continued

• Ascending Modulation
• Large diameter sensory fibers, message, heat and
  cold applications
• Transcutaneous electrical nerve stimulation
  (TENS) unit, electrical stimulation is applied to
  skin
• Descending modulation

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Factors Affecting the Pain Experience

• Ethnic and Cultural Values
• Developmental Stage
• Environment and Support People

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Continued

• Past Pain Experience
• Meaning of Pain
• Anxiety and Stress

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Why clients may be reluctant to report pain

• Unwillingness to trouble staff
• Fear of injectable route of analgesic
  administration
• Belief that pain is to be expected as part of
  recovery
• Concern about addiction

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Continued

• Fear about cause of pain or that reporting pain
  will lead to further tests and expenses
• Concern about unwanted side effects, especially
  of opioid drugs
• Difficulty expressing personal discomfort

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Pain Assessment

• Accurate pain assessment is essential for
  effective pain management. Pain is subjective and
  experienced uniquely by every individual, nurses
  need to assess all factors affecting the pain
  experience.

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Pain History

• Previous pain treatment and effectiveness
• When and what analgesics were last taken
• Allergies to medications, other medications being
  taken

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Continued

• Location (abdomen)
• Intensity (scale of 0-10)See figures 43-7 and
  43-8, pgs 1090-1091)
• Quality (perceiving like a knife)
• Pattern (onset, duration, and recurrence of
  intervals without pain.

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Continued

• Precipitating Factors (Environmental factors,
  heat or cold)
• Alleviating factors (herbal teas, rest, t.v.,
  prayer)
• Associated Symptoms (N/V, dizziness, diarrhea)
• Effects on ADLS (Sleep, appetite, concentration,
  school, work, driving, walking)

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Continued

• Coping resources (prayer or other religious
  practices)
• Affective Responses (nurse to explore feelings)
• Observation of Behavioral and Physiologic
  Responses

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Barriers to Pain

• Misconceptions and biases
• Clients respond to pain based on their culture,
  personal experiences and the meaning the pain has
  for them.
• Clients may not report pain because they expect
  nothing to be done, they think it is not severe
  enough, or because they feel it would distract or
  prejudice the healthcare provider.

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Key Factors in Pain Management

• Acknowledging and accepting
• Assisting Support Persons
• Reduce misconceptions about pain
• Reducing fear and anxiety
• Preventing Pain

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Individualizing Care for Clients with Pain

• Establish a trusting relationship
• Consider the clients ability and willingness to
  participate actively in pain relief measures
• Use a variety of pain relief measures
• Provide measures to relieve pain before it
  becomes severe.

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Continued

• Use pain relieving measures that the client
  believes are effective
• Base the choice of pain relief measure on the
  clients report of he severity of the pain
• If a pain relief measure is ineffective encourage
  the client to try it once or twice before
  abandoning it

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Continued

• Maintain an unbiased attitude about what might
  relief the pain
• Keep trying
• Prevent harm to the client
• Educate the client and support people about pain.

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Pharmacologic Pain Management

• Involves the use of opioids (narcotics)
• Nonopioids/NSAIDS (nonsteroidal antiinflammatory
  drugs)
• Adjuvants or Coanalgesic Drugs (See box on pg
  1098)

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Opioid Analgesics

• Opium derivatives (M.S., and Codeine)
• Relieve pain and provide a sense of euphoria
  binding to opiate receptors and activating
  endogenous pain suppression in the CNS.
• MU, Delta, and Kappa receptors (opiate receptors)

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Types of Opioids

• Full agonist- MS, Demerol, Codeine, Darvon,
  Dilaudid- their doses can be increased to relieve
  pain.
• Mixed agonist-antagonist
• Partial agonists

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NONPHARMOCOLOGIC PAIN MANAGEMENT

• Physical Interventions-Provide Comfort
• Cutaneous Stimulation-Massage, application of
  heat or cold, acupressure
• Contralateral Stimulation
• Immobilization
• Distraction (visual, auditory, tactile,
  intellectual)

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Transcutaneous Electrical Nerve Stimulation

• TENS is a method of applying low voltage
  electrical stimulation directly over identified
  pain areas, at an acupressure point, along
  peripheral nerve areas that innervate the pain
  area, or along the spinal column.

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Pain Evaluation

• The nurse and client must determine if overall
  goals and outcomes are achieved.
• Flow sheet records and diaries are helpful in
  this process, to evaluate the effectiveness of an
  analgesic.