1. PAIN

2. Pain
Is unpleasant sensory and emotional experience associated with actual and potential tissue damage.
It is considered the fifth vital sign.
It is one of the human body defense mechanisms that indicates the person is experiencing problem.

3. Sources of Pain
Nociceptive: pain that is usually transmitted after normal processing of noxious stimuli
Cutaneous (superficial): usually involves the skin or the subcutaneous tissue
Somatic: is diffuse or scattered and originates in tendons.
Visceral: is poorly localized and originates in body organs
Neuropathic: results from injury or abnormal functioning of peripheral nerves or CNS
Psychogenic: unknown physical cause

4. PAIN PHYSIOLOGY OF PAIN SOURCES Chemical/Thermal PAIN RECEPTORS
Injury, Inflammation
Heat, Cold
PAIN RECEPTORS
(Nociceptors)
Histamine, Bradykinin, Serotonin, E-prostaglandin
DISCHARGE IMPULSES
Electrical Activity to spinal cord and onto the Brain
BRAIN = Electrical activity becomes the experience of
PAIN

5. Duration of pain
Acute pain: generally rapid in onset, varies in intensity from mild to severe, lasts from brief period to less than 6 months
Chronic pain: may be limited, intermittent or persistent but lasts for 6 months or longer and interferes with normal functioning.
Remission: when the pain present but the patient does experience symptoms
Exacerbation: reappear of symptoms
Intractable pain: resistant pain to therapy, and persists despite a variety of interventions

6. Origin of Pain Physical cause — cause of pain can be identified
Psychogenic — cause of pain cannot be identified
Referred — pain is perceived in an area distant from its point of origin

7. Perception of Pain
Pain threshold: is the lowest intinsity of stimulus that causes the subject to recognize pain
Adaptation
Modulation of pain
Neuromodulators
Endorphins, dynorphins enkephalins

8. Common Responses to Pain
Physiologic: ↑BP, ↑HR,↑RR, pupil dilation, muscle tension and tension rigidity, pallor, ↑adrenaline level, ↑blood glucose
Behavioral: moving from painful stimuli, grimacing, moaning, crying, restlessness, protecting painful area
Affective: exaggerated weeping, withdrawal, anxiety, depression, fear, anger, anorexia, fatigue, hopelessness, powerlessness.

9. Factors Affecting Pain Experience
Culture
Ethnic variables
Family, gender, and age variables
Religious beliefs
Environment and support people
Anxiety and other stressors
Past pain experience

10. General Assessments of Pain
Patient’s verbalization and description of pain
Duration of pain
Location of pain
Quantity and intensity of pain
Quality of pain
Chronology of pain
Aggravating and alleviating factors
Physiologic indicators of pain
Behavioral responses
Effect of pain on activities and lifestyle

11. Pain Assessment Tools

12. Pain assessment tools WILDA Scale Words that describe the pain
Intensity of pain
Location of pain
Duration of pain
Aggravating or alleviating factors

13. Diagnosing Pain Type of pain Etiologic factors
Behavioral, physiological, affective response
Other factors affecting pain process

14. Nursing Interventions for Pain
Establishing trusting nurse-patient relationship
Initiating nonpharmacologic pain relief measures
Considering ethical and legal responsibility to relieve pain
Teaching patient about pain

15. Manipulating Pain Experience Factors
Remove or alter cause of pain
Alter factors affecting pain tolerance
Initiate nonpharmacologic relief measures

16. Nonpharmacologic Pain Relief Measures
Distraction
Humor
Music
Imagery
Relaxation
Cutaneous stimulation
Acupuncture
Hypnosis
Therapeutic touch

17. Pharmacologic Pain Relief Measures
Analgesic administration
Nonopiod analgesics e.g. NSAIDs
Opioids or narcotic analgesics
Adjuvant drugs e.g. anticonvulsants, antidepressants, ..

18. Why clients may be reluctant to report pain:
Unwillingness to trouble staff who are perceived as busy
Fear of injectable route of analgesic administration
Belief that pain is to be expected as apart of the recovery process
Belief that pain is a normal part of aging
Belief that expression of pain reveal weakness
Concerns about side effects and risks especially of opioid drugs

19. Additional Methods for Administering Analgesics
Patient controlled analgesia
Epidural analgesia
Local anesthesia