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Nursing Care of Clients Experiencing Pain. Pain Pathway A-delta fibers: transmit pain quickly, associated with acute pain C-fibers: transmit pain more.

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Presentation on theme: "Nursing Care of Clients Experiencing Pain. Pain Pathway A-delta fibers: transmit pain quickly, associated with acute pain C-fibers: transmit pain more."— Presentation transcript:

1 Nursing Care of Clients Experiencing Pain

2 Pain Pathway A-delta fibers: transmit pain quickly, associated with acute pain C-fibers: transmit pain more slowly, diffuse burning pain and chronic pain Inhibitory mechanisms: the analgesia system stimulates a pain inhibitory center in the dorsal horns of the spinal cord (the exact mechanism is unknown) Endorphins: naturally occurring opioid peptides present in the neurons in the brain

3 Pain Pathway

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6 Acute, Chronic, Central, Phantom, and Psychogenic Pain Acute Pain – Somatic Pain May be sharp or diffused May be accompanied by nausea and vomiting – Visceral Pain Arises from the body organs Usually dull and poorly localized May be referred or may radiate – Referred Pain Perceived in an area distant from the site of the stimuli

7 Acute, Chronic, Central, Phantom, and Psychogenic Pain

8 Chronic Pain – Recurrent Acute Pain Well-defined episodes of pain Migraine headaches, sickle cell crisis – Ongoing Time-limited Pain Persists for a definite time period Ends with control of the disease, rehabilitation, or death

9 Acute, Chronic, Central, Phantom, and Psychogenic Pain Chronic Pain – Chronic Nonmalignant Pain Not life-threatening but persists past expected time for healing – Chronic Intractable Nonmalignant Pain Syndrome Client unable to cope well with the pain Pain may be mild to severe The pain itself becomes the pathologic process

10 Acute, Chronic, Central, Phantom, and Psychogenic Pain Central Pain – May be caused by a vascular lesion, tumor, or inflammation Phantom Pain – Thought to be due to stimulation of severed nerves at the amputation site Psychogenic Pain – Involves a long history of severe pain – The pain is real and can lead to physiologic changes

11 Factors Affecting Pain Response Age Sociocultural influences Emotional status Past experiences with pain Meaning associated with the pain Lack of knowledge

12 Myths and Misconceptions Concerning Pain Pain is a result, not a cause Chronic pain is really a masked form of depression Narcotic medication is too risky to be used for chronic pain It is best to wait until a client has pain before giving medication Many client’s lie about the existence or severity of pain Pain relief interferes with diagnosis

13 Collaborative Care for Pain Medications – NSAIDs: analgesic, antipyretic, and anti- inflammatory action – Narcotics: opioids – Antidepressants: act on the retention of serotonin, thus inhibiting the pain sensation – Anticonvulsants: used for headache and neuropathic pain – Local anesthetics: blocks the transmission of nerve impulses, therefore blocking pain

14 Collaborative Care for Pain

15 Surgery – Cordotomy: an incision into the anterolateral tracts of the spinal cord to interrupt the transmission of pain – Neurectomy: removal of part of the nerve – Sympathectomy: destruction of the ganglia by incision or injection – Rhizotomy: surgical severing of the dorsal spinal roots – Transcutaneous electrical nerve stimulation (TENS): electrodes stimulate the A-beta touch fibers to close the “pain” gate

16 Collaborative Care for Pain

17 Complementary Therapies – Acupuncture – Biofeedback – Hypnotism – Relaxation – Distraction – Cutaneous stimulation

18 Nursing Process for Clients with Pain Assess the client’s pain level Establish a nursing diagnosis Plan and implement a care plan Educate the client Evaluate the patient’s response to the care plan

19 Nursing Process for Clients with Pain

20 Resources Evidence Report/Technology Assessment Pain assessment and management of cancer pain. Evidence Report/Technology Assessment American Cancer Society Principles of pain management in the treatment of acute and chronic pain. American Cancer Society Department of Veterans Affairs Pain as the 5th vital sign. Department of Veterans Affairs

21 Resources The Joint Commission Type in “pain management standards” in the search box. Be sure to use quotation marks. The Joint Commission American Society for Pain Management Nursing Provides information for nurses on pain management through education, standards, advocacy, and research. American Society for Pain Management Nursing

22 Resources American Pain Foundation Handles the undertreatment of pain. American Pain Foundation American Pain Society A wide range of resources on pain at this professional site, including bulletins, journals, advocacy/policy, events and guidelines. American Pain Society American Academy of Pain Management Serves professionals and clients in pain, including an online forum, local resources, programs, and a pain management databank. American Academy of Pain Management

23 Resources American Chronic Pain Association Offers support and information for people with chronic pain through support and education. Includes FAQs, links, and resources. American Chronic Pain Association Agency for Healthcare Research and Quality Offers pain management guidelines, resources, and research citations. Agency for Healthcare Research and Quality


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