1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 20 Pain Management

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Definition of pain The process of pain –Transduction –Transmission –Perception –Modulation

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Phases of Pain

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? C-fibers carry impulses rapidly at a rate of approximately 5 to 30 meters per second.

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. C-fibers carry impulses at a slower rate of 0.5 to 2 meters a second. A-delta fibers, which are large myelinated fibers, carry impulses rapidly at a rate of approximately 5 to 30 meters per second.

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain (cont’d) Pain theories –Endogenous opioids oEndorphins oDynorphins oEnkephalins

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Mechanism of Pain Transmission and Interference

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain (cont’d) Types of pain –Cutaneous –Visceral –Neuropathic –Acute –Chronic

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Phantom limb pain belongs to which of the following categories of pain? a. Cutaneous b. Visceral c. Neuropathic d. Acute

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer c. Neuropathic Phantom limb pain is an example of neuropathic pain, which is often experienced days, weeks, or even months after the source of the pain has been treated and resolved.

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Somatic pain is discomfort that originates at the skin level.

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Somatic pain is discomfort generated from deeper connective tissue. Cutaneous pain is discomfort that originates at the skin level and is a commonly experienced sensation resulting from some form of trauma.

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Assessment Standards Pain: the fifth vital sign JCAHO standards Compliance with established standards of care

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins JCAHO Components of a Comprehensive Pain Assessment

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Assessment Data Components of brief or basic pain assessment Questions to be asked during admission assessment Underassessed and undertreated clients

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Pain Assessment

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Intensity Assessment Tools Four types of pain assessment tools –Numeric scale –Word scale –Linear scale –Picture scale Different scales for different ages

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Intensity Assessment Tools (cont’d)

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Management Treatment biases Pain management techniques Drug therapy –Nonopioid drugs –Opioid drugs

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins World Health Organization Analgesic Ladder

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Management (cont’d) Opioid drugs (cont’d) –Patient-controlled analgesia –Intraspinal analgesia Adjuvant drugs Botulinum toxin therapy

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Management (cont’d) Surgical approaches –Rhizotomy –Cordotomy

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Client and Family Teaching: Pain and Its Management

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Management (cont’d) Nondrug/nonsurgical interventions –Education –Imagery –Meditation –Distraction –Relaxation

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Management (cont’d) Nondrug/nonsurgical interventions (cont’d) –Heat and cold –Transcutaneous electrical nerve stimulation –Acupuncture and acupressure

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Pain Management (cont’d) Nondrug/nonsurgical interventions (cont’d) –Percutaneous electrical nerve stimulation –Biofeedback –Hypnosis

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Percutaneous Electrical Nerve Stimulation

28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications Various nursing diagnoses Addiction Placebos

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations Pain in older people Assessment of pain in older people –Fear and anxiety can cause them to endure pain –Downplaying of pain –Misleading data

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) Assessment of pain in older people (cont’d) –Older people with cognitive impairment Pain control measures for older people –Adverse effects of certain drugs

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) Pain control measures for older people (cont’d) –Topical application of heat –Determining appropriate route for individual medication administration –Increased sensitivity to narcotics among older people

32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Older adults are less sensitive to pain stimuli.

33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Age-associated changes in pain perception, sensitivity, and tolerance affect the experience of pain in older adults. Therefore, it is a dangerous assumption to believe that older adults are less sensitive to pain stimuli.