1. What is pain? According to the International Association for the Society of Pain, Pain is: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. http:/www.iasppain.orgContentNavigationMenuGeneralResourceLinks/ PainDefinitions/default.htm

2. “Pain can be due to a wide variety of diseases, disorders and conditions that range from a mild injury to a debilitating disease”. http://www.localhealth.com/article/pain Aetiology: What causes pain?

3. Aetiology

4. Acute & Chronic Pain “The terms acute and chronic refer exclusively to the time course of the pain, irrespective of aetiology” (Craft, Gordon, and Tiziani, 2011, p.144). Acute Pain: Acute pain refers to any pain that lasts less than 3 months. Usually has a predicable ending (healing). Examples: Aching muscles after exercise, cut to the finger, broken bone.

5. Chronic Pain: Chronic Pain is a “persistent or recurring pain that continues for more than 3 months” (Bryant & Knights, 2011, p.281). Usually prolonged, recurring or persisting over a long period time. Examples include: arthritis and back pain

6. Another way to categorise pain is to refer to the pathophysiology of pain: Nociceptive Neuropathic Psychogenic

7. Nociceptive: Most common type of pain. Typically described as sharp and well localised. Caused by irritation of the peripheral sensory nerves. (Glouke, 2003, p. 444)

8. Nociceptive: External: Most common, pain usually involves trauma to the skin but may extend to the underlying tissues. Usually lasts from a few seconds to a few days. Internal Less common and usually more severe. It has numerous causes, eg severe trauma due to bone fractures, surgery or childbirth. Virtually a symptom of all diseases at some point during disease progression. Usually lasts few days to weeks.

9. Neuropathic Pain Injury or disease of the central nervous system rather than the peripheral tissue. Usually lasts between a few months to many years. Difficult to treat due to the lack of knowledge of the underlying cause. May occur in the presence of a neurological deficit May be unaccompanied by ongoing tissue damage. May occur in an area of sensory loss. May be burning, shooting or pins and needles (not sharp like nociceptive).

10. Psychogenic Pain Severe and persistent pain but for which there appears to be no underlying pathology. Pain experienced (Headaches, abdominal pain, back pain) is indistinguishable from that experienced by people with identifiable injuries or diseases. This kind of pain can be very frustrating to sufferers and can interfere with their ability to function normally.

11. Clinical Manifestations of Pain “No two people are likely to experience the same level of pain for a given painful stimulus” (Craft et al., 2011, p.150). Pain Tolerance: “Maximum amount of painful stimuli that a person is willing to withstand without seeking avoidance of the pain or relief” (Berman et al., 2010, p.1249). What affects Pain Tolerance? Fatigue, anger, boredom, apprehension, sleep deprivation. Alcohol consumption, medication, hypnosis, warmth, distracting activities and strong beliefs or faiths.

12. Pain tolerance is influenced by a number of factors including; Age Cultural perceptions Expectations Gender Physical and mental health

13. Age: Different reaction to pain Understanding of pain Gender: “Females display greater sensitivity to pain than males do. There are differences in the way women cope with pain, report pain and respond to pain” (Crisp & Taylor, 2009, p.1096). Physical & Mental Health Physical mobility Depression, difficulty coping, fatigue.

14. Cultural Variations: Cultures vary in the meaning of pain, how if it expressed and how it is treated: Meaning Expression Treatment

15. Pain Threshold Pain Threshold is the “lowest intensity at which a stimulus is perceived as pain and may be influenced by genetics” (Craft et al., 2011 p.150).

16. Location: It is important record a patients pain location to be able to monitor any changes. Pain can feel like it is coming from one part of the body but in fact it is another, this type of pain is called referred pain.

17. Signs and Symptoms: “Pain elicits a stress response in the human body, triggering the sympathetic nervous system, resulting in physiological responses” (Weber 2010 p. 93) When someone is in pain they may: Scream, cry, jump around, swear, change facial expressions. Patient may describe pain as: Sharp, stabbing, Dull, achy, burning, pins & needles sensation. Patients may experience an increase in: Temperature, Blood pressure, Ventilation, Nausea vomiting, Sweating, Anxiety, fear, fatigue, insomnia, suicidal thoughts.

18. Case Study Name: David Age: 30 Gender: Male Summary: Sustained an injury to his calcanium in his left foot after falling from a height of 3 metres at work. Vital signs: B/P: 120/70 Temperature: 36.6 Pulse: 120 Respirations: 22 Sao2: 100%

19. What are the possible aetiologies of David’s pain? Injury to left heel bone caused by injury at work where he fell 3 metres. Already had previous injury in his ankle from playing football a year ago (Not sure what else to write here…..)

20. What are the physiological manifestations of the signs and symptoms David s experiencing? Swelling Numbness Tenderness Pain Decreased mobility Tachycardia Shock? (If you can think of any more please add)

21. Questions for quiz: What is the difference between Chronic and Acute pain? What are the 3 types of pain? List 3 factors that influence pain

22. References Berman, A., Snyders, S., Kozier, B., Erb, G., Levert-Jones, T., Dwyer, T.,… Stanley, D. (2010). Kozier & Erb’s fundamentals of nursing. (1 st Australian ed.). Sydney: Pearson & Prentice Hall. Bryant, B., & Knights, K. (2011) Pharmacology for Health Professionals (3 rd ed.). Chatswood NSW: Elsevier Mosby. Crisp, J., & Taylor, C. (2009) Potter & Perry’s fundamentals of nursing (3 rd ed.). Chatswood, NSW: Elsevier Mosby. Craft, J., Gordon, C., & Tiziani, A. (2011) Understanding pathophysiology. Chatswood NSW: Elsevier Mosby. Glouke, R. C., (2003) The Management of persistent pain. Medical Journal of Australia, 178(9), 444-447. Loeser, D. (2011) IASP Taxonomy. Retrieved from http://www.iasp- pain.org/Content/NavigationMenu/GeneralResourceLinks/PainDefinitions/default.htmhttp://www.iasp- pain.org/Content/NavigationMenu/GeneralResourceLinks/PainDefinitions/default.htm Weber, J. R., (2010) Nurses’ handbook of health assessment. ( 7 th ed.). Sydney: Woters Kluwer Health / Lippincott Williams & Wilkins. Williams, R. (2011) Pain. Retrieved from http://www.localhealth.com/article/painhttp://www.localhealth.com/article/pain