Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 43 Pain Management

2 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Survival  I will survive I will survive I will survive

3 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Nature of Pain  Involves physical, emotional, and cognitive components  Physical and/or mental stimulus  Is exhausting and demands energy  Interferes with relationships

4 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Physiology of Pain TransductionTransmission PerceptionModulation

5 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Pain is in the Brain Pain

6 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Gate Control  Nonpharmacological relief=Gate closed  Gate open=pain transmission  Nonpharmacological interventions

7 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

8 Types of Pain Acute/transient pain Protective, identifiable, short duration Chronic/persistent Is not productive and has no purpose or may not have identifiable cause Chronic episodic Occurs sporadically over an extended duration Cancer Can be acute or chronic Inferred physiological Musculoskeletal, visceral, or neuropathic Idiopathic Chronic pain without an identifiable physical or psychological cause

9 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Knowledge Base  Attitude of health care providers  Fabricator or complainer  Assumptions about clients in pain  Biases based on culture, education, experiences

10 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Factors Influencing Pain  Physiological  Age, fatigue, genes, neurological function  Social  Attention, previous experiences, family and support groups  Spiritual

11 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

12 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Factors Influencing Pain (cont.)  Psychological  Anxiety, coping style  Cultural  Meaning of pain, ethnicity

13 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Process and Pain  Pain management needs to be systematic.  Pain management needs to include the client’s quality of life.  Clinical guidelines are available to manage pain.  American Pain Society  National Guideline Clearing House

14 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Assessment  Client’s expression of pain  Characteristics of pain  Onset and duration  Intensity  Pattern  Contributing symptoms  Behavioral effect

15 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

16 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

17 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Assessment (cont.)  Location  Quality  Relief measures  Effect of pain  Influence on ADLs

18 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Diagnosis and Planning  Focuses on the specific nature of pain  Mandates a thorough assessment  Selected from NANDA-I–approved list  Interventions selected after client goals and outcomes are identified

19 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Implementation  Nonpharmacological interventions  Relaxation and guided imagery  Distraction  Music  Cutaneous stimulation Massage, TENS, heat, cold, acupressure Massage, TENS, heat, cold, acupressure  Herbals  Cloud Cloud

20 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Pharmacological Pain Relief  Analgesics  Nonopioids  Opioids  Adjuvants/coanalgesics  PCA  Local/regional anesthesia  Topical agents

21 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Chronic Noncancer and Cancer Pain Management  Cancer pain either chronic or acute  Breakthrough pain  Transdermal and transmucosal fentanyl

22 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

23 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

24 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Barriers to Effective Pain Management  The client, health care provider, and health care system  Physical dependence, addiction, and drug tolerance  Placebos

25 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Pain Clinics, Palliative Care, and Hospice  Pain centers treat clients on an inpatient or outpatient basis.  The goal of palliative care is to learn how to live life fully.  Hospices are programs for end-of-life care.

26 Mosby items and derived items © 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc. Evaluation  Evaluation of pain is considered a major responsibility of nurses.  The client’s response to pain may not be obvious.  Evaluating the appropriateness of pain medication will require nurses to evaluate clients 15 to 30 minutes after administration.