Comfort Ch 41

Pain Considered the 5th Vital Sign Is what the patient says it is

Pain Basics Source Area to which it is referred Duration Nociceptive – sensory Neuropathic – from nerves Psychogenic – mental Area to which it is referred Duration Acute Chronic

Sources of Pain Nociceptive Cutaneous Somatic Visceral Neuropathic

Types 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

Duration of Pain Acute Chronic Rapid in onset, varies in intensity and duration Protective in nature Chronic May be limited, intermittent, or persistent Lasts for 6 months or longer Periods of remission or exacerbation are common

Pain Process Transduction — activation of pain receptors Transmission — conduction along pathways (A-delta and C-delta fibers) Modulation — initiation of the protective reflex response Perception of pain — awareness of the characteristics of pain

Chemicals of Pain Bradykinin Prostaglandins – send stimuli to CNS Powerful vasodilator Constricts smooth muscle Involved in pain awareness Prostaglandins – send stimuli to CNS Substance P Sensitizes nerve receptors Increases rate of firing

Gate Control Theory Relationship between pain and emotions Small and large diameter nerve fibers conduct and inhibit pain stimuli Gating mechanisms determine impulses that reach the brain

Pain Perceptions Pain threshold – lowest intensity at which pain is perceived Adaptation Modulation of pain – regulation or modified by: Neuromodulators- natural, resemble morphine Endorphins – pain blockers, prolonged effect Dynorphins – most potent Enkephalins – less potent, inhibit release of sub.P

Pain Responses Physiologic – automatic (involuntary) responses Behavioral – change in behavior Affective – emotional response Box 41-1, p 1203

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

Assessing Pain Psychological Emotional Sociologic Physiologic

Assessing Pain, cont’d Patient’s verbalization and description of pain Duration of pain Location of pain Quantity and intensity of pain Quality of pain Chronology of pain

Assessing Pain, cont’d Patient’s verbalization and description of pain Duration of pain Location of pain Quantity and intensity of pain Quality of pain Chronology of pain

More Assessing Aggravating and alleviating factors Physiologic indicators of pain Behavioral responses Effect of pain on activities and lifestyle

Assessment Tools McGill-Melzack pain questionnaire Pain scale Faces McCaggery method WILDA pain measurement scale

WILDA Scale Words that describe the pain Intensity of pain Location of pain Duration of pain Aggravating or alleviating factors

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

Nursing Interventions Establishing trusting nurse-patient relationship Initiating non-pharmacologic pain relief measures Considering ethical and legal responsibility to relieve pain Teaching patient about pain

Nursing Plan Remove or alter cause of pain Alter factors affecting pain tolerance Initiate non-pharmacologic relief measures

Non-Drug Comfort Measures Distraction Humor Music Imagery Relaxation Cutaneous stimulation Acupuncture Hypnosis Biofeedback Therapeutic touch

Drug-Related Treatments Analgesic administration Non-opioid analgesics Opioids or narcotic analgesics Adjuvant drugs

Administering Analgesics Patient controlled analgesia Epidural analgesia Local anesthesia

Sedation Scale 1 — awake and alert, no action necessary 2 — occasionally drowsy, but easy to arouse, no action necessary 3 — frequently drowsy, drifts off to sleep during conversation, reduce dosage 4 — somnolent with minimal or no response to stimuli, discontinue opiod, consider use of naloxone (Narcan)

Managing Chronic Pain Give medications orally if possible. Administer medications ATC (around-the-clock) rather than prn. Adjust the dose to achieve maximum benefit with minimum side effects. Allow patients as much control as possible over the regimen.