Caring for Individuals Experiencing Pain NURS 2016

Pain An unpleasant sensory and emotional experienceAn unpleasant sensory and emotional experience Associated with actual or potential tissue damageAssociated with actual or potential tissue damage Tells us that something is wrong with our boddyTells us that something is wrong with our boddy

Pain Perception Subjective Experience Past experiencePast experience Anxiety/depressionAnxiety/depression Culture and ethnicityCulture and ethnicity AgeAge

Categorizing Pain By DurationDuration LocationLocation EtiologyEtiology

Pain Pain is now considered another VITAL SIGNPain is now considered another VITAL SIGN 3 main types of pain3 main types of pain –Acute –Chronic –Chronic (malignant) It is important to listen to what patients tell you about their painIt is important to listen to what patients tell you about their pain –Verbally –Nonverbally

Acute Pain Recent onsetRecent onset Associated with a specific causeAssociated with a specific cause Decreased with healingDecreased with healing Duration of seconds to 6 monthsDuration of seconds to 6 months

Chronic Pain Constant or intermittentConstant or intermittent Last beyond expected healing timeLast beyond expected healing time Origin is unclear: person can not easily identify where pain is coming fromOrigin is unclear: person can not easily identify where pain is coming from Duration longer than 6 monthsDuration longer than 6 months No useful purposeNo useful purpose

Malignant or Cancer-related Pain Acute or chronicAcute or chronic Associated with tumor formation, treatment or traumaAssociated with tumor formation, treatment or trauma 2 nd most common fear for people dx with cancer2 nd most common fear for people dx with cancer Cyclic: pain, anxiety, fear,... painCyclic: pain, anxiety, fear,... pain

Painful Terms Pain Tolerance Pain Threshold OpioidsAnalgesiaAnalgesic Drug Tolerance Drug Dependence Drug Addiction Breakthrough Pain

Physiological Basis of Pain Nociceptive System: the system involved in the transmission and perceptions of painNociceptive System: the system involved in the transmission and perceptions of pain Nociceptors: free nerve endings in the skin that respond only to intense, potentially damaging stimuli (mechanical, thermal, chemical)Nociceptors: free nerve endings in the skin that respond only to intense, potentially damaging stimuli (mechanical, thermal, chemical) –Joints, skeletal muscle, fascia, tendons, and cornea also have pain receptors.

Physiology of Pain Referred PainReferred Pain –Results from intense stimulation of the visceral branch of a nerve fibre, leading to vasodilation and pain in the area of the body associated with that fibre. Chemical mediators of painChemical mediators of pain –Prostoglandins increase the sensitivity to pain –Endorphins or enkephalins decrease the sensitivity to pain

Nursing Process related to Pain AssessmentAssessment PlanningPlanning InterventionIntervention EvaluationEvaluation

Assessing Pain Perception of Pain Verbal descriptionVerbal description –Intensity –Location –Timing: onset, duration –Factors that relieve –Personal meaning Impact on activitiesImpact on activities Concerns about painConcerns about pain

Pain Assessment Tools Pain Intensity Scales –Visual analogues –Rating 1-10 –Smiley faces

Physiological Responses to Pain Very individual Increased heart rateIncreased heart rate Increased BPIncreased BP PallorPallor DiaphoresisDiaphoresis Chronic pain sufferers may show no phys signs of pain

Behavioural Responses to Pain Facial expressionsFacial expressions Body movementsBody movements MoaningMoaning Clenching fistsClenching fists WithdrawingWithdrawing Etc.Etc.

Factors Influencing Pain Response Past ExperiencePast Experience CultureCulture AgeAge Anxiety & DepressionAnxiety & Depression

Planning Consider assessment data Nursing Diagnosis In collaboration with client Develop Pain Management Goals

Pain Management Strategies and Nursing Interventions Non-pharmacolgicalNon-pharmacolgical –Cutaneous Stimulation and Massage –Transcutaeous Electrical Nerve Stimulation –Ice and Heat –Relaxation techniques –Distraction –Hypnosis –Emotional support –Trusting relationship: encourage communication

Pain Management Strategies and Nursing Interventions Pharmacological Balanced Analgesia: opioids, NSAID, anestheticsBalanced Analgesia: opioids, NSAID, anesthetics Regular medication administration: maintain steady reliefRegular medication administration: maintain steady relief Pro Re Nata: traditional standard – often leaves clients sedated or in painPro Re Nata: traditional standard – often leaves clients sedated or in pain *Preventative approaches*

Pain Management Strategies and Nursing Interventions Pharmacological Local Anesthetics: block nerve conductionLocal Anesthetics: block nerve conduction NSAIDs: inhibit production of prostoglandins from inflamed or injured tissue.NSAIDs: inhibit production of prostoglandins from inflamed or injured tissue. Opioids: act as agonists at specific opioid receptors in the CNS. Mimick endorphinsOpioids: act as agonists at specific opioid receptors in the CNS. Mimick endorphins

Evaluation of Pain Management Intervention Post- intervention data Pre- intervention data

Triple Whammy Effect Clients under-report their pain Physicians under- prescribe Nurses under-administer

What impact does unrelieved pain have on people? PositiveNegative

Final words... Use the Nursing Process in caring for your clients experiencing painUse the Nursing Process in caring for your clients experiencing pain Listen and value client perceptionListen and value client perception Provide supportProvide support