1. Pain Management

2. Nature of Pain Involves physical, emotional, and cognitive components
Results from physical and/or mental stimulus
Reduces quality of life
Not measurable objectively
Subjective and highly individualized component

3. Inferred pathological
Types of Pain
Acute/transient pain
Protective, identifiable, short duration; limited emotional response
Chronic/persistent noncancer
Is not protective, has no purpose, may or may not have an identifiable cause
Chronic episodic
Occurs sporadically over an extended duration
Cancer
Can be acute or chronic
Inferred pathological
Musculoskeletal, visceral, or neuropathic
Idiopathic
Chronic pain without identifiable physical or psychological cause

4. Nursing Knowledge Base
Attitude of health care providers
Malingerer or complainer
Assumptions about patients in pain
Biases based on culture, education, experiences
Acknowledge pain through patient’s experiences
Limit your ability to help the patient

5. Factors Influencing Pain
Physiological
Age, fatigue, genes, neurological function
Fatigue increases the perception of pain and can cause problems with sleep and rest.
Social
Attention, previous experiences, family and support groups, spiritual
Spirituality includes active searching for meaning in situations, with questions such as “Why am I suffering?”

6. Factors Influencing Pain (cont’d)
Psychological
Anxiety
Coping style
Pain tolerance
The level of pain a person is willing to accept
Cultural
Meaning of pain
Ethnicity

7. Nursing Process and Pain
Pain management needs to be systematic.
Pain management needs to consider the patient’s quality of life.
Clinical guidelines are available to manage pain:
American Pain Society
National Guideline Clearing House (
Agency for Healthcare Research and Quality (AHRQ)

8. Assessment Patient’s expression of pain Characteristics of pain
Onset and duration
Location
Intensity
Quality
Pattern
Relief measures
Contributing symptoms
Effects of pain on the patient

9. Assessment Effects of pain on the patient Behavioral effects
Assess verbalization, vocal response, facial and body movements, and social interaction.
For patients unable to communicate pain, it is vital for you to be alert for indicative behaviors.
Influence on activities of daily living
Physical deconditioning
Sleep disturbances
Sexual relationships
Ability to work (outside of and in the home)

10. Pain Assessment and Management:
A: Ask about pain regularly. Assess pain systematically.
B: Believe the patient and family in their report of pain and what relieves it.
C: Choose pain control options appropriate for the patient, family, and setting.
D: Deliver interventions in a timely, logical, and coordinated fashion.
E: Empower patients and their families. Enable them to control their course to the greatest extent possible.

11. Nursing Diagnosis Acute Pain Chronic Pain
Self care deficit: dressing/grooming r/t pain
Impaired physical mobility r/t pain

12. Planning
Determine with the patient what the pain has prevented the patient from doing.
Then agree on an acceptable level of pain that allows return of function.
For example, for the goal, “The patient will achieve a satisfactory level of pain relief within 24 hours,” possible outcomes are as follows:
Reports that pain is a 3 or less on a scale of 0 to 10
Identifies factors that intensify pain
Uses pain relief measures safely
Level of discomfort does not interfere with activities of daily living (ADLs).

13. Implementation: Health Promotion
Nonpharmacological pain relief interventions
Relaxation, guided imagery
Biofeedback
Distraction, music
Cutaneous stimulation
Massage, transcutaneous electrical nerve stimulation (TENS), heat, cold, acupressure
Herbals
Reducing pain perception

14. Implementation: Health Promotion (cont’d)
Pharmacological pain relief
Acute pain management
Analgesics
Nonopioids
Opioids
Adjuvants/co-analgesics
Delivery systems
Patient-controlled analgesia (PCA)
Local/regional anesthesia
Topical agents

15. Patient-Controlled Analgesia

16. Implementation Nursing implications
You maintain responsibility for providing emotional support to patients receiving local or regional anesthesia.
After administration of a local anesthetic, protect the patient from injury until full sensory and motor function return.
Nursing implications for managing epidural analgesia are numerous.
Nurses monitor IV sites, lines, and controllers.

17. Barriers to Effective Pain Management
Physical dependence: A state of adaptation that is manifested by a drug class–specific withdrawal syndrome produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist
Addiction: A primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations
Drug tolerance: A state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more effects of the drug over time
Placebos

18. Checklist for Communication with Colleagues
What is the pain rating now? Over the past period of time?
Which pain rating is acceptable to the patient?
How do you recommend that the patient’s treatment be changed to reduce the pain rating?
Which professional reference can be used, if needed, to support this recommendation?

19. Evaluation
Evaluation of pain is one of many nursing responsibilities that require effective critical thinking.
The patient’s response to pain may not be obvious.
Evaluating the appropriateness of pain medication will require nurses to evaluate patients’ responses after administration.

20. Safety Guidelines
The patient is the only person who should press the button to administer the pain medication when PCA is used.
Monitor the patient for signs and symptoms of oversedation and respiratory depression.

21. Study Guide for Pain Chapter
Physiological Responses pg 964
Behavioral Responses
Types of Pain
Knowledge, Attitudes, and Belief pg 966
Factors influencing Pain
Physiological Factors
Psychological Factors

22. Study Guide for Pain Chapter
Nursing Process
Assessment
Planning
Implementation
Not!: Nonpharmacological pain relief interventions or Cutaneous Stimulation, but massage and cold and heat applications; TENS
Acute pain managaement
Pharmacological pain-relief interventions
PCA—Stop until Barriers to effective pain Management pg 988
Evaluation