1. Pain Management

2. What is pain? One of the most common reasons people seek healthcare
One of the most widely under-treated health problems

3. Pathophysiology A sensation caused by some type of noxious stimulation
A pattern of responses that function to protect the individual from harm
Whatever the experiencing person says it is whenever he says it does

4. Components of Pain Physical Caused by some kind of noxious stimulant
Emotional
Results of combination of thoughts, feelings, and beliefs
Behavioral
Pattern of responses that function to protect the individual from further harm

5. Causes of Pain Cutaneous Direct stimulation to skin (cut) Somatic
From musculo-skeletal system (sprained muscle)
Visceral
Arising from hollow organs (appendicitis)

6. Neuropathic
Damage to nervous system
Referred
Pain arising from someplace else in body

7. Descriptions of pain Chronic: occurring over a long period of time
Acute: sudden, brief onset

8. Visual Analog Scale
This is a line 10 cm. long (about 4 inches) that is divided into ten divisions. Patients are asked to show the amount of pain on a 1-10 scale.
Researchers say that patients cannot function with a scale with more than ten points.

9. PQRST This mnemonic is devised to show the steps in pain assessment:
Provoking factors
Quality
Region/Radiation
Severity/Symptoms
Timing

10. Provoking factors include what caused the pain and what might be making it worse
Quality questions refer to how the pain feels…let the patient tell but offer suggestions if necessary, like sharp, dull, throbbing, burning, etc.

11. Region….have patient point to area that hurts
Severity can be measured with the pain rating scales
Symptoms may accompany the pain….nausea, vomiting, etc
Timing refers to when the pain started, how long it lasts

12. Be aware
Just because a patient cannot respond to pain doesn’t mean there is no pain
Activities of daily living (ADLs) may be effected
Neurological status will alter the response to pain

13. Pain Management Management must be timely, individualized,
and bring the pain to an acceptable level of tolerance

14. Pharmacologic interventions
Must be individualized
Three main categories:
Non-opioids
Opioids
Adjuvants

15. Non-opioids: Opioids Adjuvants Acetominophen (Tylenol) Aspirin
NSAIDs (Advil)
Opioids
Weak  Strong
Codeine  Hydromorhone
Oxycodone  Morphine
Vicodin  Merperidine
Adjuvants
Primary function is not pain relief but provide relief
May modify mood so patient feels better

16. Precautions to giving pain medications
Medication choice may depend on practitioner’s preference, however:
Should not give two analgesics from same class at same time
Must be aware of effects of medications
Must watch for allergic reactions

17. Routes of medication administration
Oral
Injection
Intravenous (includes PCA)
Epidural
Rectal
Topical

18. WHO Pain Ladder
SEVERE PAIN: Keep giving mild pain medication and add a strong opioid such as morphine or Fentanyl
MODERATE PAIN:
Keep giving mild pain
medication and add a mild
Opioid such as codeine
MILD PAIN:
Aspirin, ibuprophen
Acetominophen,
naprosyn

19. Concepts of WHO Pain Ladder
By the mouth
By the clock
By the ladder
For the individual
With attention to detail

20. Placebos
Controversial use of an inactive substance to satisfy the demand for medication

21. Non-pharmacologic interventions
Pain control without using medications
Alter the environment
Relaxation and guided imagery
Meditation
Cutaneous stimulation
Massage, acupressure, acupuncture, TENS
Biofeedback
Therapeutic touch
Education

22. JCAHO Standards for Pain Management
Address care at the end of life
Assess and manage pain appropriately
Assess pain in all patients
Support safe medication ordering and administration

23. Monitor patient during post-procedure period
Rehabilitate for optimal level of function
Educate about pain an managing pain
Plan for discharge continued care if needed
Collect data to monitor performance

24. Nurses spend more time with patients than any other provider
Nurses spend more time with patients than any other provider. They must stay informed in order to give the best care to their patients.

25. References:
Falk. Kim Marie. Pain Management. National Center of Continuing Education. Catalog 98 TX.