Chapter 43-Pain Management
Part I
Ouch! That hurts! I’m hurting!
OMG! It’s killing me. I can’t live any
longer! Can’t you do anything?
The Concept for this unit is
com·fort (k m f rt) tr.v. com·fort·ed,
com·fort·ing, com·forts 1. To soothe in
time of affliction or distress.2. To ease
physically; relieve.n. 1. A condition or
feeling of pleasurable ease, well-being, and
contentment.2. Solace in time of grief or
fear.3. Help; assistance: 4. One that brings
or provides comfort.5. The capacity to give
physical ease and well-being.
Concepts related to Pain
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Pain-symptom of disease
Pain-now considered a separate disease
Pain-subjective
Pain-highly individualized
Pain-highly feared. The fear of pain is
second only to the fear of death
Causes of pain
• Thermal
• Chemical
• Mechanical
Processes of Pain
• Transduction
• Transmission
• Perception
• Modulation
Transduction
• Transduction-energy from stimuli converted
to electrical energy
• Begins in the periphery with stimulus
• Pain impulse via nerve fibers
• Transduction completed results in
transmission
Transmission
• Transmission involves neurotransmitters
• Intact pain fibers-ECF & Spinal Cord
• Message received by cerebral cortex
• Interpretation by CNS
Perception
• Message received-awareness
• Limbic system determines how one feels
about the pain
Modulation
• Message interpreted and received
• Release of inhibitory neurotransmitters
• Modulation is the inhibitory/analgesic effect
Gate-Control Theory p.1053
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Emotional
Cognitive
Gate-keepers
Pain threshold
Pain tolerance
Types of Pain p.1055
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Acute/Transient
Chronic/Persistent
Chronic Episodic
Cancer
Idiopathic
Inferred
Misconceptions/Biases
• P. 1056
• The person experiencing the pain is the best
indicator of the characteristics of pain
• Assess pain
• Believe the person
Factors Affecting Pain
p. 1056-1060
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Age
Culture
Gender
Genetic
Neurological functioning
Social
Spiritual
Nursing Assessment
• No pain meter available
• Must rely on patient
• Nurse must ascertain subjective data
• Expression of pain
Characteristics of Pain
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Onset/Duration
Location
Quality
Pattern
Relief measures
Contributing symptoms
Behavioral effects
Effects on ADL’s
Pain Assessment
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Pain scales p. 1065
Oucher scale
Wong-Baker
Pneumonic-P,Q,R,S,T
Assessment of pain is considered the fifth
vital sign!
Questions/Statements R/T Pain
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Be a reporter-who, what, when, where, why
Ask opened-ended questions
Avoid leading statements
Observe nonverbal cues
Congruent nonverbal actions and verbal
comments
• Remember to assess drug allergies