Pain Type
Cause

Acute

Characteristics
Results from effects of
direct tissue damage
Identified with a specific
injury or condition



Defined onset and end
Changes in vital signs due to sympathetic nervous system stimulation
Patient looks “sick”
Chronic

Difficult to identify
pathologic process
involved



Persistent pain for 3 or more months
May recur at intervals for months or years
No physical signs
Somatic
 Skin, soft tissue, or bone

Activation of pain
receptors in skin and
deep tissues




Well-localized
Aching
Sharp
Throbbing

Spasm of smooth or
skeletal muscle


Cramping
Gripping

Activation of intact
mechanical, chemical, or
thermal receptors
located in organs such as
HEART, LUNGS, GI, GU
tracts\




Deep aching
Crampy
Pressure
Colicky

Pathology may be
stretching, distention,
inflammation or
infiltration

Disordered function
and/or direct damage to
nerves in the PNS




Burning
Shooting
Tingling
Numbness

Muscle
Visceral
Neuropathic
 Peripheral Nervous
System (PNS)

Spinal Cord

May be due to
compression, transection,
infiltration, ischemia,
and/or metabolic injury

Neurological
deficits, weakness, loss of strength, gait changes, urinary incontinence or
retention

Central Nervous System
(CNS)

Disordered function;
damage to nervous tissu

Headache changes in vital signs, loss of cerebral functions, Nausea and vomiting
STEP (WHO ladder)*
PAIN INTENSITY
ANALGESIC OF CHOICE
Step 1
Mild Pain:
 1 – 3 on a 10 numerical
analogue scale




Aspirin (ASA)
Acetaminophen (Acet)
NSAID’s
Coanalgesics
Step 2
Moderate Pain:
 4 - 6 on a 10 numerical
analogue scale






Codeine
Hydrocodone (Vicodin)
Oxycodone (Percocet)
Dihydrocodeine
Nonopioid analgesic
Coanalgesics
Step 3
Severe Pain:
 7 – 10 on a 10 numerical
analogue scale








Morphine (Roxanol)
Oxycodone
Hydromorphone (dilaudid)
Fentanyl (duragesic)
Methadone
MS Contin
Nonopioid analgesics
Coanalgesics
*World Health Organization – 3 STEP Ladder for Management of Pain* Focuses on proper selection, dosing,
titration and administration of analgesics in relation to persons’ self-described pain intensity and type of
physical pain responsive to opioid therapy.
Pain Source
Somatic: Bone of soft tissue pain
Pain Character
Tenderness over bone or joint
Muscle
Somatic – Visceral Pain
Examples of Medications



Ibuprofen (motrin)
Trilisate
Prednisone
Myofascial

Cyclobenzaprine (flexeril)
Cramping, Colic

Dicyclomine HCI (Bentyl);
Levsin or Levsinex

Atropine tabs/drops
Neuropathic Pain
Burning, Tingling
 Amitriptyline (Elavil)
Shooting, stabbing, lancinating
 PNS
 Carbamazepine
 Spinal Cord
(Tegretol)
 CNS
 Gabapentin (Neurotin)
Suggested List of Coanalgesic Drug Therapies Commonly Prescribed (Medication therapy may vary based on
physician preference)
Symptom
Cause
Suggested Treatment
Uticaria, pruritus
Mast cell destabilization and release
of histamine
Constipation
Common to all opioids
Nausea, Vomiting
Starts with onset of opioids;
tolerance develops within days. May
also be due to constipation





Phenergan (PO, PR)
Ativan (PO, SL)
Reglan (stimulates motility)
Haldol
Scopolamine patch
Diarrhea
Nurse to check for impaction prior to
medication administration


Imodium
Lomotil
Anxiety
Depresses the CNS, most likely
potentiating GABA, an inhibitory
neurotransmitter, causing sedation,
decreased anxiety, decreased seizure
activity


Lorazepam (Ativan)
Xanax (Alprazolam)
Oral Thrush
Generally from Abx therapy


Mycostatin (antifungal)
Magic Mouthwash (equal parts of Benadryl, Nystatin, Maalox, lidocaine) –
Sleeplessness
Acts at many levels in the CNS,
producing generalized depression

Restoril
Respiratory secretions
Small doses decrease salivary and
bronchial secretions and decrease
diaphoresis;




Levsin
Albuterol (dilator, bronchioles)
Scopolamine patch
Atropine gtts
Sedation effects
Defined as inability to wake up fully;
need to evaluate with patient and
family the amount of “natural”
sedation patient desires. Could also
be due to electrolyte imbalance such
as high calcium levels


May need to alter pain control plan to balance with desired level of sedation
Ritalin may be ordered (depends of prescribing physician preference)
Muscle jerking, twitching
accompanied by insomnia, delirium,
muscle spasms
Opioid excess in tolerant patient; no
decrease in RR or LOC, however CNS
is excited


Reduce opioid dose or consider rotating to another opioid
Give Ativan for twitching as ordered


Diphenhydramine (Benadryl)
Atarax
Follow bowel protocol for appropriate titration of bowel stimulant and stool softener
 Docusate (stool softener)
 Milk of Magnesia
 Magnesium Citrate
 Glycerin or Dulcolax Supp
 Lactulose
 Enema (fleets)
 2% lidocaine jelly for disimpaction
Possible adverse effect of Opioids, Cause and Suggested Treatments