Chapter 20
Pain Management
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pain
 Pain is
 The major cause of physical distress among clients.
 An unpleasant sensation usually associated with disease or injury.
 The process of pain
1. Transduction-Phase:

Conversion of chemical information at the cellular level into
electrical impulses that move toward the spinal cord.
2. Transmission-Phase :

During which stimuli move from the peripheral nervous
system to the brain
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3. Perception-Phase:

Conscious experience of discomfort when the pain threshold is
reached.
4. Modulation-Phase:

Brain interacts with the spinal nerves in a downward fashion to
alter the pain experience
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Phases of Pain
Pain theories
 Endogenous opioids: (naturally produced morphine-
like chemicals) e.g., endorphins.
 When it is released, they bind to sites on the nerve
cell’s membrane that block the transmission of pain
impulses.
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Mechanism of Pain Transmission and Interference
TYPES OF PAIN
1. Cutaneous pain:

Discomfort that originates at the skin level
2. Visceral pain :


Discomfort arising from internal organs
Referred pain:

Discomfort perceived in a general area of the body, usually away
from the site of stimulation ( appendicitis )
3. Neuropathic pain:


Pain with atypical characteristics also called functional pain
Example : phantom limp pain
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TYPES OF PAIN (cont’d)
4. Acute pain:



Lasts a few seconds to less than 6 months
Associated with tissue trauma, surgery, or recent
identifiable etiology.
Gradual reduction in pain promotes coping
5. Chronic pain



Discomfort that lasts longer than 6 months
Physical and emotional distress
Depression
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PAIN ASSESSMENT STANDARDS






Pain is the fifth vital sign
Should be assessed with temperature, pulse, respirations,
and blood pressure
Pain should be regularly assessed throughout the healthcare
delivery
Healthcare workers should be educated on pain
Clients and families should be educated on effective pain
management
Client’s choices regarding pain management is respected
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PAIN ASSESSMENT DATA
1. Onset :
Time under which the pain became apparent ( e.g. after
surgery)
2. Quality:
Degree of suffering ( e.g. throbbing, crushing)
3. Intensity:
Magnitude of pain ( e.g. mild ,moderate, severe) (numeric
scale from 0-10)
4. Location
Anatomic site ( e.g. chest, abdomen)
5. Duration
Time span of pain ( e.g. continuous, intermittent, weeks)
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NONVERBAL PAIN INDICATORS
 Moaning
 Crying
 Grimacing
 Guarded position
 Increased vital signs
 Reduced social interactions
 Irritability
 Difficulty concentrating
 Changes in eating and sleeping
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PAIN MANAGEMENT TECHNIQUES
1. DRUG THERAPY:
1. Nonopioids (non-narcotic drugs). e.g. Aspirin,
acetaminophen, NSAIDS ibuprofen, naproxin
2. Opioids (narcotic drugs), e.g. Morphine sulfate,
Codeine sulfate
3. Adjuvant drugs that assist in accomplishing the
desired effect of a primary drug (e.g. antidepressant,
anticonvulsant)
2. SURGICAL APPROACHES
 Intractable pain - Pain unresponsive to other
methods of pain management p. 427
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3. Nondrug/ Nonsurgical interventions:
1. Education:
Educate client about pain and methods for pain management
2. Imagery:
Intentional daydreaming
3. Meditation: (Spiritual)
Concentrating on a word or idea that promotes tranquility,
4. Distraction:
Intention diversion of attention to switch focus from unpleasant
sensory experience
5. Relaxation:
Technique for releasing muscle tension and quieting the mind
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6. Heat and Cold:
Thermal therapy for pain relief
7. Acupuncture:
Pain management technique in which long, thin needles are
inserted into the skin
8. Acupressure:
Technique that involves tissue compression rather than needles to
reduce pain
9. Hypnosis:
Therapeutic technique in which a person enters a trance-like state
10. Transcutaneous electrical nerve stimulation
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Nursing Implications-Nursing Diagnoses
1.
2.
3.
4.
5.
6.
Acute pain
Chronic pain
Anxiety
Fear
Ineffective Coping
Deficient Knowledge: Pain Management
 Placebo : an inactive substance sometimes
prescribed as a substitute for analgesic drugs
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 trance (trăns)n.
 1. A hypnotic state.
 2. Detachment from one's physical surroundings, as in
contemplation or daydreaming.
 3. A semiconscious state, as between sleeping and
waking; a daze.
 in which ability to function voluntarily may be
suspended.
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