PAIN
MANAGEMENT
JoeBeth C. BerGado, RN, LPT
HealthCare 2
2
CONTENTS
1
INTRODUCTION
CLASSIFICATION
TYPES
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2
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PAIN
ASSESSMEN
T
TREATMENT
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1
INTRODUCTION
Introduction
Definition : An unpleasant sensory and
emotional experience associated with
actual or potential tissue damage.
Pain may not be directly proportional to
amount of tissue injury.
Highly subjective, leading to
undertreatment
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In cancer, the prevalence of pain in
advanced disease is 70-90%.
" In HIV disease, pain prevalence is
about 50%.
" Other illnesses may have significant
pain but no clear data.
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CLASSIFICATION
Classification
I. Acute
II. Chronic :
i.
Non malignant
ii. Malignant
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Acute Pain
 Injury, trauma, spasm or disease to skin, muscle, somatic
structures or viscera;
 Perceived and communicated via peripheral mechanisms
(pathways)
 Usually associated with autonomic response as well
(tachycardia, blood pressure, diaphoresis, pallor,
mydriasis (pupil dilation).
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Cont.
 Usually subsides quickly as pain producing stimuli
decreases
 Associated with anxiety-(decreases rapidly)
 Can be understood or rationalized as part of the healing
process.
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II. Chronic Pain
i. Non-malignant
 Pain persists beyond the precipitating injury
 Rarely accompanied by autonomic symptoms
 Sufferers often fail to demonstrate objective
evidence of underlying pathology.
 Characterized by location-visceral, myofacial, or
neurologic causes.
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II. Chronic Pain
ii. Malignant
 Has characteristics of chronic pain as well as
symptoms of acute pain (breakthrough pain).
 Has a definable cause, e.g. tumor recurrence
 In treatment, narcotic habituation is generally
not a concern.
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TYPES OF PAIN
 Types of Pain
 Somatic
 Visceral
 Bone
 Neuropathic
 Emotional/Spiritual
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I- Somatic Pain






o
o
Aching, often constant
May be dull or sharp
Often worse with movement
Well localized
Skin, Muscle, Joints, superficial or deep.
Eg:
Bone & soft tissue
chest wall
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





II- Visceral Pain
Constant or crampy
Aching, burning
Poorly localized
Referred
Organs of Thorax & Abdominal Cavity.
Usually as a result of stretching, infiltration and
compression
 Eg:
o Liver capsule distension
o Bowel obstruction
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

Both Somatic & Visceral pain
travel along the same
pathways. Pain stimuli arising
from the viscera is perceived
as somatic in origin.
This can be confused by the
brain and is often described as
referred pain.
III- Bone Pain




Poorly localized, aching, deep, burning.
Common with malignancy of Breast, Lung,
Prostate, Bladder, Cervical, Renal, Colon,
Stomach and Esophagus
Can lead to pathological fractures.
Vertebral Metastases can lead to cord
compression.
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IV- Neuropathic Pain




Caused by disturbance of function or pathological
changes in a nerve.
May arise from a lesion or trauma, infection,
compression or tumour invasion.
Described as burning, shooting, tingling.
Does not respond well to standard analgesics.
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 Categories of Pain
 Classified by inferred pathophysiology:
I. Nociceptive pain (stimuli from somatic and
visceral structures)
II. Neuropathic pain (stimuli abnormally
processed by the nervous system)
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I.
Nociceptive:
 Caused by invasion &/or destruction &/or pressure on
superficial somatic structures like skin, deeper skeletal
structures such as bone & muscle and visceral structures
and organs.
 Types: superficial somatic, deep somatic, & visceral.
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II. Neuropathic:
 Caused by pressure on &/or destruction of peripheral,
autonomic or central nervous system structures.
 Radiation of pain along dermatomal or peripheral nerve
distributions.
 Often described as burning and/or deep aching &
associated with dysesthesia or lancinating pain.
Effects of pain

o
o
o
o
o
o
Sympathetic responses
Pallor
Increased blood pressure
Increased pulse
Increased respiration
Skeletal muscle tension
Diaphoresis
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Effects of pain

o
o
o
o
o
o
Parasympathetic responses
Decreased blood pressure
Decreased pulse
Nausea & vomiting
Weakness
Pallor
Loss of consciousness
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Pain Assessment
Pain History





The site of pain
Type of pain
Exacerbating & Relieving factors
How frequently
Impact on daily life
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Pain History
 Other important additional questions to be asked.
o What is the response to past and current analgesic
therapy?
o Any kind of diary or record about the pain?
o Fears they have about analgesics?
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PAIN ASSESSMENT Tools
 Verbal Analogue Scales.
 Visual Analogue Scales.
 The Faces Scale
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Factors to consider in choosing a
pain scale
1.
2.
3.
4.
5.
Age of patient
Physical condition
Level of consciousness
Mental status
Ability to communicate
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Numeric Pain Rating Scale


Ask the patient to rate their pain intensity on a scale
of 0 (no pain) to 10 (the worst pain imaginable).
Some patients are unable to do this with only verbal
instructions, but may be able to look at a number
scale and point to the number that describes the
intensity of pain.
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Numeric Pain Rating Scale
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Wong-Baker FACES Pain Rating
Scale



Can be used with young children (sometimes as young as 3 years
of age)
Works well for many older children and adults as well as for
those who speak a different language
Explain that each face represents a person who may have no
pain, some pain, or as much pain as imaginable. Point to the
appropriate face and say the appropriate description. e.g. “This
face hurts just a little bit”
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Wong-Baker FACES Pain Rating
Scale

Ask the patient to choose the face that best matches how she or
he feels or how much they hurt.
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Color Pain Rating Scale


Ask the patient to point to the area on the scale that shows their
level of pain from white (no pain) to dark red (worst possible
pain).
Obtain a number corresponding to the area where the patient
points.
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Severity Assessment




McGill Pain Questionnaire
Scale from 0 to 5
From None to Severe Pain
for children or adults who understand numerical
relationships.
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PAIN ASSESSMENT Tools
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Pain Treatment
Goals of Pain Management Therapy
1)
2)
o
o
3)
o
o
Decreased pain
Decreased healthcare utilization
Decreased “shopping” for care
Decreased emergency room visits
Improved functional status
Increased ability to perform activities of daily living
Return to employment
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Management


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

Non-Pharamcological treatment
Pharmacological treatment:
Analgesics
Adjuvants
Others
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Thanks
for Coming