Pain management
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Patho
Nociceptors: Pain receptors on nerve endings
that respond selectively to painful stimuli.
Nociception: The transmission of pain.
Chemical substances: some increase pain
sensitivity some decrease pain sensitivity.
Cox 1: Mediates prostaglandin formation, platelet
formation, provides gut protection from ulcers.
Cox 2: Present in inflammation, pain and fever.
Inhibition will reduce symptoms of fever
inflammation and pain. Inhibits substance P.
Decrease pain sensation: Endorphins and
enkephalins, act as endogenous opioids.
Types of pain
Chronic : Persistent malignant pain that
lasts longer than six months.
Factors that influence pain
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Past experience.
Anxiety: decreases pain threshold.
Depression: decreases pain threshold.
Age.
Gender.
Culture: different cultures respond to pain differently
based on what they were taught to be appropriate.
Effects of pain
Acute: Increased cardiac output, impaired insulin response, immune
supression, increased cortisol production, and increased fluid
retention.
Chronic: Immune suppression, depression, disability, fatigue,
anger, inability to perform ADL’s.
Acute pain: Sudden onset of pain, specific
to injury. Lasts from seconds to six months.
Pharmacologic treatments
Non opioids
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NSAIDS: Mild pain. Ketorolac, sprix,
calador, ibuprofen.
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Acetaminophen: Can cause hepatotoxicity
can be given with NSAIDs.
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Ofirmev: IV acetaminophen, newly
approved for short term use IV piggyback.
Opioids
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Tramadol
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Tylenol 3
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Meperidine
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Propoxyphene with tylenol
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Oxycodone
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Fetanyl
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Morphine
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Dauladid
Other
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PCA pump
PRN medications
Multi modal: use of one or more drug
Routine admin: admin around the clock
Topical
Local anesthesia
Intraspinal
Non pharmacologic treatments
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Cutaneous stimulation: TENS machine
Massage
Thermal therapies: Heat and cold
Distraction
Relaxation
Guided imagery
Hypnosis
Music therapy
Alternative therapy: Acupuncture
Focused pain assessment
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Scale: 0-10
Timing: When did the pain start, what was happening
when it started?
Location: Where is the pain? Is it radiating?
Duration: How long have you had the pain?
Quality: Is it dull, sharp, or stabbing?
Aggravating and alleviating factors: What makes it
worse? What makes it better?
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