THE PATIENT AND PAIN MANAGEMENT NUR 270 SP 2024 “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (IASP, 2014b). DEFINING PAIN “Pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does” (McCaffery, 1968). Suffering PAIN: ASSOCIATED TERMS Unpleasantness Anguish Pain Discomfort Distress CATEGORIES OF PAIN: DURATION Acute pain: • Episode of pain that lasts from seconds to less than 6 months • Rapid in onset, varies in intensity and duration • Protective in nature Chronic pain: • • • • Episode of pain that lasts for 3 - 6 months or longer May be limited, intermittent, or persistent Lasts beyond the normal healing period Periods of remission or exacerbation are common Nociceptive CATEGORIES OF PAIN: ETIOLOGY Neuropathic Nociplastic NEUROANATOMY REVIEW neuron The basic functional unit of the nervous system is the _______. PAIN PATHWAY Transduction Nociceptors Somatic pain Visceral pain Transmission A-delta and C fibers Spinothalamic tract Perception Modulation 4 Serotonin and norepinephrine Nociceptive Neuropathic CATEGORIES OF PAIN: ETIOLOGY • Due to nerve damage or malfunction • Allodynia • Hyperalgesia Nociplastic • Example: Fibromyalgia COMMON MANIFESTATIONS OF PAIN Physiologic Sympathetic Responses ⬆️ BP, HR, and RR Pupil dilation, muscle tension and rigidity, pallor Metabolic Responses ⬆️ oxygen consumption ⬆️ blood glucose Behavioral Moving away from painful stimuli Grimacing, moaning, and crying Restlessness Protecting the painful area and refusing to move Fear, withdrawal, anger, anxiety, depression, stoicism, powerlessness, fatigue, anorexia Verbal report of pain ASSESSMENT Patient’s verbalization OLDCARTS OPQRSTU Numeric Scale Physical Assessment Inspection Palpation Rebound tenderness VISUAL ANALOG SCALE WILDA PAIN ASSESSMENT TEMPLATE Words Intensity Location Duration Aggravating or Alleviating Factors Fink, R. (1996). WONG-BAKER FACES FOUNDATION http://www.wongbakerfaces.org FLACC SCALE FOR USE WITH INFANTS & CHILDREN Source: https://healthjade.net/flacc-scale/ CPOT DIAGNOSIS Label: Type of pain: Acute or Chronic R/T Etiologic factors AMB behavioral, physiologic, affective cues RELATED NURSING DIAGNOSES Anxiety Ineffective coping Disabled family coping Hopelessness Ineffective health maintenance Impaired physical mobility Constipation OUTCOME IDENTIFICATION Maximize pain relief, quality of life and level of functioning Sample Goals…Client will: Report no new pain sites and reduced pain intensity and pain quality complexity. Monitor and report changes in pain location, intensity, quality, and pattern. Identify and use cognitive and behavioral techniques to decrease or cope with pain. PLANNING & IMPLEMENTING NURSING INTERVENTIONS FOR PAIN Establishing trusting nurse–patient relationship Manipulating factors affecting pain experience Initiating nonpharmacologic pain relief measures Managing pharmacologic interventions Reviewing additional pain control measures, including complementary and alternative relief measures Considering ethical and legal responsibility to relieve pain Teaching patient about pain PHARMACOLOGIC PAIN RELIEF MEASURES Nonopioid analgesics Opioids or narcotic analgesics Adjuvant drugs Patient-controlled analgesia Epidural analgesia Local anesthesia ADDITIONAL METHODS FOR ADMINISTERING ANALGESICS EPIDURAL ANALGESIA CONSIDERATIONS FOR USE OF OPIOIDS VARIES WITH PATIENT SITUATION SAFETY AND OPIOIDS Dependence Tolerance Addiction Sedation/Respiratory Depression Pulse Oximetry Capnography Constipation Risk for Falls Pasero Opioid-Induced Sedation Scale NUMERIC SEDATION ASSESSMENT SCALE S: sleep, easy to arouse: no action necessary 1: awake and alert; no action necessary 2: occasionally drowsy, but easy to arouse; no action necessary 3: frequently drowsy, drifts off to sleep during conversation; reduce dosage 4: somnolent with minimal or no response to stimuli; discontinue opioid, consider use of naloxone NONPHARMACOLOGIC PAIN RELIEF MEASURES Distraction Imagery Humor Music Relaxation Cutaneous stimulation Acupuncture and other CAM modalities EVALUATION OF PAIN Was the outcome met? Documentation of response(s) to pain intervention(s) • Use the same pain scale/tool used for the assessment Goal not met? Cycle back through the Nursing Process! • Is there new/different assessment data? • Do we have a SMART outcome? • What alternate intervention strategies can we employ? PAIN: INTERRELATED CONCEPTS Cognition Mood and affect Functional ability Nutrition Fatigue Glucose regulation Gas exchange Mobility
