Nursing Care of
Clients Experiencing
Pain
Pain Pathway
• A-delta fibers: transmit pain quickly, associated with
acute pain
• C-fibers: transmit pain more slowly, diffuse burning
pain and chronic pain
• Inhibitory mechanisms: the analgesia system
stimulates a pain inhibitory center in the dorsal
horns of the spinal cord (the exact mechanism is
unknown)
• Endorphins: naturally occurring opioid peptides
present in the neurons in the brain
Pain Pathway
Pain Pathway
Pain Pathway
Acute, Chronic, Central,
Phantom, and Psychogenic Pain
• Acute Pain
– Somatic Pain
• May be sharp or diffused
• May be accompanied by nausea and vomiting
– Visceral Pain
• Arises from the body organs
• Usually dull and poorly localized
• May be referred or may radiate
– Referred Pain
• Perceived in an area distant from the site of the stimuli
Acute, Chronic, Central,
Phantom, and Psychogenic Pain
Acute, Chronic, Central,
Phantom, and Psychogenic Pain
• Chronic Pain
– Recurrent Acute Pain
• Well-defined episodes of pain
• Migraine headaches, sickle cell crisis
– Ongoing Time-limited Pain
• Persists for a definite time period
• Ends with control of the disease, rehabilitation, or
death
Acute, Chronic, Central,
Phantom, and Psychogenic Pain
• Chronic Pain
– Chronic Nonmalignant Pain
• Not life-threatening but persists past expected time for
healing
– Chronic Intractable Nonmalignant Pain Syndrome
• Client unable to cope well with the pain
• Pain may be mild to severe
• The pain itself becomes the pathologic process
Acute, Chronic, Central,
Phantom, and Psychogenic Pain
• Central Pain
– May be caused by a vascular lesion, tumor, or
inflammation
• Phantom Pain
– Thought to be due to stimulation of severed nerves at the
amputation site
• Psychogenic Pain
– Involves a long history of severe pain
– The pain is real and can lead to physiologic changes
Factors Affecting
Pain Response
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Age
Sociocultural influences
Emotional status
Past experiences with pain
Meaning associated with the pain
Lack of knowledge
Myths and Misconceptions
Concerning Pain
• Pain is a result, not a cause
• Chronic pain is really a masked form of depression
• Narcotic medication is too risky to be used for
chronic pain
• It is best to wait until a client has pain before giving
medication
• Many client’s lie about the existence or severity of
pain
• Pain relief interferes with diagnosis
Collaborative
Care for Pain
• Medications
– NSAIDs: analgesic, antipyretic, and antiinflammatory action
– Narcotics: opioids
– Antidepressants: act on the retention of
serotonin, thus inhibiting the pain sensation
– Anticonvulsants: used for headache and
neuropathic pain
– Local anesthetics: blocks the transmission of nerve
impulses, therefore blocking pain
Collaborative
Care for Pain
Collaborative
Care for Pain
• Surgery
– Cordotomy: an incision into the anterolateral tracts of the
spinal cord to interrupt the transmission of pain
– Neurectomy: removal of part of the nerve
– Sympathectomy: destruction of the ganglia by incision or
injection
– Rhizotomy: surgical severing of the dorsal spinal roots
– Transcutaneous electrical nerve stimulation (TENS):
electrodes stimulate the A-beta touch fibers to close the
“pain” gate
Collaborative
Care for Pain
Collaborative
Care for Pain
• Complementary Therapies
– Acupuncture
– Biofeedback
– Hypnotism
– Relaxation
– Distraction
– Cutaneous stimulation
Nursing Process
for Clients with Pain
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Assess the client’s pain level
Establish a nursing diagnosis
Plan and implement a care plan
Educate the client
Evaluate the patient’s response to the care
plan
Nursing Process
for Clients with Pain
Resources
• Evidence Report/Technology Assessment
Pain assessment and management of cancer
pain.
• American Cancer Society
Principles of pain management in the
treatment of acute and chronic pain.
• Department of Veterans Affairs
Pain as the 5th vital sign.
Resources
• The Joint Commission
Type in “pain management standards” in the
search box. Be sure to use quotation marks.
• American Society for Pain Management
Nursing
Provides information for nurses on pain
management through education, standards,
advocacy, and research.
Resources
• American Pain Foundation
Handles the undertreatment of pain.
• American Pain Society
A wide range of resources on pain at this
professional site, including bulletins, journals,
advocacy/policy, events and guidelines.
• American Academy of Pain Management
Serves professionals and clients in pain, including an
online forum, local resources, programs, and a pain
management databank.
Resources
• American Chronic Pain Association
Offers support and information for people
with chronic pain through support and
education. Includes FAQs, links, and
resources.
• Agency for Healthcare Research and Quality
Offers pain management guidelines,
resources, and research citations.