Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 14
PAIN
MANAGEMENT
Pain
An unpleasant sensory sensory and
emotional experience associated with
actual or potential tissue damage.
 Whatever the client says it is, existing
whenever the client says it does.

Nature of Pain
A major function of pain is to signal
ongoing or potential tissue damage.
 Pain can also be a protective mechanism
against further injury.

Types of Pain

Pain Categorized by Origin.

Pain Characterized by Nature.
Pain Characterized by Origin

Cutaneous Pain (caused by stimulation of the
cutaneous nerve endings in the skin).

Somatic Pain (nonlocalized and originates in support
structures such as tendons, ligaments, and nerves).

Visceral Pain (discomfort in the internal organs).

Referred Pain (originating from the abdominal organs).
Pain Characterized by Nature

Acute Pain: Sudden onset, relatively short
duration; mild to severe intensity; steady
decrease in intensity over days to weeks.

Chronic Pain: Long-term (lasting six
months or longer), persistent, nearly
constant, or recurrent pain that produces
significant negative changes in the client’s
life.
Physiology of Pain

The body cannot sustain the extreme
stress response of pain for more than
short periods of time.

The body will conserve its resources by
adapting even in the face of continuing
pain of the same intensity.
The Gate Control Theory of
Pain

Theorizes that person experiences pain
with combination of these processes:
 Sensory.
 Motivational-Affective.
 Cognitive.
Conduction of Pain Impulses
Transduction (stimulus triggered).
 Transmission (impulse travels to spinal
cord).
 Perception (neural message converted
into subjective experience).
 Modulation (pain transmitters selectively
inhibited).

Factors Affecting Pain
Experience
Age.
 Previous Experience with Pain.
 Cultural Norms.

Assessment: Subjective Data
Location of pain.
 Onset and duration.
 Quality.
 Intensity (on a scale of 1 to 10).
 Aggravating and relieving factors.
 How pain affects the activities of daily
living.

Assessment: Objective Data
Physiologic (Acute pain involves
elevated respiratory rate and blood
pressure; pallor; dilated pupils, etc.
Chronic pain shows adaption).
 Behavioral (Acute pain behaviors
include crying, moaning, clenched fists,
etc. Chronic pain behaviors include
depression, listlessness, loss of libido
and weight).

Nursing Diagnoses

Two primary diagnoses used to describe
pain are acute and chronic.
General Principles of Pain
Relief
Individualize the approach.
 Use a preventive approach.
 Use a multidisciplinary approach.

Nursing Interventions
Pharmacological.
 Noninvasive.
 Invasive.

Nurse’s Role in Administering
Analgesics
Determine whether or not to give the
analgesic.
 Assess the client’s response to the
analgesic.
 Report to the physician when a change is
needed.
 Teach the client and family regarding the
use of analgesics.

Principles of Administering
Analgesics

Preventive approach.

Titrate to effect.
Preventive Approach
Pain is much easier to control if treated
when it is anticipated or at a mild intensity.
 Two methods of preventive approach are
ATC (around the clock) and PRN (“as
required”).

Titrate to Effect

The analgesic regimen needs to be
titrated until the desired effect is achieved.

This involves adjusting the following:




Dosage.
Interval.
Route .
Choice of drug.
Three Classes of Analgesics
Nonopioid.
 Opioid.
 Analgesic adjuvants.

Cognitive-Behavioral Interventions
 Trusting
Nurse-
Client
Relationship.
 Relaxation.
 Reframing.
 Distraction.
 Guided
Imagery.
 Humor.
 Biofeedback.
Reframing

Teaching clients to monitor their negative
thoughts and replace them with ones that
are more positive.
Guided Imagery

Using one’s imagination to provide a
pleasant substitute for the pain.
Biofeedback

A process through which individuals learn
to influence their physiological responses
to stimuli.
Cutaneous Stimulation
The technique of stimulating the skin to
control pain.
 Includes:
 Heat and cold application.
 Cryotherapy (cold applications)
 Acupressure and massage.
 Mentholated rubs.
 Electrical Nerve Stimulation.

Transcutaneous Electrical Nerve
Stimulation

The process of applying a low-voltage
electrical current to the skin through
cutaneous electrodes.
Other Noninvasive Pain
Interventions
Psychotherapy (including hypnosis).
 Exercise.
 Positioning and Body Alignment.

Invasive Pain Interventions
Used when noninvasive and
pharmacological measures do not provide
adequate relief.
 Include:





Nerve block.
Neurosurgery.
Radiation therapy
Acupuncture.