Comfort and Pain Funda

• Pain


  An unpleasant sensory and emotional experience associated with actual or potential tissue damage
• Pain is sometimes referred to as the FIFTH vital sign
• Pain is the most common reason for seeking health care
• Nurses must be knowledgeable about the pathophysiology of pain and its management
• Nurses encounter pain in a variety of settings, including acute care, outpatient, and long term care settings as well as in the home
• The nurse has daily encounters with pain who anticipate pain or who are in pain
• Understanding the phenomenon of pain and contemporary pain theories helps the nurse to intervene effectively
• Pain


  A subjective sensation to which people respond in different ways
• Pain


  Can directly impair health and prolong recovery from surgery, disease and trauma
• Pain


  A highly unpleasant and very personal sensation that cannot be shared with others
• Pain


  Can occupy all a person's thinking, direct all activities, and change a person's life
• Pain


  The noxious or unpleasant stimulation of threatened or actual tissue damage
• Pain sensation


  A different sensation because the purpose of pain is not to inform the CNS of the quality of the stimulus but rather to indicate that the stimulus is causing damage or injury to the tissues
• Pain


  The result of a complex pattern of stimuli generated at the pain site and transmitted to the brain for interpretation
• Categories of pain according to its origin

  • Cutaneous pain
  • Deep somatic pain
  • Visceral Pain
• Categories of pain according to its cause

  • Acute pain
  • Chronic malignant pain
  • Chronic nonmalignant pain
• Acute pain


  May have sudden or slow onset; it varies from mild to severe, some may last up to 6 months and subsides as healing takes place
• Acute pain


  Occurs within 0.1 second after application of stimulus; it may be called fast pain, sharp pain, or initial pain; impulses usually travel through the type A delta fibers and this pain is easily localized
• Chronic pain


  Lasts 6 months or longer and often limits normal functioning; it is sometimes called dull pain, slow pain and delayed pain; impulses travel in the type C fibers and are not easily localized; unpleasant autonomic signs and symptoms like nausea, sweating and generalized hypotonia, usually accompany this pain
• Cancer-related pain syndromes can result from the progression of the disease or from efforts to cure or control the disease
• Referred pain


  Pain is felt in a part of the body that is considerably removed from the tissues causing the pain
• Visceral pain


  Pain arising from organs or hollow viscera is often perceived in an area remote from the organ causing the pain
• Pain intensity levels


  • Mild pain (1-3)
  • Moderate pain (4-6)
  • Severe pain (7-10)
• Types of pain according to etiology

  • Nociceptive pain
  • Somatic pain
  • Visceral pain
  • Neuropathic pain
  • Peripheral neuropathic pain
  • Central neuropathic pain
  • Sympathetically maintained pain
• Nociceptive pain


  Experienced when an intact, properly functioning nervous system sends signals that tissues are damaged, requiring attention and proper care
• Somatic pain


  Originates in the skin, muscles, bone, or connective tissue
• Visceral pain


  Results from activation of pain receptors in the organs and/or hollow viscera; tends to be characterized by cramping, throbbing, pressing, or aching qualities; often associated with feeling sick (e.g., sweating, nausea, or vomiting)
• Neuropathic pain


  Associated with damaged or malfunctioning nerves due to illness, injury, or undetermined reasons; typically chronic; described as burning, "electric-shock," and/or tingling, dull, and aching; episodes of sharp, shooting pain can also be experienced; tends to be difficult to treat
• Peripheral neuropathic pain


  Follows damage or sensitization of peripheral nerves
• Central neuropathic pain


  Results from malfunctioning nerves in the central nervous system (CNS)
• Sympathetically maintained pain


  Occurs occasionally when abnormal connections between pain fibers and the sympathetic nervous system perpetuate problems with both the pain and sympathetically controlled functions (e.g., edema, temperature and blood flow regulation)
• Terms used in the context of pain

  • Radiating pain
  • Referred pain
  • Intractable pain
  • Phantom pain
  • Phantom sensation
  • Hyperalgesia
  • Pain threshold
  • Pain sensation
  • Pain reaction
  • Pain tolerance
  • Nociceptors
  • Pain perception
• Pain threshold


  The amount of pain stimulation a person requires in order to feel pain
• Pain sensation


  Can be considered the same as pain threshold
• Pain reaction


  Includes the autonomic nervous system and behavioral responses to pain
• Pain tolerance


  Maximum amount and duration of pain that an individual is willing to endure
• Nociceptors


  Pain receptors
• Pain perception


  The point which the person becomes aware of the pain
• Pain threshold is similar in all people, but pain tolerance and response vary considerably
• Stimuli that can stimulate nociceptors

  • Serotonin
  • Histamine
  • Potassium ions
  • Acids
  • Some enzymes