PAIN

• Pain


  • A universal but individual experience
  • Most common reason for seeking health care
  • Often underrecognized, misunderstood, and inadequately treated
  • Some healthcare professionals are overconfident despite lack of competence in assessing and treating pain
  • Pure subjective
  • Punishment for wrongdoings (Philosophical and religious basis)
  • A sensation of physical or mental suffering that causes diseases
  • Pain should not be neglected
  • A personal sensation of hurt (Subjective)
  • A harmful stimulus that signals tissue damage
  • Complex
  • Involving more than a single physiological sensation caused by a specific stimulus
  • Has physical, emotional and cognitive components
  • Depletes a person's energy and can contribute to chronic fatigue
  • If left untreated it can lead to serious physical, physiological, social, and financial consequences
• UNDERLYING PRINCIPLES FOR REPORT

  ●      Pain management is a moral imperative

  ●      Chronic pain can be a disease in itself

  ●      The value of comprehensive treatment

  ●      The need for interdisciplinary approaches

  ●      The importance of prevention

  ○      No need to wait until you feel it

  ●      Wider use of existing knowledge

  ●      Recognition of the conundrum of opioid

  ●      Collaborative roles for patient and clinicians

  ●      The value of a public health and community-based approach
• ●      Pain is a national challenge

  ○      All people are at risk for pain

  ○      Pain is a uniquely individual, subjective experience

  ●      Comprehensive and interdisciplinary (biopsychosocial) approaches are the most important and effective ways to treat pain

  ●      Such care is difficult to obtain because of structural barriers - including financial and payment

  ●      A cultural transformation is needed to better prevent, assess, treat, and understand pain
• PHYSIOLOGY OF PAIN

  TRANSDUCTION

  ●      Thermal, chemical or mechanical stimuli

  ●      Converts energy produced to an electrical stimuli

  TRANSMISSION

  ●      Cellular damage or chemical stimuli results in the release of excitatory neurotransmitters suchs as prostaglandin, bradykinin, histamine

  ●      Nerve impulse travel along afferent (peripheral) nerves

  PERCEPTION

  ●      Point in which a person is aware of pain
• Specificity Theory

  ●      Described by Descartes

  ●      Assumes that there are certain specific nerve receptors that responds to noxious stimuli which are always interpreted as pain
• Pattern Theory

  ●      Pain is produced by intense stimulation of non specific fiber receptors

  ●      Any stimulus is painful if intense enough
• Affect Theory

  ●      Avers that the pain is emotional. The intensity perceived depends on the value of the organ affected to the individual

  ●      Does not include physiologic aspect

   
• Parallel Processing Theory

  ●      By Leventhal and Everhart

  ●      Believes that the physiologic or neurologic deciphering of pain sensation and the cognitive emotional properties occur along different nerve fibers

   
• Gate Control Theory

  ●      The most accepted theory

  ●      There is a gate in the spinal cord called substantial gelatinosa

  ○      Open - pain stimulus is transmitted = pain

  ○      Close - pain stimulus is blocked = no pain

  ●      “Opened”

  ○      By attitudes, past experiences, thoughts

  ●      “Closed”

  ○      Conflicting impulses from the skin conducted over large diameter fibers

  ○      Impulses from the reticular formation in the brainstem

  ○      Impulses from the entire cortex or thalamus
• Physiological Factors

  • Age/developmental stage
  • Fatigue - heightened pain perception
  • Genes
  • Neurological function
• Social Factors

  • Attention
  • Previous experience
  • Family and social support
  • Spiritual factor
  • Ethnic and cultural values
• Psychological Factors

  • Anxiety
  • Coping style
• Cultural Factors


  Meaning of pain
• Pain Threshold


  Refers to the intensity of the noxious stimulus necessary for the person to perceive pain
• Pain Tolerance


  • The maximum amount and duration of pain the person can endure
  • Varies greatly among people
• Hyperalgesia


  Excessive sensitivity to pain
• ●      Acute/transient pain:

  ○      Usually protective

  ○      has an identifiable cause

  ○      in short duration

  ○      limited tissue damage

  ●      Chronic / persistent non cancer pain:

  ○      Not protective, thus serves no purpose

  ○      Has dramatic effect on the QoL

  ○      Prolonged, varies in intensity usually lasts longer
• ACCORDING TO LOCATION

  ●      Superficial / cutaneous somatic pain

  ○      Arising from the skin, muscles, or joints

  ○      Short duration

  ○      Localized, sharp, prickling type of pain

  ●      Deep visceral

  ○      Pain in any body cavity (abdominal, thoracic, cranial)

  ○      Longer duration

  ○      Diffuse or radiating

  ○      Sharp or dull or unique to organ involved

  ■      Crushing pain - angina

  ■      Burning pain - ulcer
• Types of pain according to periodicity or pattern

  • Intractable pain
  • Intermittent pain
  • Phantom Pain
  • Referred pain
  • Radiating pain
• Intractable pain

  • Chronic pain
  • Resistant to cure or relief
  • Caused by uncontrolled cancer or progressive disorders
  • Pain in arthritis, cancer, etc.
• Intermittent pain

  • On and off
  • Dysmenorrhea
• Phantom Pain


  • Felt in a body part that is no longer present
  • Amputated foot
• Referred pain


  • Felt in areas other than those stimulated
  • Common in visceral organs without pain receptors
  • E.g. pain in groins - due to kidney stones
  • Pain in jaws, left arms and shoulder - due to MI
• Radiating pain


  • Extension of pain from source to another body part
  • E.g. cardiac pain can radiate to left shoulder
• ACCORDING TO INTENSITY / SEVERITY

  0 = no pain

  1 - 3 = mild pain

  4 - 6 = moderate

  7 - 10 = severe
• According to QUALITY

  ●      Dull – more annoying than painful

  • ●      Sharpsticking in nature and is intense

  ●      Diffuse – covers a large area

  ●      Shifting – moves from one area to another
• EFFECTS OF PAIN ON A PATIENT

  ●      Behavioral Effects

  ●      Influence on activities of Daily living

  ●      Concomitant symptoms (associated)

  ○      Nausea, headache , dizziness, urge to urinate, constipation ,depression and restlessness
• Cutaneous Stimulation for pain

  closes gate, serotonin release

  ●      Touch

  ●      Vibration

  ●      Hot & cold application

  ●      Counter irritants – increase circulation to area

  ●      Acupuncture/ Acupressure

   
• Distract Attention for pain

  closes gate, acts on thalamus

  ●      Deep breathing exercises

  ●      Singing, reading, listening to music

  ●      Conversation

  ●      Playing, favorite toy

  ●      Busying oneself
• Promote Relaxation

  
• Autogenic training