PAIN

• PAIN


  Unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
• 5th Vital Sign


  Whatever the patient says it is
• Nature of Pain


  • Highly subjective and individualized
  • Stimulus is physical and/or mental in nature
  • Interferes with personal relationships and influences the meaning of life
  • Only the patient knows whether pain is present and how the experience feels
  • May not be directly proportional to amount of tissue injury
  • Primary source of information
  • Associated with Central and Peripheral Nervous System
• Pain Stimulation


  1. Pain stimulates the nociceptors (peripheral nerve endings) that are responsible for transferring sensation to CNS

  2. It detects signals from the damaged tissues
• Stimulation of the Sympathetic Nervous System

  • Increased RR
  • Increased HR
  • Peripheral vasoconstriction
  • Pallor
  • Elevated BP
  • Increased Blood Glucose
  • Diaphoresis
  • Dilated Pupils
  • Moaning
  • Guarding the area
  • Restlessness
  • Irritability
• Acute Pain


  When pain lasts only through the expected recovery period, is protective, has an identifiable cause, is of short duration, and has limited tissue damage and emotional response
• Chronic Pain

  The pain that last longer than 6 months and is constant or recurring with a mild-to-severe intensity, does not always have an identifiable cause and leads to great personal suffering
• Types of Chronic Pain

  • Chronic Non Cancer Pain
  • Chronic Cancer Pain
  • Chronic episodic pain
• Referred Pain

  Pain due to problems in other areas manifest in different body part
• Pain Intensity


  • Mild Pain - 1 to 3
  • Moderate Pain - 4 to 6
  • Severe Pain - 7 to 10
• Nociceptive Pain

  Experienced when an intact, properly functioning nervous system send signal that tissues are damaged, requiring attention and proper care
• Types of Nociceptive Pain

  • Somatic Pain
  • Visceral Pain
• Neuropathic Pain

  Associated with damaged or malfunctioning nerves due to illness, injury, or undetermined reasons
• Types of Neuropathic Pain

  • Peripheral Neuropathic Pain
  • Central Neuropathic Pain
• Factors Influencing Pain

  • Developmental Factors
  • Physiological Factors
  • Social Factors
  • Spiritual Factors
  • Psychological Factors
  • Cultural Factors
• Pain Assessment

  1. Precipitating / Alleviating Factors

  2. Quality of Pain

  3. Radiation

  4. Severity

  5. Timing
• Objective Signs of Pain

  • Facial Expression
  • Vocalization
  • Body movement
• Pain Assessment Tools

  • Verbal Rating Scale
  • Numeric Rating Scale
  • Wong Baker's Faces Pain Scale
• Pain Management

  1. Pharmacological Interventions

  2. Non-Pharmacological Pain Management
• Pharmacological Interventions

  • Analgesics (Non-Opioids, Opioids, Adjuvants)
  • WHO Pain Management Ladder
  • Patient-Controlled Analgesia
  • Topical Analgesics
  • Local Anesthesia
  • Regional Anesthesia
• Non-Pharmacological Pain Management

  • Heat and cold applications
  • Meditation
  • Distraction
  • Imagery
  • TENS (Transcutaneous electrical nerve stimulation)
  • Music therapy
  • Massage
  • Yoga
  • Acupuncture
  • Herbal therapy