Pain management

• Pain assessment


  Communicating with other healthcare providers
• Patient right


  Relief of Pain
• Pain medication frequency


  PRN (as needed)
• Definition of pain


  Whatever the person experiencing pain says it is, existing whenever the person says it does
• Pain medication cannot be withheld, but patterns and behavior can be charted
• Pain


  Subjective but can be objective
• Pain can become problematic in populations like Dementia and Comatose
• Information that can help pain assessment


  • Nonverbal; behaviors (hunched over with pain stating "I'm fine")
• Dimensions of pain


  • Physiological
  • Affective
  • Cognitive
  • Behavioral
  • Sociocultural
• Primary afferent fibers


  • A-delta fibers: small, myelinated fibers that conduct pain rapidly and are responsible for the initial, sharp pain that accompanies tissue injury
  • C fibers: small, unmyelinated fibers that transmit painful stimuli more slowly and produce pain that is typically aching or throbbing in quality
• Segments in pain transmission


  • Transmission along the peripheral nerve fibers to the spinal cord
  • Dorsal horn processing
  • Transmission to the thalamus and the cerebral cortex
• Factors that can increase pain tolerance

  Endogenous opioids
• Examples of endogenous opioids


  • Enkephalins
  • Endorphins
  • Dynorphins
  • Endomorphins
• Neurotransmitters that can inhibit pain impulse transmission


  • Serotonin
  • Norepinephrine
• How medication resolves pain within the central nervous system

  Medication is blocking the receptor
• What nociceptive input is perceived as

  Pain in the brain
• Types of underlying pathology


  • Nociceptive
  • Neuropathic
• Segments of nociceptive pain


  • Somatic
  • Visceral
• Examples of nociceptive pain


  Broken bone, surgical incision, or arthritis
• Treatments for nociceptive pain


  Opioid and nonopioid medication
• Why neuropathic pain is more difficult to treat


  Since it is damage to the nerves; it's harder to pinpoint
• Types of neuropathic pain


  • Sudden
  • Intense
  • Short-lived; Complex Regional pain syndromes (CRPS); Snow without gloves
  • Lingering: Phantom Limb Pain; Amputee limb
• Treatments for neuropathic pain


  • Opioid analgesics
  • Adjuvant analgesics
  • Tricyclic antidepressants: can be depressed from pain
  • Serotonin norephinephrine reuptake inhibitors (SNRIs): Stop unfavorable impulses
  • Antiseizure drugs: Stop unfavorable impulses
• Acute pain


  Sudden onset, short duration, < 3 months for normal healing to occur; Can identify cause; Treatment goal: Pain control & eventual elimination
• Clinical manifestations of acute pain on the sympathetic nervous system


  • Hypertension, Tachypneia, Tachycardia
• Chronic pain


  Persistent pain, gradual or sudden onset, 3 months <; Cause may be unknown; Treatment goals: control extent possible (optimal health) & focus on enhancing function & quality of life
• Pattern of chronic pain

  Waxing and waning; Does not go away
• Nurse's responsibility during pain assessment


  Gather and document data; Make collaborative decisions with patient & other healthcare providers
• Elements of a pain assessment


  • Direct interview
  • Observation
  • Diagnostic Studies
  • Physical Examination
• PCA pump


  Patient Controlled Analgesia; Breakthrough pain when no longer effective
• End-of dose failure


  Feeling pain before next available dose
• Use of pain location

  Cause and treatment
• Ways pain can move

  • Localized
  • Referred/Radiating to different site
  • All over
• What to look for when assessing pain intensity and quality in patients


  Nonverbals; hunching over, supporting a particular area
• Associated symptoms of pain


  • Depression
  • Anxiety
  • Fatigue
• How nurses can decrease risk of developing associated symptoms

  Get them up and moving
• Pain treatment principles


  • Every patient deserves adequate pain management
  • Treatment is based on the patient's goals
  • Use drug & nondrug therapies
• What is needed to guide reassessment of vitals


  • Pain Severity
  • Physical & Psychosocial interaction
  • Types of interventions
  • Risks of adverse effects
  • Institutional policy
• Categories of medication


  • Nonopioid
  • Opioid
  • Adjuvant
• What non opioid medication can produce and not produce


  Produce: Analgesic Ceiling- increasing dose until it does not treat pain; Does not produce: Addiction