Pain

• Pain


  One of the human body's defense mechanisms, which indicates that the person is experiencing a problem
• Pain


  Unpleasant sensory and emotional experience associated with actual or potential tissue damage
• Pain receptors (nociceptors)


  • Located at the ends of small afferent neurons and are present throughout all the tissues of the body, numerous in the skin and muscles
• Stimuli that cause pain

  1. Mechanical factors

  2. Thermal factors

  3. Electrical factors

  4. Chemical factors

  5. Local release of bio-chemicals secondary to cell injury as Bradykinin, Histamine and Hydrogen ions
• Low & moderate pain

  Fight-Flight reaction: Increase HR, CO, Bl.P; Increase RR, hypoxemia; Mental confusion, pupil dilation; General weakness, muscle spasm
• Severe pain


  Parasympathetic activity: Decrease HR, CO, Bl.P; Pupil contraction; Warm & dry skin; Nausea & vomiting
• Psychological response to pain

  • Anxiety, Fear
• Behavioral response to pain

  • Fetal posture, Withdrawn when touched, Hold or protect the painful area, Crying
• Acute pain


  Temporary, Sudden onset, Localized, Lasts <6 months
• Chronic pain


  Prolonged, Range from mild to severe, Lasts >6 months, Intermittent to continuous (e.g. cancer pain)
• Severity of pain


  • Mild
  • Moderate
  • Severe
• Types of pain by origin/location

  • Cutaneous pain (skin & body surface)
  • Somatic pain (bone, muscle, nerve, Bl.v)
  • Visceral pain (Internal organs)
  • Referred pain
  • Radiating pain
  • Phantom pain
  • Central pain

  
• Referred pain


  A stimulus in one part of the body is felt in another (e.g. irritation under diaphragm causing right shoulder pain)
• Radiating pain


  Pain starts where the insult is and then goes somewhere else (e.g. heart attack pain starting in left chest and going to jaw or left arm)
• Patterns of pain


  • Pricking
  • Burning
  • Aching (Dull)
  • Crushing
  • Tender
  • Knifelike
  • Cutting or tearing
• Factors affecting pain experience

  • Age
  • Previous pain experiences
  • Drug Abuse
  • Cultural norms
  • Responses of others
  • Psychological status
  • Sex
  • Religious beliefs
  • Environment
  • Knowledge deficit
  • Attention
  • Anxiety
  • Coping style
  • Personality traits
  • Time of day
  • Type of pain
• Nursing process for pain assessment

  1. Subjective data: Characteristics of pain, Aggravating and alleviating factors, Influence of activities of daily living, Psychosocial response

  2. Objective data: Observe patient physical response and concomitant symptoms and signs, Inspect and palpate painful area
• Numerical Rating Pain Scale


  Used to assess pain
• Nursing diagnoses related to pain

  • Altered body comfort
  • Sleep pattern disturbance
  • Impaired physical mobility
  • Ineffective coping
  • Anxiety
  • Powerlessness
• Potential nursing diagnoses related to pain

  • High risk for disturbed body image related to physical & physiological changes
  • High risk for disturbed thought process related to disease process
• Nursing care planning for pain

  1. Prevent the cause of pain

  2. Prevent or minimize the sensation of pain
• Invasive pain interventions


  • Pharmacological intervention
  • Neurosurgical intervention
  • Acupuncture
• Pharmacological interventions


  • Nonopioid analgesics
  • Opioid analgesics
• Routes of pharmacological pain relief

  • Intravenously
  • Intraspinal
  • Implantable infusion pump
• Neurosurgical interventions


  • Neuroectomy (interruption of peripheral nerve fibers)
  • Cordotomy (interruption of pain pathways in spinothalamic tract)
• Non-invasive pain interventions


  • Cutaneous stimulation (TENS, heat/cold, massage, vibration, acupressure)
  • Distraction (music therapy, guided imagery)
  • Yoga
  • Hypnosis
  • Relaxation & breathing techniques
  • Biofeedback
• Biofeedback


  Combining 'bio' (physiology) with 'feedback' (messages/information sent back to the source) to become aware of physiological processes
• Pain should be assessed daily as it affects all aspects of an individual's health including physical well-being, mental status and effectiveness of coping mechanisms
• The term 'biofeedback' is derived by combining 'bio' with 'feedback'