3. occurs as the result of many
disorders, diagnostic tests,
and treatments
the fifth vital sign
most common reason for
seeking health care
4. Disables and distresses
more people than any single
disease (Smeltzer et al, 2008).
A cardinal symptom of
inflammation and is valuable
in the diagnosis of many
disorders and conditions.
5. It may be;
*mild or severe,
*chronic, acute,
*lancinating,
*burning,
*dull or sharp,
*precisely or poorly localized, or
referred
8. 1. Major Events
1.1Peripheral transmission (first
order neuron)
Type of Receptors:
a .Nociceptors (Noxious stimuli) -
found in skin, meninges, periosteum
and some internal organs
b .Thermoreceptors - heat and cold
c. Mechanoreceptors - stretching,
cutting, tearing
9. 1.2 Spinal cord transmission (second order neuron)
1.3Transmission in the Cortex orThalamus (third order neuron)
10. 2.ThreeTypes
ofSensory
Nerve, Fiber
for
Transmission
of PainStimuli
2.1 A-fibers - are large, myelinated
fibers that conducts a stimuli rapidly
2.2 B-fibers - are smaller myelinated
fibers with a slow conduction item.
2.3 C-fibers - are non-myelinated
small fibers with the slowest conduction
time. Believed to transmit the “second”
or dull pain.
11. PAIN
THEORIES
A. SpecificityTheory - holds
that there are certain specific
nerve receptors that respond to
noxious stimuli and that these
noxious stimuli are always
interpreted as pain.
12. B. PatternTheory -any stimulus
could be perceived as painful if
the stimulation were intense
enough.
13. C. Gate ControlTheory -there is
a specialized system (gate
control) that modulates sensory
input before evoking perception
and response to the stimuli.
14. PATTERNS
a. Constant pain - occurs
continuously
b. Intermittent pain occurs
periodically
c. Intractable pain- not relieved by
ordinary measures
15. DURATION
a. Acute Pain
Usually of recent onset and
commonly associated with a specific
injury(Smeltzer et al, 2008)
pain that resolves quickly
Lasts from seconds to 6 months
(Smeltzer et Pain According to duration:
al, 2008)
16. b. Chronic Pain
Constant or intermittent pain that extends beyond the
expected healing period
Seldom attributed to a specific cause or injury
May be defined as pain that lasts for 6 months or
longer, although 6 months is an arbitrary period for
differentiating between acute and chronic pain.
17. Chronic pain serves no useful
purpose but if it continues, it
may become a patient’s primary
disorder. (Smeltzer et al, 2008)
18. 2. Cancer – Related Pain
Pain associated with cancer may be acute or
chronic.
Can be directly associated the cancer (eg, Bony
infiltration with tumor cells or nerve
compression), a result of cancer treatment (eg,
Surgery or radiation) or not associated with
cancer (eg, trauma). (Smeltzer et al, 2008)
19. 3. Pain Classified According to Region and
System
Pain can be classed according to its location in
the body, as in headache, low back pain and
pelvic pain
20. According to the body system
involved….
myofascial (emanating from skeletal
muscles or the fibrous sheath
surrounding them),
rheumatic (emanating from the joints
and surrounding tissue),
21. causalgia (“burning” pain in the skin of the
arms or, sometimes, legs; thought to be the
product of peripheral damage),
neurologic caused by damage to or
malfunction of any part of the nervous system
vascular - pain from blood vessels
22. SOURCESOF
PAIN
a. Physical sources- stimulation by injury,
pressure or oxygen deprivation.
b. Environmental sources - extreme
loud noise; air-pollution
23. 4. Pain Classified According to
Etiology
a. Somatogenic – pain arising from
a pertuberation of the body
a.1 Nociceptive: caused by
activation of nociceptors
24. Nociceptive pains may be classified to
the modes of noxious stimulation
Thermal (heat or cold
Mechanical (crushing, tearing,
etc
Chemical (iodine in a cut, chili
powder in the eyes)
25. Superficial pains are initiated by activation of nociceptors in the
skin or superficial tissues, and are sharp, well defined, clearly
localized pain (eg., minor wounds and minor (first degree) burns.)
26. Deep somatic pains are initiated by
stimulating of nociceptors in
ligaments, tendons, bones, blood
vessels, fasciae and muscles, and are
dull, aching, poorly localized pains.
Examples are sprains, broken bones.
27. Visceral pains originate in the
viscera (organs) and are usually
more aching or cramping than
somatic pain.
28. SOURCESOF
PAIN
a. Physical sources- stimulation by
injury, pressure or oxygen
deprivation.
b. Environmental sources - extreme
loud noise; air-pollution
30. NURSING
MANAGE-
MENT
Nurse’s Role in Pain Management
Helps relieve pain by administering pain –
relieving interventions (including
pharmacologic and non – pharmacologic
approaches)
Assessing the effectiveness of those
interventions
31. Monitoring for adverse effects
Serving as an advocate for the
patient when the prescribed
intervention is ineffective in relieving
pain.
32. 1.
ASSESSMENT
1.1 Subjective Data:
The PQRST of Pain:
Precipitation/predisposing factor – determines what,
if anything, makes the pain worst or better
Quality – description of pain such as (burning, aching,
throbbing, or stabbing
Radiation/region – indicates the location of the pain
whether it is radiating or referred.
Severity – ranges from none to mild discomfort to
excruciating.
Timing – “at what time is the pain worst”
33. 1.2 Objective Data
Physiologic –Vital Signs, pallor,
diaphoresis, dilated pupils, muscle tension,
nausea, and vomiting
Behavioral – restlessness, clenched teeth
and fist, rigid body posture, crying, moaning,
frowning.
34. 2.
INSTRUMENT
FOR
ASSESSING
THE
PERCEPTION
OF PAIN
2.1 Pain Intensity Scales – are useful
in assessing the intensity of pain.
Simple descriptive pain intensity
scale (no pain, mild pain,
moderate pain, severe pain, very
severe pain, worst possible pain)
0 – 10 Numeric Pain Intensity
Scale (0= no pain, 5= moderate
pain, 10= worst possible pain)
35. Visual Analog Scale (VAS) – left
side = no pain, right side = pain as
bad as it could possibly be
2.2 Faces Pain Scale – Revised –
has six faces depicting an expression
that ranges from contented to
obvious
distress.
