APPROACH TOWARDS PAIN

1. PAIN
"I don't accept the maxim 'there's no gain without pain', physical or
emotional. I believe it is possible to develop and grow with joy rather than
grief. However, when the pain comes my way, I try to get the most growth
out of it." Alexa McLaughlin
MAJOR ARSHAD HAYAT
MCPS FCPS
DEPT OF CRITICAL CARE MEDICINE
MH

2. The International Association for the Study of Pain
defines pain as:
“An unpleasant sensory and emotional experience associated with
actual or potential tissue damage, or described in terms of such
damage"
DEFINITION

3. HISTORY
Derived from Latin -“Poena” meaning punishment from God.
Homer thought pain was due to arrows shot by God.
Aristotle, who probably was the first to distinguish five physical
senses considered pain to the “passion of the soul” that
somehow resulted from the intensification of other sensory
experience.

4. Plato contented, pain and pleasure arose from within the body, an
idea that perhaps gave birth to the concept that pain is an emotional
experience more than a localized body disturbance.
The Bible makes reference to pain not only in relationship to injury
and illness but also an anguish of the soul.

5. ‘SOCRATES’ is a mnemonic acronym used by emergency medical
services, doctors, nurses and other health professionals to evaluate
the nature of pain that a patient is experiencing.
The acronym is used to gain an insight into the patient's condition,
and to allow the Health Care Provider to develop a plan for dealing
with it.
INQUIRY INTO PAIN

6. Site - Where is the pain? Or the maximal site of the pain.
Onset - When did the pain start, and was it sudden or gradual? Include
also whether if it is progressive or regressive.
Character - What is the pain like? An ache? Stabbing?
Radiation - Does the pain radiate anywhere?
WHAT DOES THE ACRONYM STAND FOR?

7. Associations - Any other signs or symptoms associated with the pain?
Time course - Does the pain follow any pattern?
Exacerbating/Relieving factors - Does anything change the pain?
Severity - How bad is the pain?

8. 1. SITE
Central chest pain
Peripheral chest pain
Epigastrium
Right hypochondria
Left hypochondria
Periumblical
Lumbar areas
Suprapubic
Right iliac fossa
Left iliac fossa

9. 2. ONSET OF PAIN
THUNDERCLAP
OVER MINUTES
OVER HOURS
DAYS

10. 3. CHARACTER OF PAIN
SHARP WELL LOCALIZED PAIN:
DULL BORING PAIN
BURNING PAIN
PLEURITIC
COLIC / CRAMPING PAIN
DISTENDING PAIN
STABBING/ PRICKING PAIN
SHOOTING / LANCINATING PAIN

11. 4. RADIATION OF PAIN
1. Retrosternal pain radiating to the left arm/neck/ right arm
2. Epigastric pain radiating to the back
3. Right hypochondria pain radiating to the right shoulder
4. Loin to groin pain
5. Back pain radiating down the leg
6. Neck pain radiating down the arms

12. 5. ASSOCIATIONS
Pain of acute MI
Peptic ulcer
Pneumonia
S.A.H
Acute Cholecystitis
Renal colic
Intestinal obstruction
Migraine
Glaucoma

13. 6. TIME/COURSE
Worsening/aggravating over time? No change, Decreasing over time
Any specific time? Nocturnal? After meals? Fatty meals?
Early morning headaches?
Backache while lying supine at night?

14. 7. AGGRAVATING/RELIEVING FACTORS
Pain of MI
Pleuritic pain
SOL Brain
Migraine
APD
Angina
Cholecystitis
pericarditis

15. 8. SEVERITY
Mild , moderate , severe
Scale of 1-10

16. THANKYOU