Pain- Definitions, types, physiology, factors influencing, assessment and nursing management

1. NURSING MANAGEMENT
OF PAIN
PRESENTED BY
JANNET REENA

2. DEFINITIONOFPAIN
“Pain is complex multifactorial phenomenon
which includes an emotional experience
associated with actual as potential”
-MERSKEY & BUGDULK, 1994
The International Association for the Study of
Pain (IASP) defines pain as a "sensory and
emotional experience associated with tissue
damage or described in terms of such
damage."

3. TYPES OF PAIN
ACUTE PAIN: Acute pain is a type of pain that typically lasts less than
3 to 6 months, or pain that is directly related to soft tissue damage
such as a sprained ankle or a paper cut. Acute pain is of short duration
but it gradually resolves as the injured tissues heal.
CHRONIC PAIN: Is pain that is ongoing and usually lasts longer than
six months. This type of pain can continue even after the injury or
illness that caused it has healed or gone away.
NOCICEPTIVE PAIN: Pain from physical damage or potential damage
to the body.
 SOMATIC PAIN: Pain that includes skin pain, tissue pain,
or muscle pain.
 VISCERAL PAIN: Pain that arises from internal organ.
Visceral pain often is diffuse or vaguely localized.
 NEUROPATHIC PAIN:
Pain that originates in peripheral nerves or the central nervous system

4. PHYSIOLOGY OF PAIN
THERE ARE FOUR MAJOR PROCESSES:
TRANSDUCTION, TRANSMISSION, MODULATION, AND PERCEPTION.
1. TRANSDUCTION REFERS TO THE PROCESSES BY WHICH TISSUE-
DAMAGING STIMULI ACTIVATE NERVE ENDINGS.
2. TRANSMISSION REFERS TO THE RELAY FUNCTIONS BY WHICH THE
MESSAGE IS CARRIED FROM THE SITE OF TISSUE INJURY TO THE
BRAIN REGIONS UNDERLYING PERCEPTION.
3. MODULATION IS A RECENTLY DISCOVERED NEURAL PROCESS
THAT ACTS SPECIFICALLY TO REDUCE ACTIVITY IN THE
TRANSMISSION SYSTEM.
4. PERCEPTION IS THE SUBJECTIVE AWARENESS PRODUCED BY
SENSORY SIGNALS; IT INVOLVES THE INTEGRATION OF MANY
SENSORY MESSAGES INTO A COHERENT AND MEANINGFUL
WHOLE. PERCEPTION IS A COMPLEX FUNCTION OF SEVERAL
PROCESSES, INCLUDING ATTENTION, EXPECTATION, AND

6. FACTORS AFFECTING PAIN
• PHYSIOLOGICAL
• AGE
• FATIGUE
• GENETIC MAKEUP
• MEMORY
• STRESS RESPONSE
• PSYCHOLOGICAL
• FEAR AND ANXIETY
• COPING
• CULTURAL
• RACE AND ETHNIC DIFFERENCES
• CULTURE VALUES OR DISVALUES, THE DISPLAY OF EMOTIONS,
POSTURAL MOBILITY OR VERBAL EXPRESSION IN RESPONSE TO PAIN OR
INJURY.
• SOME CULTURAL GROUPS EXPECT AN EXTRAVAGANT DISPLAY OF
EMOTION IN THE PRESENCE OF PAIN, BUT OTHERS VALUE STOICISM,
RESTRAINT AND PLAYING DOWN THE PAIN.

7. ASSESSMENT OF PAIN
The pain assessment involves an overall
appraisal of the factors that may influence a
patients experience and expression of pain
Assessment includes
SUBJECTIVE DATA
OBJECTIVE DATA

8. A. SUBJECTIVE ASSESSMENT
1. PAIN HISTORY
While taking pain history, nurse must provide an
opportunity for clients to express in their own
words, how they view it and their situation
This will help the nurse to understand means of
pain to client and how the client is coping with
it.

9. 2. ONSET AND DURATION OF OCCURRENCE:
- When did pain begin?
- How long has it lasted?
- Does it occur at same time each day?
- How often does it occurs?

10. 3. LOCATION
- In which area it is felt? Do the area differ
under different circumstances?
- If several parts of body are painful, do pain
occur simultaneously?
- Is pain unilateral / bilateral?
- Ask the individual to point site of discomfort

11. 4. INTENSITY
- Use of pain intensity scale is an easy and
reliable method of determining the clients
pain intensity
- Most scales are either 0 to 5 or 0 to 10
- Currently used scales are:
• Numerical scale
• Descriptive scale
• Visual analog scale

12. PAIN ASSESSMENT SCALE
1. NUMERICAL RATING SCALE
 A numerical rating scale with the range of 0 to
10 is another type of pain scale that is used
 The word “no pain” appear by “0” and “worst
pain possible” is found by “10”
 Patient are asked to choose a number from 0
to 10 that best reflects his/her level of pain

14. 2. VERBAL RATING SCALES
Verbal pain scales as name suggests, use words
to describe pain. Word such as no pain, mild
pain, moderate pain & severe pain are used to
describe pain levels.

15. 3. VISUAL ANALOGUE SCALES:
- VSA use a vertical or horizontal line with
words that convey “no pain” at one end and
“worst pain” at opposite end
- Patient is asked to place a mark along line that
indicates his/her level of pain.

16. WONG-BAKER FACES PAIN RATING
SCALEWith the wong-baker pain scale, six faces are
used that are numbered 0 to 5 underneath
Face 0 is a happy face
Face 2 is still smiling
Face 4 is not smiling or frowning
Face 6 is starting to frown
Face 8 is definitely frowning
Face 10 is crying

18. B. OBJECTIVE ASSESSMENT
1. BEHAVIORAL EFFECTS:
Assess verbalization, vocal response, facial
and body movements & social interaction
Facial expression is often 1st indication of pain
& may be only one manifestation
Vocalization like moaning, groaning, crying,
grunting, screaming are associated with pain.

19. 2. PHYSIOLOGICAL RESPONSES:
 It vary with the origin and duration of pain
 Early in onset of acute pain, the symapthetic
nervous system is stimulated
 Results in increased blood pressure, pulse
rate, respiration, pallor, diaphoresis and pupil
dilation

20. P-Q-R-S-T FORMAT
PROVOCATION: how the injury occurred &
what activities increase or decrease the pain
QUALITY: characteristics of pain
REFERRAL/ RADIATION
 Referred: site distant to damaged tissue that
does not follow course of peripheral nerve
 Radiating: follows peripheral nerve, diffuse
pain

21. QUESTION TO ASK ABOUT PAIN
PATTERN: onset & duration
AREA: location
INTENSITY: level
NATURE: description

22. WHO 3-STEP
LADDER

23. PHARMACOLOGICAL MANAGEMENT
OF PAIN
• TYPES OF ANALGESIC MEDICATIONS
ANALGESIC DRUGS CAN BE
• DIVIDED INTO TWO GROUPS:
• NON-OPIOID
- ALSO REFERRED TO AS NON-
NARCOTIC, PERIPHERAL, MILD &
ANTIPYRETIC AGENTS
• OPIOIDS
- ALSO CALLED NARCOTIC, CENTRAL
OR STRONG AGENTS

24. NON PHARMACOLOGICAL
MANAGEMENT OF PAIN
 HEAT
 COLD APPLICATION
 MASSAGE
THERAPY
 PHYSICAL
THERAPY
 TRANSCUTANEOUS ELECTRICAL NERVE
STIMULATION (TENS)
 SPINAL CORD STIMULATION
(SCS)
 AROMATHERAPY
 GUIDED IMAGERY
 LAUGHTER
 MUSIC
 BIOFEEDBACK
 SELF
HYPNOSIS
 ACUPUNCTURE

25. SURGICAL INTERVENTIONS OF
PAIN
• CORDOTOMY: DIVISION OF CERTAIN TRACTS OF THE
SPINAL CORD . CORDOTOMY IS PERFORMED TO
INTERRUPT THE TRANSMISSION OF PAIN.
• RHIZOTOMY: SENSORY NERVE ROOTS ARE DESTROYED
WHERE THEY ENTER THE SPINAL CORD.

26. NURSES ROLE IN PAIN
MANAGEMENT
• PLANNING
• GOALS AND OUTCOMES
• EX: GOAL- “THE CLIENT WILL ACHIEVE A SATISFACTORY LEVEL OF
PAIN RELIEF WITHIN 24 HOURS”; POSSIBLE OUTCOMES-“ REPORTING THAT
THE PAIN IS A 3 OR LESS ON SCALE, USING PAIN RELIEF MEASURES SAFELY”
• SETTING PRIORITIES:
• EX: PAIN RELATED TO INCISIONAL PAIN CAN BE REDUCED BY
ANALGESICS BUT PAIN RELATED TO EARLYLABOR CONTRACTIONS WILL
ONLY REDUCED BY RELAXATION EXCERCISES.
• CONTINUITY OF CARE:
• A COMPREHENSIVE PLAN INCLUDES A VARIETY OFRESOURCES
FOR PAIN CONTROL WHICH INCLUDE NURSE SPECIALISTS, DOCTORS OF
PHARMACOLOLOGY, PHYSICAL THERAPIST, OCCUPATIONALTHERAPIST.

27. NURSING DIAGNOSIS
1. Ineffective airway clearance r/t chest pain
2. Anxiety r/t past experience of poor control of pain
3. Altered health maintenance r/t chronic pain
4. Impaired physical mobility r/t asthmatic pain perception
5. Knowledge deficit r/t pain
6. Self-care deficit r/t pain or disease condition
7. Ineffective coping
8. Disturbed sleep pattern
9. Impaired social interaction
10. Ineffective role performance

28. NURSING INTERVENTION
Use pain assessment scale to identify intensity
of pain
Assess and record pain & its characteristics,
condition, quality, frequency & duration
Administer analgesics as prescribed to
promote optimal pain
Document severity of patient pain on chart

29. Identify & encourage patient to use strategies
that have been successful with previous pain
Consider cultural influence on response
Eliminate the factors that increase the pain
experienced
Teach the use of non pharmacological therapy
techniques