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1. Bekalu A.( BSc N)
Pain perception and Comfort
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2. Objectives
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At the end of this Session you will be able to:
 Define pain
Discuss Pain mechanism
 Discuss pain assessment tools/approaches
Identify Altered functions resulting pain

3. Pain
The “fifth vital sign”
 Is an unpleasant emotional or sensory experience
initiated by potential or actual tissue damage
 It is a subjective experience
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4. Pathophysiology of Pain
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 The processing of noxious stimuli & the resulting perception of
paininvolvetheperipheral&CNS.
Nociception:- the process by which noxious stimulation(tissue
damage) is communicated through the peripheral and central
nervoussystem.(simplyitisdetectionofpainfulstimuli).
Nociceptors are neuro-receptors which detect pain, transmit pain
perceptionsto&fromthebrain.
 Nociceptioninvolvesfourprocesses

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6. Factors affecting pain
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Factors Affecting Patient Response to Painful Stimuli
 Age, gender
psychiatric factors
Genetics
 Previous experiences
 Patient perceptions
 Patient expectations

7. Types of Pain
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 Pain is categorized according to its :
 Duration
Location, and
 Etiology

8. Pain Classification by Duration
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Acute Pain:
 Recent onset, typically occurs over less than 6-week period
of time
 Commonly associated with a specific injuries like surgery,
broken bones, burns or cuts, and childbirth
Chronic Pain
 Persists beyond the expected healing time
 >3 months; may start as acute injury but it continues even
after recovery.

9. Pain Classified by Location
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 Pain can also be categorized according to location
 Pelvic pain
 Headache
 Muscle pain
 Joint pain
 Chest pain etc.
 This type of categorization aids in communication
about assessment and treatment of the pain

10. Pain Classified by Etiology
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There are two major types of pain based on its etiology
 Somatogenic pain
o Nociceptive pain
o Neuropathic pain
 Psychogenic pain

11. Pain Classified by Etiology cont’d
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Somatogenic pain: is pain which arises from localized
body tissue and usually known causes.
A. Nociceptive pain:- pain due to tissue damage resulting
from trauma, non-healing injury or inflammatory
processes.
 Nociceptive pain can be:
 Somatic
 Visceral

12. Pain Classified by Etiology cont’d
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Somatic pain: Pain originating from bone, muscle,
connective tissue.
Described as aching, sharp, stabbing, throbbing and is
well localized
Visceral pain: Pain originating from internal organs such
as pancreas, liver, GI tract, kidney…
Described as cramping, dull, colicky, squeezing
 Often poorly localized, and may be referred to other
areas

13. Pain Classified by Etiology cont’d
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B. Neuropathic pain: It is caused by an injury or dysfunction of the
peripheral or central nervous system. ‘pain caused by a lesion or
diseaseofthesomatosensorynervoussystem.
Characterized by:- Spontaneous pain (pain that comes without
stimulation): Shooting, burning, stabbing, or electric shock-like pain;
tingling,numbness,ora“pinsandneedles”feeling.
Psychogenic pain :-Psychogenic pain is a pain disorder associated
with psychological factors. Some types of mental or emotional
problemscancause,increaseorprolongpain.

14. Tools to Assess the Intensity of Pain
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Pain intensity can be measured using scales such as :
Verbal Rating Scale (VRS)
Numeric Rating Scale (NRS)
Visual Analog Scale (VAS)

15. Tools to Assess the Intensity of Pain cont’d
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Verbal Rating Scale (VRS)
Is the simplest measure
“None, “mild”, “moderate”, and “severe”
Numeric Rating scale (NRS)
Is more commonly applied in hospitals or home
0 1 2 3 4 5 6 7 8 9 10
No pain Mildpain Moderatepain Severepain Veryseverepain Worstpossiblepain

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17. Tools to Assess the Intensity of Pain cont’d
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Visual Analog Scale (VAS)
Consists of a 10-cm line with one end labeled “no
pain” & the other end labeled “worst pain imaginable.”
Patient marks the line at the point that best describes
the pain intensity.
Patient’s mark is measured & recorded in millimeters.
VAS ratings of >70 mm-‘severe pain’ & 0 to 5 mm ‘no
pain’, 5 to 44 mm ‘mild pain’ & 45 to 70 ‘moderate
pain

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19. Pain Management
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Care is individualized and may depend on:
Pain source and intensity
Patient’s age
Developmental, physical, emotional & cognitive status
Treatment preferences
Concurrent medical conditions

20. Non-pharmacological pain management
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Non pharmacologic pain relief methods can be categorized
as physical or cognitive strategies
A. Physical Pain Relief Strategies
 Acupuncture:-The technique of inserting thin needles
through the skin at specific points on the body to control
pain and other symptoms.
 Application of heat and cold
 Exercise
 Massage

21. Acupuncture:- traditional Chinese treatment of pain.
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22. B . Cognitive Therapies
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 Distraction:-shifting or moving your attention away
something in this case pain. It just means that you use
your brain to focus your attention onto something else.
Relaxation strategies
Relaxation breathing
Meditation
Art therapy
Music therapy
Progressive muscle relaxation

23. Pharmacological pain management
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A. Non Opioids ( Acetaminophen, Aspirin, NSAIDs i.e.
ibuprofen, naproxen, diclofenac, indomethacin)
B. Opioids ( Morphine, Meperidine, Fentanyl, codeine,
Tramadol)
C. Adjuvants (Local anesthetics, Antidepressants,
Anticonvulsants)

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Choice of Drugs in Treatment of Acute / Chronic
Pain
WHO Analgesics Ladder

25. Comfort
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Comfort is more complex than just achieving a
state of relief from discomfort or pain
Comfort exists when an individual experiences a
feeling of well-being and a sense of being
strengthened

26. Dimensions of Comfort
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1. Relief: Discomfort or pain is lessened
2. Ease: Absence of discomforts
3. Transcendence: Rising above discomforts when
they cannot be lessened

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