The document discusses the nature of pain, types of pain including acute and chronic pain, and factors that affect the pain experience. It covers pain assessment methods like pain scales and history. Key approaches to pain management include pharmacologic interventions like opioids and non-pharmacologic options like TENS, as well as the use of patient-controlled analgesia pumps and epidural analgesia. Nursing responsibilities in pain management focus on establishing trust, considering the client's preferences, educating about pain, and providing relief measures.

1. Pain & its Management

2. Nature of Pain
Pain is a complex, subjective response
with several quantifiable features,
including intensity, time, course, quality,
impact & personal meaning.
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3. Nature of Pain
It is unpleasant & very personal sensation.
No two people experience pain in exactly
the same way.
Unrelieved pain presents both physiological
& psychological dangers to health &
recovery.
Care providers has to believe that the
client is really experiencing pain.
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4. Types of Pain
Acute Pain- pain lasting only through the
expected recovery period. (sudden/slow
onset).
Chronic Pain- lasts beyond the usual
course for recovery, usually reoccurring or
persisting over six months duration or
longer & interferes with functioning.
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7. Continued
Pain can be categorized according to its
origin:
– Cutaneous :- originates in the skin or sub-
cutaneous tissue. For e.g. paper cut causing
a sharp pain with burning.
– Deep somatic:- originates from ligaments,
tendons, bones, blood vessels & nerves. It
lasts longer e.g. ankle sprain
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8. Continued
Radiating:- It is perceived at the source of the
pain & extends to nearby tissues e.g. cardiac
pain.
Referred:- Pain felt in the part of the body that is
considerably remote from the tissues causing the
pain. E.g. pain from one part of the abdomen
viscera may be perceived in an area of the skin
remote from the organ causing the pain
e.g. Heart-sides of jaw, kidney-lower back pain etc.
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9. Continued
Intractable:- Pain is highly resistant to relief.
e.g. pain from advanced malignancy.
Neuropathic:- It is the result of current or
past damage to the peripheral or CNS & may
not have a stimulus e.g. tissue or nerve
damage e.g. prolapsed disc.
Phantom:- Painful sensation perceived in a
body part that is missing e.g. Amputated leg.
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10. – Visceral:- Results from stimulation of pain
receptors in the abdominal cavity, cranium &
thorax. It is caused by stretching of the tissues,
ischemia, or muscle spasms e.g. obstructed
bowel.
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11. Pain Syndromes
Central Pain Syndromes
– Trigeminal neuralgia
Peripheral Pain Syndromes
– Phantom Limb Pain
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13. Factors Affecting the
Pain Experience
Ethnic and Cultural Values
Developmental Stage
Environment and Support People
Past Pain Experience
Meaning of Pain
Anxiety and Stress
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14. Why clients may be reluctant
to report pain
Unwillingness to trouble staff
Fear of injectable route of analgesic
administration
Belief that pain is to be expected as part of
recovery
Concern about addiction
Fear about cause of pain or that reporting pain
will lead to further tests and expenses
Concern about unwanted side effects, especially
of opioid drugs
Difficulty expressing personal discomfort
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15. Pain Assessment
Accurate pain assessment is essential
for effective pain management.
Pain is subjective and experienced
uniquely by every individual.
Nurses need to assess all factors
affecting the pain experience.
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16. Pain History
Previous pain treatment and effectiveness
When and what analgesics were last taken
Allergies to medications, other medications
being taken
Location (abdomen)
Intensity (scale of 0-10 =visual analogue
scale)
Quality (perceiving like a knife)
Pattern (onset, duration, and recurrence of
intervals without pain.
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17. Pain Scales (VAS)
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18. Continued
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19. Key Factors in Pain
Management
Acknowledging and accepting
Assisting Support Persons
Reduce misconceptions about pain
Reducing fear and anxiety
Preventing Pain
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20. Pharmacologic Pain
Management
Involves the use of opioids
(narcotics)
Non-opioids/NSAIDS (non-
steroidal anti-inflammatory
drugs)
Adjuvants or Co-analgesic Drugs
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22. Non-Pharmacologic Pain
Management
Physical Interventions- Provide
Comfort
Cutaneous Stimulation-
Massage, application of heat
or cold, acupressure
Immobilization
Distraction- visual, auditory,
tactile, intellectual
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23. Transcutaneous
Electrical Nerve Stimulation
TENS is a method of applying low
voltage electrical stimulation directly
over identified pain areas, at an
acupressure point, along peripheral
nerve areas that innervate the pain
area, or along the spinal column.
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24. Pain Evaluation
The nurse and client must determine if
overall goals and outcomes are
achieved.
Flow sheet records and diaries are
helpful in this process, to evaluate the
effectiveness of an analgesic.
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25. Pain Management Equipment
Two devices to aid in the effective
management of pain
Patient Controlled Analgesia Pump
Epidural Analgesia
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26. Patient controlled
Analgesia (PCA)
The PCA device consists
of an intravenous pump
joined to a timing unit.
The patient triggers the
device to deliver a dose
of medication (usually
morphine, meperidine, or
hydromorphone) into a
running IV line.
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27. Nsg. Care & Assessment of patient
with PCA Pump
At the beginning of each shift – verify PCA
parameters & see if it has been programmed
correctly.
Respiratory Rate – 2hourly for 8hrs,then 4th hourly.
Level of pain
Sedation level
IV site inspection.
Pump history
Patient education
Documentation
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28. Sedation Level
0 – none
S – sleep (normal sleep,easy to arouse)
1 – mild (occasionally sleepy, easy to
arouse)
2 – moderate (occasionally sleepy, easy
to arouse)
3 – severe (somnolent,difficult to arouse)
4 – unresponsive
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29. Epidural Analgesia
The delivery of medication via a
catheter placed into the epidural
space.
2 types of drugs commonly used:
Local anesthetic – this drug helps
to dull the feeling in a specific part
of body, including the operation
site.
Opioid/Narcotic – this is the most
commonly used drug in pain
control.
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30. Nursing Care & Assessment
of patient with Epidural Pump
Vital signs including respiratory rate –15min. for 2
hrs, 30min.for 3 hrs., then 4 hourly.
Sedation level
Verbal analogue scale for pain assessment.
Sensory/motor function – 2 hrly
Site assessment for redness, swelling, drainage &
pain.
Documentation
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31. Nursing Responsibilities
Establish a trusting relationship
Consider the clients ability and
willingness to participate actively in pain
relief measures
Provide measures to relieve pain before
it becomes severe.
Maintain an unbiased attitude about
what might relief the pain
Educate the client about pain.
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32. Side effects of
Epidural Analgesia
Pain:- may be at the site of catheter insertion.
Motor Dysfunction:- because local anesthetics e.g.
Bupivacaine.
Sedation:- due to central effect in the brain.
Toxicity:- signs of toxicity e.g. tinnitus,
hypotension, tingling.
Hypotension:- due to vasodilation but rare.
Itching
Nausea
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