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Bekalu A.( BSc N)
Pain perception and Comfort
10/27/2023
1
Objectives
10/27/2023
2
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
Pain
The “fifth vital sign”
 Is an unpleasant emotional or sensory experience
initiated by potential or actual tissue damage
 It is a subjective experience
10/27/2023
3
Pathophysiology of Pain
10/27/2023
4
 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
10/27/2023
5
Factors affecting pain
10/27/2023
6
Factors Affecting Patient Response to Painful Stimuli
 Age, gender
psychiatric factors
Genetics
 Previous experiences
 Patient perceptions
 Patient expectations
Types of Pain
10/27/2023
7
 Pain is categorized according to its :
 Duration
Location, and
 Etiology
Pain Classification by Duration
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8
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.
Pain Classified by Location
10/27/2023
9
 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
Pain Classified by Etiology
10/27/2023
10
There are two major types of pain based on its etiology
 Somatogenic pain
o Nociceptive pain
o Neuropathic pain
 Psychogenic pain
Pain Classified by Etiology cont’d
10/27/2023
11
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
Pain Classified by Etiology cont’d
10/27/2023
12
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
Pain Classified by Etiology cont’d
10/27/2023
13
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.
Tools to Assess the Intensity of Pain
10/27/2023
14
Pain intensity can be measured using scales such as :
Verbal Rating Scale (VRS)
Numeric Rating Scale (NRS)
Visual Analog Scale (VAS)
Tools to Assess the Intensity of Pain cont’d
10/27/2023
15
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
10/27/2023
16
Tools to Assess the Intensity of Pain cont’d
10/27/2023
17
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
10/27/2023
18
Pain Management
10/27/2023
19
Care is individualized and may depend on:
Pain source and intensity
Patient’s age
Developmental, physical, emotional & cognitive status
Treatment preferences
Concurrent medical conditions
Non-pharmacological pain management
10/27/2023
20
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
Acupuncture:- traditional Chinese treatment of pain.
10/27/2023
21
B . Cognitive Therapies
10/27/2023
22
 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
Pharmacological pain management
10/27/2023
23
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)
10/27/2023
24
Choice of Drugs in Treatment of Acute / Chronic
Pain
WHO Analgesics Ladder
Comfort
10/27/2023
25
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
Dimensions of Comfort
10/27/2023
26
1. Relief: Discomfort or pain is lessened
2. Ease: Absence of discomforts
3. Transcendence: Rising above discomforts when
they cannot be lessened
10/27/2023
27

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5. pain perception and comfort (2).pptx

  • 1. Bekalu A.( BSc N) Pain perception and Comfort 10/27/2023 1
  • 2. Objectives 10/27/2023 2 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 10/27/2023 3
  • 4. Pathophysiology of Pain 10/27/2023 4  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
  • 6. Factors affecting pain 10/27/2023 6 Factors Affecting Patient Response to Painful Stimuli  Age, gender psychiatric factors Genetics  Previous experiences  Patient perceptions  Patient expectations
  • 7. Types of Pain 10/27/2023 7  Pain is categorized according to its :  Duration Location, and  Etiology
  • 8. Pain Classification by Duration 10/27/2023 8 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 10/27/2023 9  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 10/27/2023 10 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 10/27/2023 11 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 10/27/2023 12 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 10/27/2023 13 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 10/27/2023 14 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 10/27/2023 15 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
  • 17. Tools to Assess the Intensity of Pain cont’d 10/27/2023 17 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
  • 19. Pain Management 10/27/2023 19 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 10/27/2023 20 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. 10/27/2023 21
  • 22. B . Cognitive Therapies 10/27/2023 22  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 10/27/2023 23 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)
  • 24. 10/27/2023 24 Choice of Drugs in Treatment of Acute / Chronic Pain WHO Analgesics Ladder
  • 25. Comfort 10/27/2023 25 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 10/27/2023 26 1. Relief: Discomfort or pain is lessened 2. Ease: Absence of discomforts 3. Transcendence: Rising above discomforts when they cannot be lessened