For first year and second year nursing students. keep reading and i will keep uploading. thanks.

2. CARE OF PATIENT
WITH PAIN
Abhishek A. Joshi
Nursing Tutor
GCON, Bhavnagar

3. Thought of the day
Good, Better, Best.
Never Let it Rest……
‘Till your Good is better &
Your better is Best…!’

4. Content
• Introduction & Definition
• Types of pain
• Causes of pain
• Nursing Assessment of Pain
• Management of Pain

5. Definition
• Pain defined as “ An Unpleasant sensory and
emotional experience associated with actual
or potential tissue damage.”

6. Types of Pain
• Pain is categorized according to its duration, location and
etiology.
• There is mainly two types of pain.
• (A) General Pain
• (B) Specific type of pain

7. (A) General Pain
• (i) Acute pain:
• Acute pain is usually of short duration (less than 6
months) and results from disease, inflammation, or injury
to tissues.
• This type of pain generally comes on suddenly, for
example, after trauma or surgery, and may be
accompanied by anxiety or emotional distress.
• The cause of acute pain can usually be diagnosed and
treated. In some rare instances, it can become chronic.

8. • (ii) Chronic Pain:
• Chronic pain is usually considered pain that lasts more
than 6 months.
• Chronic pain is widely believed to represent disease itself.
• It can be made much worse by environmental and
psychological factors.
• It may have poorly defined onset and it is often difficult to
treat because the cause of origin may be unclear.

9. Characteristics of Chronic Pain
• Depressed mood
• Increased or decreased appetite and weight
• Reduced work capacity,
•
• Poor physical tone, and increased depression,
• Social withdrawal;
• Poor sleep and chronic fatigue

10. (B) Specific Type of Pain
• (1) Nociceptive Pain:
• Nociceptive pain is a type of pain caused by damage to a
normal body tissue.
• Nociceptors are the nerves which sense and respond to parts
of the body which suffers from damage.
• Nociceptive pain is the body’s reaction to painful stimuli such
as a pulled back muscles/bone.
• It does not cause nerve damage itself.
• Examples: Sprains, Burns, Bruises

11. • (ii) Somatic pain:
• Somatic pain is due to stimulation of the somatic nervous
system.
• Somatic pain occurs when pain receptors in tissues (like skin,
muscles, skeleton, joints and connective tissues) are activated.
• Pt may describe this as sharp, aching/throbbing pain that is
easily localized.
• Examples: Bone fractures, Strained muscles, Skin cuts, joint
pain etc.

12. • (iii) Visceral pain:
• Visceral pain results from Autonomic Nervous
system(ANS).
• This pain is related to the internal organs of the body such
as Heart, GI tract, lungs etc.
• Pain tends to be poorly localized, vague and dull pain.
• Example: Bladder pain, Irritable bowel syndrome, Heart
attack pain etc.

13. • (2) Referred Pain:
• Referred pain is perceived at an area that is distant from
it’s point of origin OR perceived at a location other than
the site of the painful stimulation/origin.
• It is the result of a network of interconnecting sensory
nerves that supplies different many tissues.
• Example: Pain associate with myocardial ischemia, Is
frequently referred to neck, shoulder/left arm.

14. • (3) Psychogenic Pain:
 Psychogenic pain is not official diagnostic term, it’s used
to describe a pain disorder attributed to psychological
factors.
 It is a type of pain for which no physical cause can be
identified.

15. • (4) Phantom Pain:
• Phantom pain is pain that feels like it’s coming from a
body part that’s no longer there.
• It’s commonly observed after amputation of limb. Painful
sensations, which are typically intermittent, are described
as stabbing, shooting, burning etc.
• The missing limb may feel twisted or cramped.

16. • (5) Neuropathic Pain:
• Neuropathic pain results from an injury to or abnormal
functioning of peripheral nerves/CNS.
• Injury to the peripheral nerves cause spontaneous
paresthesia, numbness, pain with movement, tenderness,
electric shock like pain etc. it’s also called spontaneous
neuropathic pain.

17. • (6) Superficial/Cutaneous pain:
• Cutaneous pain resulting from stimulation of skin.
• Pain is of short duration and is localized.
• Superficial somatic pain includes laceration, abrasions
and minor burns.

19. Etiology & Precipitating factor
• Surgical & Accidental trauma
• Inflammation
• Musculoskeletal Disorder
• Visceral disorder
• Cancer
• Visual Disorder

20. Nursing Assessment of Pain
• Pain History
• Location
• Intensity
• Past pain experience
• Physical Examination
• Physiologic response
• Daily Pain Diary

21. Visual Analogue Scale

22. Management of Pain
• (A) Non-Pharmacological
• (B) Pharmacological

23. (A) Non-Pharmacological Management
• 1) Relaxation: is mental and physical freedom from
tension/stress.
• It’s reduces muscle’s tension, oxygen consumption, pulse,
blood pressure and lessen anxiety.
• This means that one way to minimize pain without
pharmaceuticals is through complementary techniques,
such as relaxation techniques.
• These techniques can cause natural pain medicine to
release from the brain.
• Meditation, Deep breathing exercise, stretching and social
support are some methods client can use to relax in an
effort to control pain.

24. Cont…
• (2) Distraction: “Distraction teaches client to focus attention on
something other than pain”
• Distraction alone may relieve mild pain but is best used before
pain begins or soon there after.
• Visual counting: holding/stoking a loved person, pet/toy.
• Project: playing a challenging game, playing cards, perform
meaningful play of work.
• Using planned activities according the client’s age and needs
can prevents boredom and relieves pain.

25. Cont…
• (3) Guided imagery: The client creates an image of
sights, sounds, tastes, smells and feeling in their mind,
concentrate on that image and gradually becomes less
aware of pain.
• with guided imagery, client learns how to change the way
body senses and responds to pain.
• It’s more effective for a client with chronic pain, than for
client with severe pain.

26. Cont…
• Acupuncture: it is based on the belief that life forces or
energy move through the body in specific paths, these
paths are called Meridians.
• Acupuncture is a technique that uses needles of various
lengths to prick specific parts of the body to produce
insensitivity to pain, this needle blocks the meridian which
stops or decrease the pain.
• It’s alternative technique to help control discomfort from
disorders such as headache, low back pain, menstrual
cramps, dental pain etc.

27. Meridians of Body

29. Cont…
• (5)Massage: Massage therapy is “Hands-on” treatment in
which a therapist manipulates muscles and other soft
tissues.
• It’s stimulates the circulatory and lymphatic systems,
lower blood pressure, relieves joint pain, reduce swelling
etc.
• It can be even more effective if client also use guided
imagery, breathing exercise and music.

30. Cont…
• (6) Music therapy: Music therapy has evidence to
support its use to reduce chronic pain, anxiety and
depression in adults.
• It can be either active or passive.
• Active music therapy involves patients playing music or
singing.
• Passive music therapy is listening to live or recorded
music. And it’s utilized during procedures, during surgery,
reduce pain, anxiety and stress and shorten recovery time
from medical procedure.
• Playing/listening to music 20 minutes per day can
decrease chronic pain, anxiety, stress and increases
social and physical functioning.

31. Cont…
• (7) Laughter Therapy: it has been said that” 10 minutes
of laughter gives 2 hours of pain free sleep”
• Laughter helps client breathe deeper and stomach digest
food.
• It’s also helps client relax mood and let go of stress,
anger, fear, depression etc.
• (8) Thermotherapy: is the application of hot and cold
treatments for alleviation of chronic pain.

32. Cont…
• (9) Exercise therapy:
• (10) Hypnosis: means achieving an intense state of
relaxation and receiving suggestions to alter sensations,
behavior, feelings/thoughts.
• Hypnosis is a technique that produces a subconscious
state accomplished by suggestions made by hypnotist,
has been used successfully in many instances to control
pain.

33. Cont…
• (11) Biofeedback: Biofeedback is an alternative
medicine approach that teaches people to change the
way their bodies function.
• It is a mind-body therapy that may improve your physical
and mental health.
• During a biofeedback session, a practitioner uses
monitoring equipment and instruments to measure your
body's functions.

35. • (12) Cutaneous stimulation: is techniques that stimulate
the skin surface to relieve pain.
• It stimulates large diameters of fibers carrying impulses,
which close to the gate in spinal cord to painful stimuli.
• A wide variety of cutaneous stimulation includes
massage, vibration, application of hot and cold,
acupressure etc.

36. Cont…
• (13) Transcutaneous electrical nerve
stimulation(TENS):
• It’s used to treat patient with various pain conditions
including neck and lower back pain.
• It’s contraindicated in initial management of
cervical/lumber spine pain.

37. Cont…
• (14) Aromatherapy: is a way of using good smells to help
client relax and decrease pain.
• Candles, massage oils, scented bubble baths and even
baking cookies are all ways that smells are used.
• It may also help brain makes special chemicals like
endorphins.
• Endorphins are a natural body chemical like morphine
that decrease pain.

38. (B) Pharmacological Management:
• (i) Non-opioid Analgesics: are include common over
the counter medications such as aspirin, ibuprofen etc.
• The damaged tissues releases enzymes that stimulate
local pain receptors.
• Non opioids analgesics interfere with the enzymes and
reduce inflammation and pain.
• There are most often used for minor pain.

39. Cont…
• (ii) Opioid Analgesics (Narcotics): it’s act on synaptic
transmission in various parts of the central nervous
system by binding to natural opioid receptors.
• They inhibits ascending pathways of pain perception.
• Narcotic analgesics only available with doctor’s
prescription and in lock and key chamber.
• Used for more severe pain,, cancer pain, during the
operation, intestinal obstruction etc.
• Example: Morphine, Fentanyl etc.

40. Cont…
• (iii)Adjuvant Drugs: are most often used for neuropathic
and chronic pain.
• There is several types includes,
• Corticosteroids – Dexamethasone, Prednisone etc.
• Anticonvulsant – Phenytoin, Carbamazepine etc.
• Antidepressants, sedatives, Muscle relaxants are also
an adjuvant drugs.
•

41. (C) Patient Controlled Analgesia (PCA):
• PCA is a small, lightweight , battery operated pump
attached to a syringe filled with pain medication.

42. (D) Epidural Analgesia
• It it being most used to provide pain relief from immediate post
operative pain particularly thoracic, abdominal, orthopedic
surgery.
• This type of analgesia is administered in spinal epidural space.
• (E) Local Analgesia: This type of analgesia is applied locally
to the skin for the loss of sensation to a localized body part, it’s
called infiltration.
• The agents work by chemically Blocking the nerve pathways
involved pain sensation and responses are called nerve block.
• Example: Lidocaine, bupivacaine

43. 1. PEE VEE ; ‘‘ FUNDAMENTALS OF NURSING’’
SECOND EDITION;PUBLISHED BY JAYPEE BROTHERS
MEDICAL PUBLISHERS (P) LIMITED;NEW DELHI;
P NO.-532-538.
2. LOTUS PUBLISHERS; ‘‘A TEXT BOOK OF NURSING
FOUNDATIONS’’2ND EDITION;EDITED
BY CELESTINA FRANCIS & KRITIKA
;P.NO. 354 TO 364.
3. WEBPAGE; WWW.WIKIPEDIA.COM: THE TOPIC OF “NURSING
CARE FOR PATIENT WITH PAIN” BY DR ARJAN SHAH.
Bibliography