introduction and managment of pain in health and medicine

1. Presented to
Maam shmeela Kamran
Presented by :
Huma anwar
Rimsha zahoor
Hafiza Afshan
Maryam eman
Sadaf iram
Kainat Khan

2. Objectives :
 At the end presentation students will be able to :
• Define pain.
• Explain the Sign and symptoms of pain.
• Describe the physiology of pain.
• Explain the classification of pain.

3. Definition Of Pain:
• Pain is a complex and subjective phenomenon.
• The International Association for the study of pain define pain as:
“ An unpleasant sensory and emotional experience associated with actual or
potential tissue damage or described in terms of such damage.”
Sign and symptoms of pain:
1. Increased respiratory rate.
2. Increased heart rate.
3. Pallor.
4. Moaning.
5. Guarding the area.
6. Restlessness.
7. Irritability.

4. Physiology Of Pain:
• The transmission and perception of pain is a complex process.
• Transmission of pain occurs by:
1. Transduction .
2. Transmission .
3. Perception .
4. Modulation .

5. 1. Transduction :
• Painful stimuli(mechanical , thermal , chemical)triggers the release of
biochemical mediators(such as prostaglandins , histamine and substance –P)
which activates nociceptors.
2. Transmission :
• Transmission is done in 3 steps.
o Step-1 : Transmission of pain from PNS to Spinal Cord.
o Step-2 : From ascending pathway in Spinal Cord to Brain.
o Step-3 : Information transmission to Brain where pain perception occur.
3. Perception :
• In this process the client becomes conscious of pain and shows cognitive
behaviors.

6. 4. Modulation :
• Also known as descending system .
• The nerves that goes downward from brain to the reflex organs via the spinal
cord is known as descending pathway.
• Brain signals by descending fibers to spinal cord.
• Descending fibers releases substances ( such as endogenous opioids ,
serotonin ) which inhibit or reduce the painful stimulation.

8. 1. Duration
2. Location
3. Intensity
4. Etiology
Classification Of Pain:
Pain is classified on the basis of :

9. Duration:
• Acute pain: When pain lasts only through expected recovery period
is described as acute pain, whether it has a sudden or slow onset.
• Chronic pain: it is a prolonged pain usually recurring or lasting 6
months or longer and interferes with functioning.

11. Location:
• Referred pain: Appear to arise in different areas or other parts of
body. E.g. cardiac pain may be felt in shoulder or left arm.
• Visceral pain: Pain arising from organs or hollow viscera. E.g.
abdominal pain or bladder pain.

12.  Intensity:
 Intensity of pain may be classified by using standard scale.
 0 (no pain) and 10 (worst possible pain)
 Mild pain: Pain in range of 1 to 3.
 Moderate pain: Rating of 4 to 6.
 Severe pain: Pain reaching 7 to 10.

13.  Etiology:
• Nociceptive pain: It is experienced when properly functioning
nervous system sends signals that tissue are damaged and required
attention.
• Somatic pain: Originates in skin, muscle, bones or connective tissue
• Neuropathic pain: It is associated with damaged or malfunctioning
of nerves due to illness, injury or undetermined reasons.

14. Factor Contributing To Pain And
Discomfort In The Critically Ill:
1. Physical :
• Illness and injuries treated in the critical care setting.
• Wounds –post trauma , postoperative or post procedural.
• Sleep disturbance and deprivation.
• Immobility
• Tempreature extremes associated with critical illness and the
enviornment –fever and hypothermia.

15. 2. Psychological :
• Anxiety and depression.
• Impaired communication.
• Fear of pain , disability or death.
• Separation from family.
• Unfamiliar and unpleasant surroundings.
3. Environment and routine :
• Continuous noise from equipment and staff.
• Unnatural pattern of light.
• Continuous or frequent painful procedures.
• Awakening and physical manipulation every 1-2 hours for vital signs or
positioning.

16.  Procedural Pain:
• Critical care nurses must continuously performs procedures or
treatment that cause pain to the patient , such as chest tube insertion
and removal , wound debridement , and even turning a patient in the
bed.
• Before undergoing procedures known to be associated with pain ,
patient should be premedicated , and the procedures should be
performed only after the medication has taken effect.

17.  Consequences Of Pain:
• People who have high level od uncontrolled pain during an acute
hospitalization are at high risk for delayed recovery and development of
chronic pain after discharge.
• Pain produces many harmful effect on body that inhibit the healing and
recovery from critical illness , the effects are summarized as :
1. Cardiovascular:
• Effect : increased heart rate , blood pressure , vasoconstriction.
• Outcome : increased myocardial workload, exacerbating ischemia.
2. Neurological:
• Effect : increased anxiety and mental confusion , disturbed sleep .
• Outcome : delayed recovery , more pain.

18. 3. Musculoskeletal:
• Effect : muscle contractions , spasms and rigidity .
• Outcome : inhibit movement and coughing and deep breathing ,
putting patient at risk for complications of immobility .
4. Immune;
• Effect : suppressed immune system .
• Outcome : increased risk of pneumonia ,wound infections and sepsis.

19. Promoting effective pain control
• Critical care nurses are often concerned that analgesic
administration for pain control may create problems, such as
hemodynamic and respiratory compromise, oversedation, or drug
addiction.
• Patient and Family Education
• To balance pain control and risks of treatment, communication
between nurse, patient, and family is essential. Emphasis is on the
prevention of pain because it is easier to prevent pain than to treat it.
Patients need to know that most pain can be relieved and that
unrelieved pain may have serious conse- quences for physical and
psychological well-being and may interfere with recovery.

22. Pain Assessment
The failure of healthcare providers to assess pain and pain relief
routinely is one of the most common reasons for unrelieved pain in
hospitalized patients.
• The acuity of the patient's condition
• Altered levels of consciousness
• An inability to communicate pain
• Restricted or limited movement
• Endotracheal intubation

23. Methods of pain Assessment
Patient self report
Observation
Psychological parameters

24. 1. Patient Self Report :
• Because pain is subjective experience , the patient self report is
considered the foundation of pain assessment; however , family
members and caregiver are often used as proxies for patient unable to
self report which can pose significant communication barriers .
• A self report or proxy assessment of pain should be obtained not only
at rest , but also during routine activity , such as coughing , deep
breathing and turning.

25. 2. Observations :
• Research has demonstrated that nurses can relay on behavioral and
physiological indicators of pain in critically ill patient who can not
provide verbal self report.
• Patient who are unable to speak may use eye or facial expressions or
movement of hands or legs to communicate their pain.
• Non-verbal behaviors : such as grimacing , clinching the teeth , tightly
closing the eyes and exhibiting restlessness and agitation can indicate
pain as well.

26. 3. Physiological Parameters :
• The observations of the physiological effect of pain assists
to some extent in pain assessment.
• Vitals signs such as heart rate , blood pressure and
respiratory rate , may increase or decrease in the presence of
pain .

27. Contradiction in pain Assessment
• These discrepancies can be due to the use of diversionary activities,
coping skills, beliefs about pain, cultural background, fears of
addiction, or fears of being bothersome to the nursing staff. When
these situations occur, they are discussed with the patient, and any
misconceptions or knowledge deficits are addressed.

28. Pain Management:
• Pharmacological
• Non pharmacological

29. Pharmacological intervention:
• Opioid
• Non opiods
• Sedatives
• Hypnotics
• Anxiolytics

30. Side effects:
Opioids cause undesirable side effects, such as
• Constipation,
• Urinary retention,
• Sedation,
• Respiratory depression
• Nausea.
• Hypotension,
• Restlessness,
• Tremors

31. Non pharmacological interventions:
• Environmental modification
• Distraction
• Relaxation techniques
• Touch
• Massage