3. PAIN
• Pain is a highly unpleasant and very personal
sensation that cannot be shared with others.
• It can occupy all of a person’s thinking, direct all
activities and change a person’s life.
• It is more than a symptom of a problem.
• Presents both physiologic and psychologic dangers to
health and recovery
• Pain is usually transitory, lasting only until the noxious
stimulus is removed or the underlying damage or
pathology has healed, but some painful conditions,
such as rheumatoid arthritis, may persist for years.
4. TYPES OF PAIN
• Pain may be acute or chronic. Acute pain is severe and lasts a
relatively short time. It is usually a signal that body tissue is being
injured in some way, and the pain generally disappears when the
injury heals. Chronic pain may range from mild to severe, and is
present to some degree for long periods of time.
5. PAIN MANAGEMENT
Examples of pharmacological pain relief include the following:
• analgesics (mild pain relievers)
• sedation (usually given by IV)
• anesthesia (usually given by IV)
• topical anesthetics (cream put on the skin to numb the area)
• pain relievers
6. INVASIVE PAIN MANAGEMENT TECHNIQUES
• Injections—direct delivery of steroids or anesthetic to
nerve, joint or epidural space.
• Prolotherapy—injection of solution to stimulate blood
circulation and ligament repair at affected site.
• Surgically implanted electrotherapy devices—
implantable spinal cord stimulators (SCS) and implantable
peripheral nerve stimulators.
• Implantable opioid infusion pumps—surgically implanted
pumps that deliver opioid agents directly to affected
nerve.
• Radiofrequency radioablation—deadening of painful
nerve via heat produced by a specialized device. The
efficacy of this treatment is mixed.
7. Non-pharmacological pain management
Non-pharmacological pain management is the management
of pain without medications. This method utilizes ways to
alter thinking and focus to decrease pain.
Methods include the following:
• psychological -The unexpected is always worse because of
what one imagines. Ways to accomplish this include:
• Explain each step of a procedure in detail, utilizing simple pictures
or diagrams when available.
• Meet with the person who will perform the procedure and ask
questions ahead of time.
• Tour the room where the procedure will take place.
• may observe a videotape, which describes the procedure
8. Non-pharmacological pain management
• hypnosis
With hypnosis, a professional (such as a psychologist or physician)
guides the child into an altered state of consciousness that helps
him/her to focus or narrow their attention, in order to reduce
discomfort.
• imagery
Guiding a child through an imaginary mental image of sights, sounds,
tastes, smells, and feelings can often help shift attention away from
the pain.
9. Non-pharmacological pain management
• distraction
Distraction can be helpful particularly for babies, by using colorful,
moving objects. Singing songs, telling stories, or looking at books or
videos can distract preschoolers. Older children find watching TV or
listening to music helpful. Distraction should not be a substitute for
explaining what to expect.
• relaxation
Children can be guided through relaxation exercises such as deep
breathing and stretching, to reduce discomfort.
10. Non-pharmacological pain management
• Exercise—physical exertion with the aim of training or improvement.
Includes the McKenzie method, water therapy, flexion exercises,
aerobic routines. Exercise is necessary for proper cardiovascular
health, disc nutrition, and musculoskeletal health.
• Manual techniques—manipulation of affected areas by means of
chiropractic adjustments, osteopathy, massage therapy and other
techniques.
11. Non-pharmacological pain management
• Behavioral modification—use of behavioral methods to optimize
patient responses to back pain and painful stimuli. Cognitive therapy
involves teaching the patient to alleviate back pain by means of
relaxation techniques, coping techniques, and other methods.
• Cutaneous stimulation —superficial heating or cooling of skin. These
pain management methods include cold packs and hot packs, and
should be used in conjunction with exercise.
• Electrotherapy —the most commonly known form of electrotherapy
is transcutaneous electrical nerve stimulation (TENS). TENS therapy
attempts to reduce back pain by means of a low-voltage electric
stimulation that interacts with the sensory nervous system.
12. Interventions/Rationales
1. Assess the client’s level of pain, determining the
intensity at its best and worst - Determines a baseline
for future assessment.
2. Listen to the client while she discusses the pain;
acknowledge the presence of pain - Acknowledging the
client’s pain decreases anxiety by communicating
acceptance and validating the client’s perceptions.
3. Discuss reasons why pain may be increased or
decreased - Helps the client determine a cause-and-
effect relationship between pain and specific activities.
13. Interventions/Rationales
4. Teach relaxation techniques such as deep breathing, progressive
muscle relaxation, and imagery - Reduces skeletal muscle tension and
anxiety, which potentiates the perception of pain.
5. Teach the client and family about treatment approaches
(biofeedback, hypnosis, massage therapy, physical therapy,
acupuncture, and exercise). - Makes the client and family aware of
the availability of treatment options.
14. Interventions/Rationales
6. Teach the client about the use of medication for pain
relief. Provide accurate information to reduce fear of
addiction. - Lack of knowledge and fear may prohibit
client from taking analgesic medications as prescribed.
7. Encourage the client to rest at intervals during the
day.- Fatigue increases the perception of pain.
8. Explain the relationship between chronic pain and
depression. - Knowledge decreases anxiety.
