Credits to Ma'am Evangeline Teruel

1. ermteruel

2. DeFiNiTiOnS
oF
pAiN

3. Pain is an
unpleasant sensory
and emotional
experience
associated with
actual or potential
tissue damage.

4. a personal private
sensation of hurt.
 a harmful stimulus that
signal current or impending
tissue damage.
 a pattern of responses to
protect the organism from
burn.

5. whatever the
experiencing
person says it is
existing whenever
the person say it is

6. 1. Pain is a part of aging
2. If a person is asleep, they are
not in pain
3. If pain is relieved by non-
pharmaceutical pain relief
techniques, the pain was not
real anyway
4. Real pain has an identifiable
cause
5. It is better to wait until a client
has pain before giving
medications

7. 6. Very young or very old people
do not have as much pain
7. Some clients lie about the
existence or severity of their
pain
8. Addiction occurs with
prolonged use of morphine or
morphine derivatives
9. The same physical stimulus
produces the same pain
intensity, duration and distress
in different people

8. 10. Clients experience severe pain
only when they have had major
surgery.
11. The nurse or other health care
professionals are the
authorities about a client’s pain
12. Visible or physiologic or
behavioral signs accompany
pain and can be used to verify
its existence.

9. tErMiNoLoGiEs

10.  Radiating pain
 perceived at the source of
the pain and extends to the
nearby tissues
 Referred pain
 felt in a part of the body that
is considerably removed or
far from the tissues causing
the pain

12. Excessive
sensitivity
to pain

13.  the amount of
pain stimulation
a person
requires before
feeling pain
 least level of
pain that the
patient is able
to detect

14.  Includes the ANS and behavioural
responses to pain
types:
ANS response
 autonomic reaction of the body that often
protect the individual from further harm.
(automatic withdrawal of hand from hot
object.)
Behavioural response
 is a learned response used as a method
of coping with pain.

15.  maximum
amount and
duration of pain
that an individual
is willing to
endure
 greatest level of
pain that the
patient is able to
tolerate

16. thepoint
which the
person
becomes
aware of
the pain

17. tRiAd Of
PaiN
pErCePtiOn

18. 1.Pain
Receptor
2.Pain Stimuli
3.Pain Fibers

19. pain receptors
Free nerve ending
in the skin that
respond only to
intense, potentially
damaging stimuli.

20. 1. Mechanical
2. Thermal
3. Chemical

21. Pain Fibers Fibers
Pain
There are two
separate pathways
that transmit pain
impulses to the
brain:
(1) Type A-delta
fibers
are associated
with fast,
sharp, acute
pain and
2) Type C fibers
are associated
with slow, chronic,
aching pain

22. pAiN
sYnDrOmEs

23. 1.Referred Pain
2.Radiating Pain
3.Psychogenic Pain
4.Neurologic Pain
5.Phantom Limb Pain
6.Intractable Pain

24.  no pathologic cause
Caused:
 Mental
 Emotional
 Behavioral factors
induced by
 social
rejection, broken
heart, grief, love
sickness, or other
such emotional
events.

25.  s/s:
 Headache,
 back pain
 stomach
pain

26. MAIN
PROBLEM:
 neurologic
system

27. Damage
PNS & CNS
Nerve fibers

28.  Alcoholism
 Amputation
 Back, leg, and hip problems
 Chemotherapy
 Diabetes
 Facial nerve problems
 HIV infection or AIDS
 Multiple sclerosis
 Spine surgery

30.  Painful
perception
perceived in a
missing body
part or in a
body part
paralyzed from
a spinal cord
injury

32.  Thistype of
pain is a
chronic pain
that is
resistant to
cure or relief.

34. pAtHo
PhYsiOLoGy
oF pAiN

35. 1.Transduction
2.Transmission
3.Perception
4.Modulation

36. 1. Transduction
2. Transmission
3. Perception
4. Modulation

37.  cerebral cortex
 Somato sensory
cortex
 association cortex
 limbic system

38.  endogenous opioids (endorphins
& enkephalins
 chemical substances
▪ spinal and medullary dorsal horn
▪ periaqueductal gray matter
▪ hypothalamus
▪ amygdala in the CNS)
 serotonin 5HT
 norepinephrine
 gamma amino butyric acid
(GABA)

39. TyPeS
oF
pAiN

40. Categories of pain
according to its
1. Origin
2. Onset
3. Cause or etiology

41. 1. Superficial Cutaneous Pain
 occurs over body surface or skin
segments.
2. Deep Somatic Pain
 occurs in the skin, muscles and joints
(musculoskeletal –
muscle, bone, periosteum, cartilage, ten
dons, deep
fascia, ligaments, joints, blood vessels
and nervous)
3. Visceral Pain

42.  Acute pain
 following acute injury, disease or
some type of surgery
 Chronic
 malignant pain
 associated with cancer or other
progressive disorder
 Chronic
 nonmalignant pain
 in the persons whose tissue injury
is non progressive or healed

44. Mechanical
 trauma
 blockage of body duct
 tumor
 muscle spasm
Thermal or cold
 extreme heat
Chemical
Tissue ischemia Blocked artery
Stimulation of pain receptors
accumulation of lactic acid

45. gAtE cOnTroL
ThEoRy
Melzack
and
Wall

47. Factors
influencing
reaction to
pain
Psychological
Physiological
Cultural

48. Infant:
 perceive pain and respond to its increasing
sensitivity
Toddler:
 respond by crying and anger because they
perceive it as a threat to security or sense that
pain is a punishment
School age:
 try to be brave and not to cry or express much
pain so parents and nurse will not be angry with
them
Adolescent:
 may not want to report pain in front of peers
because they perceive complaints of pain as
weakness
Adult:
 may not report pain for fear that it indicates
poor diagnosis. Nurse may mean weakness and
failure

49. Pain
Management

50. Pharmacologic
Treatment

51.  Analgesics :
 Non opioids/ non- narcotic analgesics
 NSAIDs
 Narcotic analgesics / opioids
 Adjuvants / co- analgesics
 Local anesthesia
 Patient controlled analgesia
 Epidural analgesia

52. Ex.
 Acetaminophen
acetyl salicylic acid

53. Ex :
Ibuprofen
Naproxen
Indomethacin
Piroxicam
Ketoralac

54. Ex:
meperidine
methylmorphine
morphine sulphate
fentanyl

55.  Sedatives,
anti-anxiety
agents, muscle relaxants
 Ex:
Amitriptyline
Hydroxyzine
diazepam

56.  A drug delivery system which is a safe
method for post operative, trauma &
obstetrics, burns, terminal care pediatrics
and cancer pain management
 Involves self IV drug administration
 Goal : to maintain a constant plasma level
of analgesic so that the problems of client
with needed dosing (PRN) are avoided
 Client preparation & teaching is important
 Check IV line & PCA device regularly

58.  Easy access for clients for medication
 Allows self administration with no risks
 Pain relief without depending on nurses
 Small doses of medications at short
intervals for sustained pain relief
 Stabilized serum drug levels
 Decreased anxiety

59.  Patient becomes dependent on PCA
 If mobility is contraindicated, client may move due
to decreased or no pain by PCA
 Respiratory depression
 Side effect may be constipation
 Mechanical failure of pump
 Relatives may press button for client
 Wrong programming parameters
 Incorrect placing of syringe can cause infusion of
excessive drug doses
 Costly & if client may not understand the system

60. 6. Local
7. Spinal
anesthesia
8. Epidural
anesthesia

61. SURGICAL
TREATMENT

64. NON-
PHARMACOLOGIC

65. A.Cognitive
Behavioral
Approaches:
1. Distraction

66. 2.
Reducing
Pain
Perception

67. 3. Bio-feed
back

70. Goals:
 to provide comfort
 to correct physical dysfunctions
 to alter physiological responses
 to reduce fears associated with pain related
immobility
Examples:
1. Acupressure / acupuncture
2. Cutaneous stimulation (massage, heat
application, TENS)
3. Binders, Chiropractic

83. Pain History

84. LOCATION:
“Where is your
pain?”
INTENSITY:

85. Visual Score
0 1-2-3 4-5-6 7-8 9-10
Verbal Score No Hurts Hurts a lot Really hurts Extremely
pain little a lot hurts
Observer Appears Comfortable Uncom- Distressed Distressed
scoring pain free except on fortable can be
movement comforted