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PRACTICE TEACHING
ON
Pain management techniques
Pain serves as a mechanism to warn us
about the potential for physical harm.
Thus pain is the body’s protective
mechanism to prevent further damage by
providing the impulse to withdraw from
the pain producing situation, the
discomfort and distress associated with
pain often last far (Distance) beyond the
tissue damaging experience. Pain is a
universally distressing feeling whether
acute or chronic. Relief of pain remains
one of the major aspects of medical
and nursing practice.
1.An unpleasant (discomfort)
sensory and emotional
experience associated with
actual or potential( tention)
tissue damage or described in
terms of such damage
Merkey & bogdeek
DEFINITION
According to American Academy of Pain
Medicine defines pain as – “An unpleasant
sensation and emotional response to that
sensation”.
2. feeling of distress
suffering stimulation of
specific nerve ending.
Mccaffery & beeb.
(1) ACUTE PAIN
Acute pain is usually associated with
body injury of some kind and it
disappears while healing is usually of
short duration. Less than 6 months.
Immediate onset such as inscisional pain
after surgery it also regarded as having a
limited and often predictable ( phle)
duration such as postoperative pain which
usually disappears as the wound heals
client are use words such as ‘’sharp’’
‘’stabbing’’ ( hard) and shooting to describe
acute pain is usually reversible or
controllable with acute treatment.
2. CHRONIC PAIN
Chronic pain may be
defined that lasts for 6
months or longer, chronic
pain is constant or
intermittent ( stop ) pain
that persists beyond ( aage)
the expected healing time.
it may have a poorly
defined onset and. It is
often difficult to treat
because the cause or
origin may be unclear.
TYPES
OF
CHRONIC
PAIN
CHRONIC
PERSISTANT
PAIN.
CHRONIC
MALIGNANT
(CANCER
RELATED)
PAIN:
CHRONIC
INTERMITTE
NT PAIN
CHRONIC
PERSISTANT PAIN.
Chronic persistent pain is pain that
continues beyond the time expected
for a painful condition or injury to
heal
If you have pain for most days of the
week for over 3 months it is
considered to be chronic persistent
pain
CHRONIC
INTERMITTENT PAIN
Chronic intermittent pain stopping or
ceasing and beginning again an
intermittent pain
Occurring at irregular intervals not
continuous or steady ( fixed ) .
CHRONIC MALIGNANT
CANCER RELATED) PAIN
Pain in cancer may come from
compressing or infiltrating nearby
body part from treatment and
diagnostic procedures or from
skin , nerve and other changes
caused bye a hormonal imbalance
or immune response .
SPECIFIC TYPES
1. Nociceptive PAIN
Nociceptive pain is caused by stimulation of peripheral nerve fibers that
respond only to stimuli approaching or exceeding harmful intensity
(nociceptors), and may be classified according to the mode of noxious (
harmful noxious ) stimulation; the most common categories being
"thermal" (heat or cold), "mechanical" (crushing, tearing, etc.) and
"chemical" (iodine in a cut, chili powder in the eyes).
THERE ARE 2 TYPES PF NOCICEPTIVE PAIN
1.SOMATIC PAIN::
Somatic pain originates from ligaments, tendons ( connect fibrous
connective tissue), bones, blood vessels and nerves. It is detected with
somatic nociceptor but these receptors are sparse, so the pain is dull
and poorly localized
Eg the pain of a sprained ( ankle. Wrist ankle is felt in the entire ankle.
Even though the injury may be only one side. Inflammation is an
important component of somatic pain. Inflammatory process
Visceral pain
2. Is pain that result from the activation of nociceptors of
the thoracic , pelvic , or abdominal viscera ( organ )
Visceral structures are highly sensitive to distention ( stretch)
ischemia and inflammation but relatively insensitive to other
stimuli that normal evoke ( normal) pain such as cutting or
burning.
NOCICEPTIVE
meaning - Free nerve
endings in the skin
respond only to intense
pain, damaging stimuli
SPECIFIC TYPE OF PAIN
REFERRED PAIN
Where pain is often felt in the neck , shoulders and back rather
than in the thorax . The site of injury.
.: Referred pain is a form of visceral
pain and is felt in an area distant from
the site of the stimulus. It occurs when
nerve fibers serving an area of the
body distant from the site of the stimulus
pass in close proximity to the stimulus.
The referred pain sensation may be
intense and there may be little or no pain
at the point of noxious stimuli
NEUROLOGIC PAIN::
Neuropathic pain is caused by damage or injury to nerve fibers in
the periphery or by damage to the CNS it is not attributable ( cause)
to nociceptor activation from injury. Noxious electrical impulses are
generated at the site of injury therefore the pain is felt as numbness,
burning, stabbing, needles and electric shock clients may experience
‘’allodynia’’ pain due to stimulus that does not normally provoke pain.
The pain is perceived to occur in the area served by the nerve for eg,
an injury may be at the spinal cord level, such pain is particularly
problematic of the individual.
hhh
PHANTOM PAIN
is pain from a part of the body that has been lost or from which the
brain no longer receives signals. It is a type of neuropathic
pain. Phantom limb pain is a common experience of amputees
PSYCHOGENIC PAIN,
also called psychalgia or somatoform pain, is pain caused, increased,
or prolonged by mental, emotional, or behavioral factors.[ Headache,
back pain, and stomach pain are sometimes diagnosed as psychogenic
Past
experie
nce
ANXIETY
AND
DEPRESS
ION
Culture
AGE
FACTORS
INFLUENCIN
G THE PAIN
RESPONSE
SIGN &
SYMPT
OM OF
PAIN
Head
ache
Body
pain
Abdominal
pain
Acute
nausea
and
vomiting
Arm
pain
Fever
Excessive
sweating
Fatigue
Breathing
difficulty
ACUTE PAIN
CHRONIC
PAIN
depression, fatigue,
and irritability, it Can
even interfere with
work ,Relationship
and activities of
daily living.
Pain transmission
The nerve mechanisms and structures of the brain
involved interprets pain are the nociceptors or pain
receptors.
Nociceptors: Free nerve endings in the skin respond
only to intense pain, damaging stimuli (stimuli may be
mechanical , thermal or chemical).
Large internal organs do not contain nerve endings
that respond to pain stimuli. So intense stimulation of
receptor that have other purpose for example,
inflammation stretching ,ischemia, dilatation or spasm
occurs in these organs cause severe pain.
PATHOPHYSIOLOGY OF PAIN
Nociceptors nerve fibres branch very near to skin and send
fibres to local blood vessels ,mast cells, hair follicles and
sweat glands.
When these get stimulated histamine is released from the
mast cell causing vasodilation.
Some receptors responds to three or more types of stimuli.
Highly specialised neurons transfer the stimulus into
electrical activity or action potential.
The cutaneous fibres communicate with paravertebral
sympathetic chain of nervous system.
Thus, pain is accompanied by vasomotor, autonomic
,visceral effects.
PHARMACOLOGIC INTERVENTION:
LOCAL
ANEST
HETIC
S
NSAI
DS
OPIOI
DS
NON PHARMACOLOGIC INTERVENTION
COMFORT
MEASURES
CUTANEOUS
STIMULATIONMASSAGE
ICE AND
HEAT
THERAPIES
TRANSCUTANEOUS
ELECTRICAL
NERVE
STIMULATION
ACU-PRESSURE
PHYSICAL INTERVENTION
TRANSCUTANEOUS ELECTRICAL NERVE
STIMULATION
COGNITIVE OR BIOBEHAVIORAL
INTERVENTIONS
DEEP BREATHING
MUSIC THERAPY
DISTRACTION
RELAXATION TECHNIQUES
GUIDED IMAGERY
HYPNOSIS
MEDITATION
SURGICA
L
MANAGE
MENT
STIMULATIO
N
PROCEDURE
ADMINISTRA
TION OF
THE SPINAL
OPIOIDS
INTERRUPTION
OF PAIN
PATHWAYS
THANK YOU

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Pain

  • 2. Pain serves as a mechanism to warn us about the potential for physical harm. Thus pain is the body’s protective mechanism to prevent further damage by providing the impulse to withdraw from the pain producing situation, the discomfort and distress associated with pain often last far (Distance) beyond the tissue damaging experience. Pain is a universally distressing feeling whether acute or chronic. Relief of pain remains one of the major aspects of medical and nursing practice.
  • 3. 1.An unpleasant (discomfort) sensory and emotional experience associated with actual or potential( tention) tissue damage or described in terms of such damage Merkey & bogdeek DEFINITION According to American Academy of Pain Medicine defines pain as – “An unpleasant sensation and emotional response to that sensation”.
  • 4. 2. feeling of distress suffering stimulation of specific nerve ending. Mccaffery & beeb.
  • 5.
  • 6. (1) ACUTE PAIN Acute pain is usually associated with body injury of some kind and it disappears while healing is usually of short duration. Less than 6 months. Immediate onset such as inscisional pain after surgery it also regarded as having a limited and often predictable ( phle) duration such as postoperative pain which usually disappears as the wound heals client are use words such as ‘’sharp’’ ‘’stabbing’’ ( hard) and shooting to describe acute pain is usually reversible or controllable with acute treatment.
  • 7. 2. CHRONIC PAIN Chronic pain may be defined that lasts for 6 months or longer, chronic pain is constant or intermittent ( stop ) pain that persists beyond ( aage) the expected healing time. it may have a poorly defined onset and. It is often difficult to treat because the cause or origin may be unclear.
  • 9. CHRONIC PERSISTANT PAIN. Chronic persistent pain is pain that continues beyond the time expected for a painful condition or injury to heal If you have pain for most days of the week for over 3 months it is considered to be chronic persistent pain
  • 10. CHRONIC INTERMITTENT PAIN Chronic intermittent pain stopping or ceasing and beginning again an intermittent pain Occurring at irregular intervals not continuous or steady ( fixed ) .
  • 11. CHRONIC MALIGNANT CANCER RELATED) PAIN Pain in cancer may come from compressing or infiltrating nearby body part from treatment and diagnostic procedures or from skin , nerve and other changes caused bye a hormonal imbalance or immune response .
  • 12. SPECIFIC TYPES 1. Nociceptive PAIN Nociceptive pain is caused by stimulation of peripheral nerve fibers that respond only to stimuli approaching or exceeding harmful intensity (nociceptors), and may be classified according to the mode of noxious ( harmful noxious ) stimulation; the most common categories being "thermal" (heat or cold), "mechanical" (crushing, tearing, etc.) and "chemical" (iodine in a cut, chili powder in the eyes). THERE ARE 2 TYPES PF NOCICEPTIVE PAIN 1.SOMATIC PAIN:: Somatic pain originates from ligaments, tendons ( connect fibrous connective tissue), bones, blood vessels and nerves. It is detected with somatic nociceptor but these receptors are sparse, so the pain is dull and poorly localized Eg the pain of a sprained ( ankle. Wrist ankle is felt in the entire ankle. Even though the injury may be only one side. Inflammation is an important component of somatic pain. Inflammatory process
  • 13. Visceral pain 2. Is pain that result from the activation of nociceptors of the thoracic , pelvic , or abdominal viscera ( organ ) Visceral structures are highly sensitive to distention ( stretch) ischemia and inflammation but relatively insensitive to other stimuli that normal evoke ( normal) pain such as cutting or burning. NOCICEPTIVE meaning - Free nerve endings in the skin respond only to intense pain, damaging stimuli
  • 14. SPECIFIC TYPE OF PAIN REFERRED PAIN Where pain is often felt in the neck , shoulders and back rather than in the thorax . The site of injury. .: Referred pain is a form of visceral pain and is felt in an area distant from the site of the stimulus. It occurs when nerve fibers serving an area of the body distant from the site of the stimulus pass in close proximity to the stimulus. The referred pain sensation may be intense and there may be little or no pain at the point of noxious stimuli
  • 15. NEUROLOGIC PAIN:: Neuropathic pain is caused by damage or injury to nerve fibers in the periphery or by damage to the CNS it is not attributable ( cause) to nociceptor activation from injury. Noxious electrical impulses are generated at the site of injury therefore the pain is felt as numbness, burning, stabbing, needles and electric shock clients may experience ‘’allodynia’’ pain due to stimulus that does not normally provoke pain. The pain is perceived to occur in the area served by the nerve for eg, an injury may be at the spinal cord level, such pain is particularly problematic of the individual. hhh
  • 16. PHANTOM PAIN is pain from a part of the body that has been lost or from which the brain no longer receives signals. It is a type of neuropathic pain. Phantom limb pain is a common experience of amputees PSYCHOGENIC PAIN, also called psychalgia or somatoform pain, is pain caused, increased, or prolonged by mental, emotional, or behavioral factors.[ Headache, back pain, and stomach pain are sometimes diagnosed as psychogenic
  • 19. CHRONIC PAIN depression, fatigue, and irritability, it Can even interfere with work ,Relationship and activities of daily living.
  • 20. Pain transmission The nerve mechanisms and structures of the brain involved interprets pain are the nociceptors or pain receptors. Nociceptors: Free nerve endings in the skin respond only to intense pain, damaging stimuli (stimuli may be mechanical , thermal or chemical). Large internal organs do not contain nerve endings that respond to pain stimuli. So intense stimulation of receptor that have other purpose for example, inflammation stretching ,ischemia, dilatation or spasm occurs in these organs cause severe pain. PATHOPHYSIOLOGY OF PAIN
  • 21. Nociceptors nerve fibres branch very near to skin and send fibres to local blood vessels ,mast cells, hair follicles and sweat glands. When these get stimulated histamine is released from the mast cell causing vasodilation. Some receptors responds to three or more types of stimuli. Highly specialised neurons transfer the stimulus into electrical activity or action potential. The cutaneous fibres communicate with paravertebral sympathetic chain of nervous system. Thus, pain is accompanied by vasomotor, autonomic ,visceral effects.
  • 23. NON PHARMACOLOGIC INTERVENTION COMFORT MEASURES CUTANEOUS STIMULATIONMASSAGE ICE AND HEAT THERAPIES TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION ACU-PRESSURE PHYSICAL INTERVENTION
  • 25. COGNITIVE OR BIOBEHAVIORAL INTERVENTIONS DEEP BREATHING MUSIC THERAPY DISTRACTION RELAXATION TECHNIQUES GUIDED IMAGERY HYPNOSIS MEDITATION