This lecture includes pain and its theories. Types of pain, pharmacologic management of pain and non pharmacologic management of pain.

1. PAIN
BY : MS.TANVI VAGHELA

2. INTRODUCTION
 The word pain originates from the Latin word
‘POENA’ meaning a fine or a penalty.
 Pain often describe as an unpleasant sensation
that can vary from mild, localized to servere
distress.
 Pain provide mechanism to warm about the
potential physical harm.
 Pain is multi-factorial phenomenon. It is an
individual, unique experience that they may be
difficulty for client to describe or explain and is
often difficulty to recognize, understands and

3. DEFINATION
‘‘An unpleasant sensory and emotional
experience associated with actual or potential
tissue damage or described in term of such
damage’’
- International association for study of pain
(IASP,2014)

4. NATURE OF PAIN
 Pain is subjective and highly individualized.
 Its stimulus is physical and mental in nature.
 Its interferes with personal relationships and
how the experience feels.
 May not be directly proportional to amount of
tissue injury.

5. SIGN AND SYMPTOMS
 Increased respiratory rate
 Increased heart rate
 Increased blood glucose level
 Peripheral vasoconstriction
 Pallor
 Elevated B.P
 Restlessness
 Irritability

6. TYPES
CLASSIFICATION
Based on
duration
Based on
location
Based on
intensity
Based on
etiology

7. Based on
duration
Acute Chronic

8. Acute pain
 When pain lasts only through the expected
recovery period, it is described as acute pain.
 Acute pain is protective, has an identifiable
cause , is of short duration, and has limited
tissue damage and emotional response.
 It eventually resolves, with or without treatment ,
after an injured area heals.
 Complete pain relief is not always achievable ,
but reducing pain to a tolerable level is realistic.
 Unrelieved acute pain can progress to chronic
pain.

9. Chronic pain
 Chronic pain is the pain that lasts longer than 6
month and is constant or recurring with a mild to
severe intensity.
 It does not always have an identifiable cause and
leads to great personal suffering.
 The possible unknown cause of chronic pain,
combined with the unrelenting nature and
uncertainty of its duration , frustrates a patient ,
frequently leading to psychological depression and
even suicide.
 Associated symptoms of chronic pain include
fatigue, insomnia, anorexia, weight loss ,

10. Based on
intensity
Mild pain
Moderate
pain
Severe
pain

11.  Mild pain : pain scale reading from 1 to 3 is
considered as mild pain.
 Moderate pain : pain scale reading from 4 to
6 is considered as moderate pain.
 Severe pain : pain scale reading from 7 to 10
is considered as severe pain.

12. Based on
etiology
Nociceptive
pain
A.Somatic
pain
B.Visceral
pain
Neuropathic
pain
A.Peripheral
neuropathic
pain
B.Central
neuropathic
pain

13. Nociceptive pain
 Nocivaptive pain is experienced when an
intact, properly functioning nervous system
sends signals that tissues are damaged ,
requiring attention and proper care.
 Ex : the pain experienced following a cut or
broken bone alerts the person to avoid further
damage until it is properly healed.
 Once stabilized or healed , the pain goes
away.

14. A. Somatic pain
 This is the pain that is originating from the
skin, muscles, bone, or connective tissue.
 The sharp sensation of a paper cut aching of a
sprained ankle are common examples of
somatic pain.

15. B. Visceral pain
 Visceral pain is pain that results from the
activation of nociceptors of the thoracic , pelvic
or abdominal organs.
 Characterized by cramping, throbbing,
pressing or aching qualitis.
 Ex : labor pain
Angina pectoris
Irritable bowel

16. Neuropathic pain
 Neuropathic pain is associated with damaged
or malfunctioning nerve due to illness, injury or
undetermined reasons.
 Ex : Diabetic peripheral neuropathy
Phantom limb pain
Spinal cord injury pain
 It is usually chronic.
 It is described as burning , ‘‘electric-shock’’
and tingling, dull and aching.

17.  Neuropathic pain tends to be difficult to treat.
 Neuropathic pain is two types based on which
parts of the nervous system damaged.
1. Peripheral neuropathic pain : Due to damage
to peripheral nervous systen . Ex : phantom
limb pain.
2. Central neuropathic pain : Results from
malfunctioning nerves in the central nervous
system (CNS). Ex : spinal cord injury pain.

18. FACTORS INFLUENCING
PAIN
1. DEVELOPMENTAL FACTORS : age,
particular in infants and older adults.
2. PHYSIOLOGICAL FACTORS : fatigue,
genes, neurological functioning.
3. SOCIAL FACTORS : attention, previous
experience, family and social support,
spiritual factors.
4. PSYCHOLOGICAL FACTORS : anxiety,
coping style.
5. CULTURAL FACTORS : cultural belief and
value affect how individuals cope with pain.

19. PAIN ASSESSMENT
 Precipitating/atteviating factors : What causes
the pain? What aggravates it ? Has medication
or treatment worked in the past?
 Quality of pain : Ask the patient to describe the
pain using words like ‘‘sharp’’, dull, stabbing,
burning.
 Radiation : Does pain exist in one location or
radiate to other area?

20.  Severity : Have patient use a descriptive,
numeric or visual scale to rate the severity of
pain.
 Timing : is the pain constant or intermittent,
when did it begin.

21.  Assess objective sign of pain :
 Facial expressions - facial grimacing (a facial
expression that usually suggests disgust or pain) ,
frowning(facial expression in which the eyebrows
are brought together and the forehead is
wrinkled) , sad face.
 Vocalizations – crying, moaning
 Body movements – guarding , resistance to
moving.

24. PAIN ASSESSMENT TOOLS
 These are various tools that are designed to
assess the level of pain. The most commonly
used tools are:
1. Verbal Rating Scale
2. Numeric rating scale
3. Wong baker’s faces pain scale

28. MANAGEMENT OF PAIN
1. Pharmacological interventions :
2. Non pharmacological interventions :

29. 1. Pharmacological intervention
 Analgesic : the analgesic may be NON
OPIODS (NSAIDS) or OPIOIDS or
ADJUVANTS
 NSAIDS - Non steroidal anti inflammatory drugs
 OPIOIDS – Opioids are medications that relieve
pain. Derived from opium.
 ADJUVANTS – Adjuvents are drugs originally
developed to treat conditions other than pain but
also have analgesic properties.

30. 2. Nonpharmacological
intervention
 Physical exercise
 Heat therapy
 Cold therapy
 Diversion therapy
 Relaxation strategy
 Music therapy
 Aromatherapy
 Herbal therapy
 Mind-body therapy

31. WHO Pain management ladder
Step 1:
NSAIDS+ADJUVENT
STEP 2 : NSAIDS +
Mild opioids +
adjuvants
STEP 3 : Strong
opioids + NSAIDS +
adjuvants

32.  Pain scale reading
 1 – 3
 4 – 6
 7 – 10
 WHO Step
 STEP 1
 STEP 2
 STEP 3

33. THANK YOU