This document defines pain and describes different types of pain. It discusses pain thresholds and tolerance, which vary between individuals. Pain can be subjective and described based on location, quality, severity, timing and other factors. Non-pharmacological and pharmacological methods for managing pain are outlined, including therapeutic touch, heat/cold, distraction techniques, and analgesics. Scales for assessing pain in adults and children are also presented.

2. PAIN: A sensation of physical or mental hurt
or suffering that causes distress or agony
to the one experiencing it
• It is whatever the patient says it is.
• It exists whenever the patient says it does.
• It is subjective in nature. Only the person
experiencing it may describe it.
• It is protective because it provides warning
signal for tissue injury.

3. • Pain Threshold – amount of pain stimulation
a person requires before feeling pain (also
called as pain sensation); Generally fairly
uniform among people
• Pain Tolerance – maximum amount and
duration of pain that an individual is willing
to endure; Varies greatly among people
• Pain perception – the actual feeling of pain

4. • Hyperalgesia – excessive sensitivity to pain

5. • CUTANEOUS or SUPERFICIAL PAIN – occurs
over the body surface or skin segment
• SOMATIC PAIN – It occurs in the skin,
muscles, or joint.
• VISCERAL PAIN – arises from stimulation of
pain receptors in the abdominal cavity and
thorax

6. • REFERRED PAIN – the pain is perceived at an area
other that the site of injury
• INTRACTABLE PAIN – pain that is resistant to cure
or relief
• PHANTOM PAIN – actual pain felt in a body part
that is no longer present
Ex: Pain experienced after amputation of a limb

7. • RADIATING PAIN – felt at the source and
extends to surrounding tissues
• PSYCHOGENIC PAIN – primarily due to
emotional factors, with no physiologic basis
• INTERMITTENT PAIN – pain that stops and
starts again

8. P-ROVOCATIVE
What brings it on?
What were you doing when you first noticed it?
Q-UALITY
How does it feel?
How intense or severe is it?

9. Burning Stabbing
Throbbing Knife-like
Cramping Sharp
Tingling Shooting
Dull Aching
Crushing Squeezing
Itching

10. • REGION or RADIATION
Where is the pain located?
Does it spread anywhere?
• S-EVERITY SCALE
How bad is it (on a scale of 1 to 10)?
Is it getting better, worse, or staying the
same?

11. • T-IMING
Onset – Exactly when did it first occur?
Duration – How long did it last?
Frequency – How often does it occur?
• U-NDERSTANDING OF THE PATIENT ABOUT
THE PAIN
What do you think it means? How does it
affect your daily activities?

13. For Infants and Children:
- Infants are incapable of “self-report” on pain
but it is important to remember that infants
do feel pain
- Children 2 years of age can report pain and
point to its location. However, they cannot
rate pain intensity at this developmental level
- Rating scales can be introduced at 4 to 5
years of age

14. - Explain to the child that each face is for a
person who feels happy because he has no
pain (hurt) or sad because he has some or a
lot of pain.
- Ask the child to choose the face that best
describes how he/she is feeling.

15. • 0-10 Numeric Rating Scale
Ask the patient to choose a number that rates
the level of pain, with 0 being no pain and the
highest score 10 – indicating the worst pain

16. Non-Pharmacologic Methods
a. Therapeutic touch – Energy is transmitted
from one person to another
b. Contralateral stimulation – Stimulating the
skin in an area opposite to the painful area
c. Heat and cold application

17. d. Counterirritants – Increase circulation to the
area (ex: liniments)
e. Acupuncture/Acupressure

18. f. Slow, rhythmic breathing (Deep Breathing
Exercises / DBE)
g. Listening to music
h. Engaging in conversation
i. Busying oneself (chores, hobbies)
j. Guided imagery
k. Meditation, yoga, biofeedback

19. 2. Techniques that distract attention
a. Slow, rhythmic breathing (Deep Breathing
Exercises / DBE)
b. Listening to music
c. Engaging in conversation
d. Busying oneself (chores, hobbies)

20. 2. Pharmacologic Methods
a. Administration of analgesics (At the start of
pain)
Placebo – A non-organic substance that
satisfies patient’s request for analgesic. It
requires physician’s order.