The document discusses pain physiology and assessment. It defines pain and describes the fast and slow pain fiber pathways. It discusses gate control theory and different classifications of pain including nociceptive, inflammatory, and pathological pain. The document also covers parameters for understanding a patient's pain like intensity, duration, frequency, relieving/aggravating factors. It provides guidance on assessing characteristics of pain from different tissues.
Pain is defined as an “unpleasant emotional experience usually initiated by a noxious stimulus and transmitted over a specialized neural network to the central nervous system where it is interpreted as such”.
Free nerve endings – responsible for carrying noxious stimulus from both superficial as well as deep somatic and visceral pain sensations therefore reffered as nociceptors
According to type of impulses they carry second order neuron can be classified as –
LOW THRESHOLD MECHANOSENSORY( ligth touch, pressure and Proprioception)
NOCIOCEPTIVE SPECIFIC ( Noxious stimulation)
WIDE DYNAMIC RANGE ( wide range of stimulus intensities from nonnoxious to noxious.
SILENT NOCICEPTORS (It is an afferent neuron that appear to remain or silent to any mechanical stimulation .These neuron become active with tissue injury and add to the nociceptive input entering the CNS.
Pain is defined as an “unpleasant emotional experience usually initiated by a noxious stimulus and transmitted over a specialized neural network to the central nervous system where it is interpreted as such”.
Free nerve endings – responsible for carrying noxious stimulus from both superficial as well as deep somatic and visceral pain sensations therefore reffered as nociceptors
According to type of impulses they carry second order neuron can be classified as –
LOW THRESHOLD MECHANOSENSORY( ligth touch, pressure and Proprioception)
NOCIOCEPTIVE SPECIFIC ( Noxious stimulation)
WIDE DYNAMIC RANGE ( wide range of stimulus intensities from nonnoxious to noxious.
SILENT NOCICEPTORS (It is an afferent neuron that appear to remain or silent to any mechanical stimulation .These neuron become active with tissue injury and add to the nociceptive input entering the CNS.
Take home message
Acute pain is a symptom, tell us that there is something wrong in our body.
Chronic pain is a disease entity and that must be treated differently to acute pain.
Since chronic pain is biopsychosocial phenomenon it must be treated by multidisciplinary team with multidisiplinary approach.
In this presentation I have tried to explain in brief about pain management, different types of pain, its diagnostic criteria, its physiology, and its treatment approaches both pharmacological and non pharmacological
pain. Medical Surgical Nursing ......pptxPatelVedanti
Pain is a complex, multidimensional phenomenon. Everyone has experienced some types or degrees of pain. Pain is the most common reason for physician and also common problems faced by nurses when they are dealing with the patients.
The word pain is derived from the Latin word ‘Poena’ which means punishment. It is a major symptom in many medical conditions, and can significantly interfere with a person's quality of life and general functioning.
Pain motivates us to withdraw from potentially damaging situations, protect a damaged body part while it heals, and avoid those situations in the future.
Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.
The International Association for the Study of Pain's widely used definition states:
"Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage".
The processes in the body that are involved in the perception of pain are called "nociception."
Mount castle defined pain as “that sensory experiences evoked by stimuli that injure or threaten to destroy tissue, defined introspectively by every man as that which hurts”.
The International Association for the Study of Pain (IASP) classification system describes pain according to five categories:
Duration And Severity,
Anatomical Location,
Body System Involved,
Cause, And
Temporal Characteristics (Intermittent, Constant, Etc)
Acute pain lasts a short time, or is expected to be over soon. The time frame may be as brief as seconds or as long as weeks.
Chronic pain may be defined as pain that lasts beyond the healing of an injury, continues for a period of several months or longer, or occurs frequently for at least months and is more difficult to manage.eg-rheumatoid arthritis
Cutaneous or superficial pain- it is directly precised &readily localized i.e. patient can indicate exactly where it hurt.
Referred pain- pain felt at a site distinct from site of pain. eg-cardiac pain is present in the heart, but felt in the left arm
Intractable pain- persistent, severe pain that cannot be effectively controlled by the usual medication is referred to as “Intractable pain”.
Localized pain- Localized pain arises directly from the site of the disturbance.
Differentiation of neurolapatic pain- severs pain caused by nervous system damage, when the flow of afferent nerve impulse has been partially or completely interrupted. eg accident.
Pain of muscular or bonny origin- the muscular ischemia of intermittent claudication(a in commonly in the legs or arms that comes on with walking or using the arms.) & occlusion vascular induce pain in the extrimities. eg joint pain
Pain is the common symptom in many chronic conditions such as cancers, neuropathies, and chronic disease. It is also experienced in trauma varying from mild to severe based on the location and degree of trauma. This presentation is a brief outline on types of pain, classification of pain, pain pathways and management of pain
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Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
2. • The International Association for the Study of
Pain's widely used definition states: "Pain is an
unpleasant sensory and emotional experience
associated with actual or potential tissue
damage, or described in terms of such
damage.
• In medical diagnosis, pain is a symptom.
• Pain is a subjective entity,and its
manifestaions are unique to each individual.
• Is a complex experience involving several
dimensions.
3. Properties of fast and slow pain fibres
Properties Fast pain Slow pain
RECEPTORS Free nerve endings Free nerve endings
AFFERENTS Grp. 3 fibres Grp.4 fibres
ACTION POTENTIAL 5-30m/s 0.5-2m/s
CONDUCTION VELOCITY Relatively slow Very slow
SUBJECTIVE SENSATION Sharp,pricking Dull burning
ONSET OF SENSATION Short latency,quick onset Long latency, slow onset
LOCALISATION Well localised Poorly localised
DURATION OF SENSATION Short Long
SUBJECTIVE RESPONSE Reflex withdrawal Possible emotional and
automatic response
4.
5. • The 20th-century theory was gate control theory,
introduced by Ronald Melzack and Patrick Wall
in the 1965 Science article "Pain Mechanisms: A
New Theory" The authors proposed that both
thin (pain) and large diameter (touch, pressure,
vibration) nerve fibers carry information from
the site of injury to two destinations in the
dorsal horn of the spinal cord, and that the more
large fiber activity relative to thin fiber activity at
the inhibitory cell, the less pain is felt. Both
peripheral pattern theory and gate control
theory have been superseded by more modern
theories of pain
6. • In 1994, responding to the need for a
more useful system for describing
chronic pain, the International
Association for the Study of Pain (IASP)
classified pain according to specific
characteristics: (1) region of the body
involved (e.g. abdomen, lower limbs), (2)
system whose dysfunction may be
causing the pain (e.g., nervous,
gastrointestinal), (3) duration and
pattern of occurrence, (4) intensity and
time since onset, and (5) etiology.
However,
7. • this system has been criticized by Clifford J. Woolf
and others as inadequate for guiding research
and treatment.Woolf suggests three classes of
pain : (1) nociceptive pain, (2) inflammatory pain
which is associated with tissue damage and the
infiltration of immune cells, and (3) pathological
pain which is a disease state caused by damage to
the nervous system or by its abnormal function
(e.g. fibromyalgia, irritable bowel syndrome,
tension type headache, etc.).
9. • a | Nociceptive pain is physiological protective
pain involving activation of high-threshold
nociceptor neurons by noxious mechanical,
chemical or thermal stimuli. b | Inflammatory
pain is pain hypersensitivity involving detection of
active peripheral tissue inflammation by
nociceptors and sensitization of the nociceptive
system. c | Pathological pain is not adaptive, has
no protective function and can be divided into
two types: neuropathic and dysfunctional.
10. Neuropathic pain is a maladaptive plasticity due
to a lesion or disease that affects the
somatosensory system and alters nociceptive
signal processing so that responses to noxious
and innocuous stimuli are enhanced and pain is
felt in the absence of stimuli. Conversely,
dysfunctional pain is the result of nociceptive
signalling amplification in the absence of neural
lesions or inflammation.
11.
12.
13.
14. The role of therapist for influencing
the inhibition of pain transmission
17. SYSTEMIC
Disturbs sleep
arthralgia,
arthralgia,fatigue,weight
loss,low grade
Deep aching or throbbing
Reduced by pressure
Constant or waves of pain and
spasms.
Associated
with:jaundice,migratory
arthralgia,fatigue,weight
loss,low grade fever,tumors
and infection.
MUSCULOSKELETAL
Generally lessens at night
Sharp or superficial ache
Usually decreases with
cessation of activity
continuous and intermittent
Aggravates by mechanical
stress.
18. Pain and its relation to severity of
repetitive stress activity
• Level 1:pain after specific activity
• Level 2:at start of the activity resolving the warm up
• Level 3:during and after specific activity that doesn’t
affects performance
• Level 4:during and after specific activity that does
affects perfomance
• Level 5:with ADLs
• Level6:constant dull aching pain at rest and doesn’t
disturbs sleep.
• Level7:highest level of severity
19. PARAMETERS TO LOOK FOR ,IN
UNDERSTANDING PATIENT`S PAIN
• Intensity
• Duration and
• Frequency
• Relieving aggravating factors
• What Time of the day
• Type or quality of pain
20. • Constant pain:chemical irritation,tumors or
possibly visceral lesions.
• Whether periodic or occasional;ask for what
activity,position or posture .
• Episodic pain:is related to specific activities.
• Morning stiffness with pain improves with
activity,indicating chronic inflammation.
• Pain at rest and pain that is worst at the beginning
of activity than at the end implies acute
inflammation.
• Pain ;not affected by rest/activity usually indicates
bone pain OR could be related to organic/systemic
disorders or diseases of viscera.
21. • pain and cramping with prolonged walking may indicate lumbar
canal stenosis[neurogenic intermittent claudication],vascular
probems[ vascular or circulatory interittent claudication].
• Iv disc pain-aggravates with forward bending and sitting.
• Facet joint pain-gets relieved by the above two and is aggravated
with extension and rotation.
• Type or quality of pain:
nerve pain-sharp[lancinating],bright and burning and tends to run in
the distribution of nerve fibres.
Bone pain-deep,and localised.
Visceral pain-diffuse,aching and poorly localized and may be referred
to other areas .
Muscle pain-hard to localize,dull and aching,aggravates with injury ay
get referred to other areas also.
Inert tisse such as ligaments,capsules,and bursa tends to be
intditinguishable from muscle pain.
Each of these above tissue pains sometimes grouped as neuropathic
pain.
Somatic pain:severe chronic or aching ,inconsistent with injury.
Radiating pain-usually is minimal in bone involvements,and is
increased; `on applying pressure to the nerve roots
22. Each of these above tissue pains sometimes
grouped as neuropathic pain.
Somatic pain:severe chronic or aching ,inconsistent
with injury.
Radiating pain-usually is minimal in bone
involvements,and is increased; `on applying
pressure to the nerve roots rs esults in
radiculopathy or radiating pain .pressure over
nerve trunks produces no pain but
parasthesia(pins and needles).
Autonomic pain-likely to be of a burning type.
Referred pain-nerve itself being a cause, lets brain
recognise pain coming from the periphery.