This document discusses pain assessment. It begins by outlining six objectives related to explaining pain pathophysiology, differentiating between acute and chronic pain, discussing physiologic pain responses, assessing pain as a vital sign, interviewing patients about their pain experience, and performing a physical assessment. It then defines pain and discusses physiologic pain responses and classifications including acute, chronic, cancer, nociceptive, neuropathic, and intractable pain. It also covers the seven dimensions of pain and psychosocial factors affecting pain perception. Finally, it discusses various pain assessment tools.

1. NCMP-102
LEC
PAIN
ASSESSMENT
Soltes | Bustamante | Pasibe | Bengoa

2. OBJECTIVES
1
2
3
Explain the pathophysiology of
pain.
Differentiate between the etiology of
acute and chronic pain.
Discuss the various physiologic response
to pain.

3. OBJECTIVES
CONT.
4
5
6
Assess pain as the fifth vital sign
Initiate an interview with the client and
ask about their experience with the pain.
Perform a physical assessment of the
client experiencing pain.

4. TABLE OF
CONTENTS
DEFINITION
PHYSIOLOGIC RESPONSES
CLASSIFICATIONS
SEVEN DIMENSION
PSYCHOSOCIAL FACTORS
PATHOPHYSIOLOGY
HEALTH ASSESSMENT

5. PAIN
(awts, pighati, lumbay)
"The Fifth Vital Sign"

6. PAIN
"An unpleasant sensory
and emotional experience,
which we primarily
associate with tissue
damage or describe in
terms of such damage."
- International Association for the study of Pain, 2011

7. PAIN
"Pain is whatever the
person says it is"
- McCaffery and Pasero

8. PAIN
"Pain is a combination of
physiologic phenomena
but with psychosocial
aspects that influence
perception of the pain."

9. The pathophysiologic phenomena of pain are
associated with the central and peripheral
nervous systems. The source of pain stimulates
peripheral nerve endings (nociceptors), which
transmit the sensations to the central nervous
system (CNS). They are sensory receptors that
detect signals from damaged tissue and
chemicals released from the damaged tissue
PATHOPHYSIOLOGY
OF PAIN

10. -Located at the peripheral ends of both
myelinated nerve ending s of endings of type A
fibers or unmyelinated type C fibers
-Distributed in body, skin, subcutaneous tissue,
skeletal muscle, joints, peritoneal surfaces,
pleural membranes, dura mater and blood vessel
walls
NOCICEPTORS
Mechanosensitive Nociceptors
Temperature-Sensitive
Polymodal Nociceptors
Three types:

11. -Involved in pain perception (nociception)
PHYSIOLOGIC PROCESSES
Transduction
Transmission
Perception
Modulation

12. - Begins when a mechanical, thermal, or chemical
stimulus results in tissue injury or damage stimulating
the nociceptor, which are the primary afferent nerves
for receiving painful stimuli.
TRANSDUCTION
TRANSMISSION
- Initiated by this inflammatory process resulting in the
conduction of an impulse in the primary afferent
neurons to the dorsal horn of the spinal cord.

13. - still poorly understood.
-Studies have shown that emotional status (depression
and anxiety) affects directly the pain perceived and
thus reported by clients.
PERCEPTION
MODULATION
-Is a difficult phenomenon to explain.
Modulation changes or inhibits the pain message relay
in the spinal cord. The descending modular pain
pathways either increase (excite) or inhibit pain
transmission

14. PHYSIOLOGIC
RESPONSES
TO PAIN
Pain Elicits a stress responses in the
human body that triggers the
sympathetic nervous system, resulting
in physiologic responses such as:
Anxiety, fear, hopelessness, sleeplessness,
thoughts of suicide
Focus on pain, reports on pain, cries and
moans, frowns and facial grimaces
decrease in cognitive function, mental
confusion, altered temperament, high
somatization and dilated pupils.
Increased heart rate, peripheral systemic, and
coronary vascular resistance, increase blood
pressure
Increased respiratory rate and sputum
retention, resulting in infection and atelectasis.

15. PHYSIOLOGIC
RESPONSES
TO PAIN
CONT.
Decreased gastric and intestinal motility
Decreased urinary output, resulting in urinary
retention, fluid overload, depression of all
immune responses
Increased antidiuretic hormone, epinephrine,
norepinephrine, aldosterone, glucagons,
decreased insulin, testosterone
Hyperglycemia, glucose intolerance, insulin
resistance, protein catabolism
Muscle spasm, resulting in impaired muscle
function and immobility, perspiration.

16. LET'S HAVE A
GAME
Take a Picture
of:
A Hybrid Bring
ME

17. MECHANICS
Take a Picture of a
subject depending on the
topic given.
Ex.
(A picture of an object
starting with Letter B
*Balloon* put it on top of your
head)
(An Object that is liquid and
clear, Place it on top of your
feet.)

18. MECHANICS
Send your photos
through our Group Chat
in NCMP102 LEC
Type the name of the
Object
First to Send that meets
the mechanics will win
TAKE NOTE: With Prizes

19. PRACTICE
ROUND
An Object that is on
your desk starting
with Letter P.
Place it on the top of
your lap

20. FIRST
ROUND
An Object that
starts with letter A.
Place it near your
ears

21. SECOND
ROUND
An Object that is
found in your Room,
starting with I
Place it on the tip of
your nose

22. THIRD
ROUND
An Object that
might cause pain
starts with N
Place it on a chair

23. CLASSIFICATIONS
OF
PAIN

24. CLASSIFICATIONS
OF
PAIN
ACUTE PAIN
CHRONIC NONMALIGNANT PAIN
CANCER PAIN
NOCICEPTIVE
NEUROPHATIC
INFLAMMATORY
INTRACTABLE PAIN
BY CAUSE

25. NOCICEPTIVE
NEUROPHATIC
Initiated or caused by a primary lesion or
disease in the somatosensory nervous system
Responses to noxious insult or injury of tissue such as skin, muscle,
visceral organ, joints, tendons, or bones
INFLAMMATORY
Result of activation and sensitization of the
nociceptive pain pathway by variety of
mediators release at the site of tissue
inflammation.

26. ACUTE PAIN
CHRONIC NONMALIGNANT PAIN
usually associated with a specific cause or injury
and described as a constant pain that
persists for more than 6 months
usually associated with a recent injury

27. INTRACTABLE PAIN
Defined by its high resistance to pain relief
often due to the compression of peripheral
nerves or meninges or from the damage to these
structures following surgery, chemotherapy,
radiation, or tumor growth and infiltration
CANCER PAIN

28. CLASSIFICATIONS
OF
PAIN
CUTANEOUS PAIN
VISCERAL PAIN
DEEP SOMATIC PAIN
BY LOCATION

29. Skin or Subcutaneous tissue
VISCERAL PAIN
CUTANEOUS PAIN
Abdominal cavity, thorax, cranium
DEEP SOMATIC PAIN
Ligaments, tendons, bones blood vessel, nerves

30. PHANTOM PAIN
ANOTHER ASPECT OF PAIN
LOCATION
Radiating, Referred, Phantom Pain
Can be perceived
in nerves left by a
missing,
amputated or
paralyzed body
part.
REFERRED
RADIATING
Received in the
body areas away
from the pain
source
Perceived both at
the source and
extending to the
other tissue

31. THE SEVEN
DIMENSIONS OF
PAIN
PHYSICAL DIMENSION
SENSORY DIMENSION
BEHAVIORAL DIMENSION
SOCIOCULTURAL DIMENSION
COGNITIVE DIMENSION
SPIRITUAL DIMENSION
AFFECTIVE DIMENSION

32. PHYSICAL DIMENSION
- the physiologic effects jus described
SENSORY DIMENSION
- the quality of the pain and how severe the pain is perceived
BEHAVIORAL DIMENSION
- the verbal and nonverbal that the patient demonstrates
as response
SOCIOCULTURAL DIMENSION
- concern the influences of the patient's social context
and cultural background on the pain experience

33. COGNITIVE DIMENSION
- concerns
'beliefs, attitudes, intentions, and motivations related to its management
AFFECTIVE DIMENSION
- concerns feelings, sentiments, and emotions related to pain experience
SPIRITUAL DIMENSION
- refers to the meaning and purpose that the person
"attributes to the pain, self, others, and divine."

34. PSYCHOSOCIAL
FACTORS
AFFECTING PAIN
PERCEPTION AND
ASSESSMENT
DEVELOPMENTAL LEVEL OR
AGE
CULTURE

35. PEDIATRIC (NEONATE TO LATER
CHILDHOOD
GERIATRIC AGE GROUPS
DEVELOPMENTAL LEVEL

36. PAIN IS A UNIVERSAL HUMAN
EXPERIENCE
PAIN CAN HAVE SEVERAL
MEANINGS IN DIFFERENT
CULTURES THAT LEAD TO THESE
DIFFERENT RESPONSE PATTERNS
CULTURE

37. PAIN ASSESSMENT TOOLS

38. UNIVERSAL PAIN
ASSESSMENT
TOOL

39. WONG-BAKER FACIAL GRIMACE SCALE

40. F.L.A.C.C

41. MEMORIAL PAIN ASSESSMENT CARD

42. MCCAFFREY INITIAL PAIN
ASSESSMENT TOOL

43. THANK YOU!