The document discusses pain management and the gate control theory of pain. It defines pain and describes how nurses encounter patients in pain in various settings. Pain is considered the fifth vital sign and accurate assessment and documentation of pain is important. There are three main types of pain - acute, chronic, and cancer-related pain. The gate control theory proposes that non-painful stimuli can inhibit pain signals from reaching the brain. The theory describes how pain signals travel through the peripheral and central nervous systems and how the brain can influence pain perception through emotional and cognitive factors.
The document discusses pain, including its definition, types, perception and pathways. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It classifies pain into physiological (nociceptive), pathological (neuropathic), and psychogenic types based on its mechanism or cause. The neural pathways for pain transmission, including the neospinothalamic and paleospinothalamic tracts, are described. The concepts of referred pain and the endogenous analgesia system, including the gate control theory, are also summarized.
This document discusses types and assessment of pain. It defines pain and lists signs and symptoms. Pain is classified based on duration as acute or chronic. Acute pain lasts through the expected recovery period while chronic pain lasts longer than 3-6 months. Chronic pain is further classified as chronic non-cancer pain, chronic cancer pain, or chronic episodic pain. Pain is also classified based on location, intensity, and etiology as nociceptive, somatic, visceral, or neuropathic. Common tools for pain assessment include verbal rating scales, numeric rating scales, Wong Baker Faces scale, and FLACC scale which evaluates facial expressions, leg movement, activity, cry, and consolability. Physiological indicators of pain like increased heart
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
Neoplasia refers to new abnormal growth of tissue. A neoplasm is an abnormal mass of tissue that grows in an uncontrolled manner. Neoplasms can be benign (non-cancerous) or malignant (cancerous). The growth of neoplasms is driven by genetic changes that allow the cells to proliferate autonomously. Tumors are monoclonal in origin, arising from a single cell. The hallmarks of neoplasms include persistent and purposeless proliferation, a parasitic nature, progression, and clonal expansion. Tumors are classified based on their tissue of origin and behavior. Malignant tumors can invade surrounding tissues and metastasize to distant sites. The development of neoplasms involves genetic and environmental factors
1) Pain physiology involves transduction, transmission, perception, and modulation of nociceptive signals from the periphery to the brain.
2) Pain signals are transmitted via Aδ and C nerve fibers to the spinal cord and then to the brain. Aδ fibers transmit fast, sharp pain while C fibers transmit slow, dull pain.
3) Central modulation occurs in the spinal cord and brain and can either facilitate or inhibit pain transmission and perception through mechanisms like windup, sensitization, and the release of neurotransmitters.
This document discusses classifications of pain. It defines pain according to several organizations and researchers. It notes the historical understanding of pain from Greek, Latin, and early philosophers' perspectives. It then describes types of pain based on speed of onset and duration, including experimental, transient, acute, and chronic pain. It also discusses types based on stimulation level, including somatic and visceral pain. The document outlines specific pains such as headaches, toothaches, and trigeminal neuralgia. It concludes by defining abnormal pains including hyperalgesia, allodynia, hyperpathia, and phantom limb pain.
Systemic effects of acute inflammation and granulomaDr. Hadia Arshad
Inflammation is the protective immune response to tissue injury or infection. It involves movement of fluid and immune cells into injured tissues and is characterized by redness, swelling, heat, pain, and loss of function. The systemic inflammatory response causes fever, increased pulse and blood pressure, and changes in white blood cell counts. Chronic inflammation lasts longer and involves macrophages and lymphocytes, often leading to fibrosis, proliferation of blood vessels, and necrosis. Granulomatous inflammation forms structures called granulomas, which contain giant cells, to wall off long-term infections or foreign materials.
The document discusses pain, including its definition, types, perception and pathways. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It classifies pain into physiological (nociceptive), pathological (neuropathic), and psychogenic types based on its mechanism or cause. The neural pathways for pain transmission, including the neospinothalamic and paleospinothalamic tracts, are described. The concepts of referred pain and the endogenous analgesia system, including the gate control theory, are also summarized.
This document discusses types and assessment of pain. It defines pain and lists signs and symptoms. Pain is classified based on duration as acute or chronic. Acute pain lasts through the expected recovery period while chronic pain lasts longer than 3-6 months. Chronic pain is further classified as chronic non-cancer pain, chronic cancer pain, or chronic episodic pain. Pain is also classified based on location, intensity, and etiology as nociceptive, somatic, visceral, or neuropathic. Common tools for pain assessment include verbal rating scales, numeric rating scales, Wong Baker Faces scale, and FLACC scale which evaluates facial expressions, leg movement, activity, cry, and consolability. Physiological indicators of pain like increased heart
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
Neoplasia refers to new abnormal growth of tissue. A neoplasm is an abnormal mass of tissue that grows in an uncontrolled manner. Neoplasms can be benign (non-cancerous) or malignant (cancerous). The growth of neoplasms is driven by genetic changes that allow the cells to proliferate autonomously. Tumors are monoclonal in origin, arising from a single cell. The hallmarks of neoplasms include persistent and purposeless proliferation, a parasitic nature, progression, and clonal expansion. Tumors are classified based on their tissue of origin and behavior. Malignant tumors can invade surrounding tissues and metastasize to distant sites. The development of neoplasms involves genetic and environmental factors
1) Pain physiology involves transduction, transmission, perception, and modulation of nociceptive signals from the periphery to the brain.
2) Pain signals are transmitted via Aδ and C nerve fibers to the spinal cord and then to the brain. Aδ fibers transmit fast, sharp pain while C fibers transmit slow, dull pain.
3) Central modulation occurs in the spinal cord and brain and can either facilitate or inhibit pain transmission and perception through mechanisms like windup, sensitization, and the release of neurotransmitters.
This document discusses classifications of pain. It defines pain according to several organizations and researchers. It notes the historical understanding of pain from Greek, Latin, and early philosophers' perspectives. It then describes types of pain based on speed of onset and duration, including experimental, transient, acute, and chronic pain. It also discusses types based on stimulation level, including somatic and visceral pain. The document outlines specific pains such as headaches, toothaches, and trigeminal neuralgia. It concludes by defining abnormal pains including hyperalgesia, allodynia, hyperpathia, and phantom limb pain.
Systemic effects of acute inflammation and granulomaDr. Hadia Arshad
Inflammation is the protective immune response to tissue injury or infection. It involves movement of fluid and immune cells into injured tissues and is characterized by redness, swelling, heat, pain, and loss of function. The systemic inflammatory response causes fever, increased pulse and blood pressure, and changes in white blood cell counts. Chronic inflammation lasts longer and involves macrophages and lymphocytes, often leading to fibrosis, proliferation of blood vessels, and necrosis. Granulomatous inflammation forms structures called granulomas, which contain giant cells, to wall off long-term infections or foreign materials.
This document provides instructions for administering intramuscular injections including the advantages and disadvantages, recommended injection sites, necessary equipment, and procedures. It discusses delivering injections into the deltoid, vastus lateralis, ventrogluteal, and dorsogluteal regions. The procedures outline preparing the medication, identifying the client, explaining the process, selecting an injection site, administering the injection, and documenting properly. Complications that can arise include abscesses, tissue damage, granulomas, hematomas, and nerve injuries.
this topic explains the nature of pain, signs and symptoms of pain, different types of pain, factors influencing pain, assessment of pain and pharmacological and non pharmacological management of pain.
The document discusses various aspects of pain, including:
1. Pain is classified based on origin (cutaneous, somatic, visceral) and nature (acute, chronic).
2. Pain involves physical, emotional, and cognitive components and is a subjective experience that varies between individuals.
3. Several theories have been proposed to explain the perception and experience of pain, including specificity theory, pattern theory, and gate control theory.
4. Pain assessment considers factors like location, intensity, age of patient, and uses scales tailored for different populations.
A detail on CSF
INTRODUCTION
PROPERTIES
COMPOSITION
FORMATION OF (CSF)
CSF is formed by choroid plexuses, situated with in the ventricles.
Choroid plexuses are tuft of capillaries present inside the ventricles.
A large amount of CSF is formed in the lateral ventricles.
SUBSTANCES AFFECTING THE FORMATION OF (CSF)
PILOCARPINE, extract of pituitary gland stimulate the secretion of CSF.
Injection of isotonic saline also stimulates CSF formation.
Injection of hypotonic saline increases CSF formation.
Hypertonic saline decreases CSF formation and CSF pressure.
ABSORPTION OF (CSF)
CSF is mostly by the archnoid villi into dural sinuses and spinal veins.
Small amount is absorbed along the perineural spaces into cervical lymphatics and into perivascular spaces.
Normally , about 500 mL of CSF is formed everyday and an equal amount is absorbed.
FUNCTIONS OF (CSF)
COLLECTION OF CSF
APPLIED PHYSIOLOGY
This document discusses different types of pain. It describes fast pain, which occurs within 0.1 seconds and is transmitted quickly, and slow pain, which takes over 1 second to start and increases slowly over minutes, being transmitted more slowly. Fast pain includes sharp and electric pain in superficial tissues, while slow pain includes aching and chronic pain that can occur deep in tissues. Pain signals travel along dual pathways in the spinal cord and brainstem. The document also discusses visceral pain referral and its causes from internal organ damage or stretching.
This document provides an overview of neonatal nursing. It begins by defining neonatal nursing as nursing care for newborn infants up to 28 days after birth, typically in a Newborn Intensive Care Unit. Neonatal nursing requires high skill and dedication as nurses care for infants with a range of health issues. The document then discusses the global burden of neonatal mortality, with most deaths occurring in low- and middle-income countries. In Ethiopia specifically, about 81,000 babies die each year in the first month of life. The document concludes by outlining several initiatives by the Ethiopian Ministry of Health to strengthen newborn care, such as community-based newborn care and establishing multiple levels of neonatal intensive care units.
This Ppt about Infusion pump explains in detail about - Definition, Principle, Uses, and types of an Infusion pump - Syringe pump and Volumetric Pump. working and maintenance of different types of pumps. Helpful for student nurses posted in intensive care units and those caring for very sick patients and babies. This Ppt is helpful in learning the maintenance of the various types of Infusion pumps available.
Physiology of Pain, Characteristic of pain, Basic consideration of nervous system, Pain receptor, Mechanism of pain causation, Theories of pain, Pathways of pain, Pain Receptors
Health education can utilize various methods and media to effectively disseminate information. Visual aids like posters are an important method, as they use graphical designs, bold colors and messages to catch people's attention from a distance and implant ideas into their minds. A good poster should be designed to convey its message to both literate and illiterate people.
Intravenous (IV) injection delivers medication directly into the bloodstream through a vein. An IV infusion involves a slow drip of medication over time to provide a constant volume of therapy. IV injection allows for quick delivery of large amounts of medication into the bloodstream and rapid action. The procedure involves selecting a suitable vein, preparing the site, inserting a needle, attaching tubing, and monitoring the infusion for complications. While effective, IV injection can cause pain, requires supervision, and risks infection.
5. pain perception and comfort (2).pptxnuradinman89
This document discusses pain perception and comfort. It begins by defining pain and outlining the objectives of discussing pain mechanisms, assessment tools, and altered functions resulting from pain. It then covers topics including the pathophysiology and factors affecting pain, different types of pain classified by duration, location and etiology, and tools for assessing pain intensity. The document also discusses approaches to pain management, including non-pharmacological and pharmacological options, and defines comfort as a more complex state than just relief from discomfort or pain.
The cellular components of blood are erythrocytes (red blood cells, or RBCs), leukocytes (white blood cells, or WBCs), and thrombocytes (platelets). By volume, the RBCs constitute about 45% of whole blood, the plasma about 54.3%, and white blood cells about 0.7%. Platelets make up less than 1%.
Role of nurse in organ donation, retrievel and banking RakhiYadav53
Nurses play a vital role in organ donation, from facilitating potential donors to supporting families. They begin by identifying potential donors and managing their care until donation. Nurses guide families through the difficult process, obtain consent, and initiate the donor protocol according to hospital policy. After retrieval, organs are preserved and transported to recipients. Nurses coordinate multiple teams and care for donors and recipients through all stages of donation and transplantation. Their role is critical in this complex process.
The document discusses pain and its management. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is subjective and involves physiological, emotional, and cognitive components. Pain assessment methods include WHATSUP, PQRST, and OLDCART. Pain management involves pharmacological approaches like opioids and non-opioids, surgical interventions, physical therapy, and complementary therapies like massage, acupuncture, and meditation. Nurses play a key role in comprehensive pain management.
The document discusses the history, prevalence, and proper procedures for intramuscular injections. It notes that while injections became popular after World War II, as many as 70-95% of injections given in India are unnecessary. The document provides guidance on selecting injection sites, preparing syringes safely, administering injections correctly, and disposing of used equipment to avoid infections and other complications. It emphasizes giving injections only when truly needed and ensuring any injection administered is done so safely.
The document discusses pain perception and transmission in the human body. It begins by defining pain and outlining the dual sensory and emotional nature of pain. It then describes how pain signals are transmitted from nociceptors to the spinal cord and brain through A and C nerve fibers. The signals travel through the spinothalamic tract to the thalamus and somatosensory cortex. Descending pathways from the brain can modulate pain perception. The gate control theory of pain is also explained. The document further discusses different types of pain and factors that influence pain experience.
INTRAMUSCULAR INJECTION
IM Injection (Introduction, Definition, Purpose, Technique, Rights of Medication, Z-Track Method, Equipment, Procedure and Responsibilities)..
The document discusses electrical activity of the heart as recorded by an electrocardiogram (ECG). It defines key ECG terminology like waves, intervals, complexes and explains what each part of the ECG represents in terms of electrical activity in the heart. Specific waves like P, QRS, T are described in detail along with common abnormalities. Other concepts covered include heart rate calculation methods, cardiac rhythms and axis determination. The document provides a comprehensive overview of interpreting and understanding ECG readings.
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is a major unmet medical need, with chronic pain reducing quality of life similar to depression. Pain signals are transmitted through nociceptors and neurons from the peripheral to central nervous system. There are two main types of pain - fast pain conducted along thin myelinated fibers for sharp pain, and slow pain conducted along unmyelinated C fibers for dull pain. Acute pain serves a protective purpose while chronic pain persists independently of tissue damage. A variety of pharmacological and non-pharmacological options are used for pain relief.
This document discusses pain management and pharmacology. It provides classifications of analgesics, describes pain pathways and nociceptor activation, lists various pain management medications and their mechanisms of action, and outlines the nursing process for pain assessment and treatment. The key points are that analgesics should relieve pain without side effects, classifications include opioids and NSAIDs, pain is transmitted via nociceptors and pathways in the CNS, and nursing focuses on thorough assessment, nonpharmacological interventions, medication administration, and education.
This document discusses terms related to pain and provides guidelines for pain management. It defines types of pain such as acute, chronic, neuropathic, and nociceptive pain. It describes the WHO analgesic ladder for treating cancer pain with non-opioids, weak opioids, and strong opioids depending on pain severity. It discusses the pharmacology and use of various analgesics like paracetamol, NSAIDs, opioids, corticosteroids, antidepressants, anticonvulsants, and others to treat different pain types and as adjuvants. It addresses myths and concerns around opioid use and emphasizes the importance of individualized treatment.
This document provides instructions for administering intramuscular injections including the advantages and disadvantages, recommended injection sites, necessary equipment, and procedures. It discusses delivering injections into the deltoid, vastus lateralis, ventrogluteal, and dorsogluteal regions. The procedures outline preparing the medication, identifying the client, explaining the process, selecting an injection site, administering the injection, and documenting properly. Complications that can arise include abscesses, tissue damage, granulomas, hematomas, and nerve injuries.
this topic explains the nature of pain, signs and symptoms of pain, different types of pain, factors influencing pain, assessment of pain and pharmacological and non pharmacological management of pain.
The document discusses various aspects of pain, including:
1. Pain is classified based on origin (cutaneous, somatic, visceral) and nature (acute, chronic).
2. Pain involves physical, emotional, and cognitive components and is a subjective experience that varies between individuals.
3. Several theories have been proposed to explain the perception and experience of pain, including specificity theory, pattern theory, and gate control theory.
4. Pain assessment considers factors like location, intensity, age of patient, and uses scales tailored for different populations.
A detail on CSF
INTRODUCTION
PROPERTIES
COMPOSITION
FORMATION OF (CSF)
CSF is formed by choroid plexuses, situated with in the ventricles.
Choroid plexuses are tuft of capillaries present inside the ventricles.
A large amount of CSF is formed in the lateral ventricles.
SUBSTANCES AFFECTING THE FORMATION OF (CSF)
PILOCARPINE, extract of pituitary gland stimulate the secretion of CSF.
Injection of isotonic saline also stimulates CSF formation.
Injection of hypotonic saline increases CSF formation.
Hypertonic saline decreases CSF formation and CSF pressure.
ABSORPTION OF (CSF)
CSF is mostly by the archnoid villi into dural sinuses and spinal veins.
Small amount is absorbed along the perineural spaces into cervical lymphatics and into perivascular spaces.
Normally , about 500 mL of CSF is formed everyday and an equal amount is absorbed.
FUNCTIONS OF (CSF)
COLLECTION OF CSF
APPLIED PHYSIOLOGY
This document discusses different types of pain. It describes fast pain, which occurs within 0.1 seconds and is transmitted quickly, and slow pain, which takes over 1 second to start and increases slowly over minutes, being transmitted more slowly. Fast pain includes sharp and electric pain in superficial tissues, while slow pain includes aching and chronic pain that can occur deep in tissues. Pain signals travel along dual pathways in the spinal cord and brainstem. The document also discusses visceral pain referral and its causes from internal organ damage or stretching.
This document provides an overview of neonatal nursing. It begins by defining neonatal nursing as nursing care for newborn infants up to 28 days after birth, typically in a Newborn Intensive Care Unit. Neonatal nursing requires high skill and dedication as nurses care for infants with a range of health issues. The document then discusses the global burden of neonatal mortality, with most deaths occurring in low- and middle-income countries. In Ethiopia specifically, about 81,000 babies die each year in the first month of life. The document concludes by outlining several initiatives by the Ethiopian Ministry of Health to strengthen newborn care, such as community-based newborn care and establishing multiple levels of neonatal intensive care units.
This Ppt about Infusion pump explains in detail about - Definition, Principle, Uses, and types of an Infusion pump - Syringe pump and Volumetric Pump. working and maintenance of different types of pumps. Helpful for student nurses posted in intensive care units and those caring for very sick patients and babies. This Ppt is helpful in learning the maintenance of the various types of Infusion pumps available.
Physiology of Pain, Characteristic of pain, Basic consideration of nervous system, Pain receptor, Mechanism of pain causation, Theories of pain, Pathways of pain, Pain Receptors
Health education can utilize various methods and media to effectively disseminate information. Visual aids like posters are an important method, as they use graphical designs, bold colors and messages to catch people's attention from a distance and implant ideas into their minds. A good poster should be designed to convey its message to both literate and illiterate people.
Intravenous (IV) injection delivers medication directly into the bloodstream through a vein. An IV infusion involves a slow drip of medication over time to provide a constant volume of therapy. IV injection allows for quick delivery of large amounts of medication into the bloodstream and rapid action. The procedure involves selecting a suitable vein, preparing the site, inserting a needle, attaching tubing, and monitoring the infusion for complications. While effective, IV injection can cause pain, requires supervision, and risks infection.
5. pain perception and comfort (2).pptxnuradinman89
This document discusses pain perception and comfort. It begins by defining pain and outlining the objectives of discussing pain mechanisms, assessment tools, and altered functions resulting from pain. It then covers topics including the pathophysiology and factors affecting pain, different types of pain classified by duration, location and etiology, and tools for assessing pain intensity. The document also discusses approaches to pain management, including non-pharmacological and pharmacological options, and defines comfort as a more complex state than just relief from discomfort or pain.
The cellular components of blood are erythrocytes (red blood cells, or RBCs), leukocytes (white blood cells, or WBCs), and thrombocytes (platelets). By volume, the RBCs constitute about 45% of whole blood, the plasma about 54.3%, and white blood cells about 0.7%. Platelets make up less than 1%.
Role of nurse in organ donation, retrievel and banking RakhiYadav53
Nurses play a vital role in organ donation, from facilitating potential donors to supporting families. They begin by identifying potential donors and managing their care until donation. Nurses guide families through the difficult process, obtain consent, and initiate the donor protocol according to hospital policy. After retrieval, organs are preserved and transported to recipients. Nurses coordinate multiple teams and care for donors and recipients through all stages of donation and transplantation. Their role is critical in this complex process.
The document discusses pain and its management. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is subjective and involves physiological, emotional, and cognitive components. Pain assessment methods include WHATSUP, PQRST, and OLDCART. Pain management involves pharmacological approaches like opioids and non-opioids, surgical interventions, physical therapy, and complementary therapies like massage, acupuncture, and meditation. Nurses play a key role in comprehensive pain management.
The document discusses the history, prevalence, and proper procedures for intramuscular injections. It notes that while injections became popular after World War II, as many as 70-95% of injections given in India are unnecessary. The document provides guidance on selecting injection sites, preparing syringes safely, administering injections correctly, and disposing of used equipment to avoid infections and other complications. It emphasizes giving injections only when truly needed and ensuring any injection administered is done so safely.
The document discusses pain perception and transmission in the human body. It begins by defining pain and outlining the dual sensory and emotional nature of pain. It then describes how pain signals are transmitted from nociceptors to the spinal cord and brain through A and C nerve fibers. The signals travel through the spinothalamic tract to the thalamus and somatosensory cortex. Descending pathways from the brain can modulate pain perception. The gate control theory of pain is also explained. The document further discusses different types of pain and factors that influence pain experience.
INTRAMUSCULAR INJECTION
IM Injection (Introduction, Definition, Purpose, Technique, Rights of Medication, Z-Track Method, Equipment, Procedure and Responsibilities)..
The document discusses electrical activity of the heart as recorded by an electrocardiogram (ECG). It defines key ECG terminology like waves, intervals, complexes and explains what each part of the ECG represents in terms of electrical activity in the heart. Specific waves like P, QRS, T are described in detail along with common abnormalities. Other concepts covered include heart rate calculation methods, cardiac rhythms and axis determination. The document provides a comprehensive overview of interpreting and understanding ECG readings.
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is a major unmet medical need, with chronic pain reducing quality of life similar to depression. Pain signals are transmitted through nociceptors and neurons from the peripheral to central nervous system. There are two main types of pain - fast pain conducted along thin myelinated fibers for sharp pain, and slow pain conducted along unmyelinated C fibers for dull pain. Acute pain serves a protective purpose while chronic pain persists independently of tissue damage. A variety of pharmacological and non-pharmacological options are used for pain relief.
This document discusses pain management and pharmacology. It provides classifications of analgesics, describes pain pathways and nociceptor activation, lists various pain management medications and their mechanisms of action, and outlines the nursing process for pain assessment and treatment. The key points are that analgesics should relieve pain without side effects, classifications include opioids and NSAIDs, pain is transmitted via nociceptors and pathways in the CNS, and nursing focuses on thorough assessment, nonpharmacological interventions, medication administration, and education.
This document discusses terms related to pain and provides guidelines for pain management. It defines types of pain such as acute, chronic, neuropathic, and nociceptive pain. It describes the WHO analgesic ladder for treating cancer pain with non-opioids, weak opioids, and strong opioids depending on pain severity. It discusses the pharmacology and use of various analgesics like paracetamol, NSAIDs, opioids, corticosteroids, antidepressants, anticonvulsants, and others to treat different pain types and as adjuvants. It addresses myths and concerns around opioid use and emphasizes the importance of individualized treatment.
This document discusses physiology and pharmacology of pain. It defines pain and describes nociceptors, types of pain pathways, and opioid analgesics. It focuses on the mechanism of action, efficacy, and adverse effects of morphine, the prototypical opioid analgesic. It summarizes morphine's pharmacological actions including analgesia, tolerance, dependence, and interactions with other drugs.
This document provides an overview of pain and pain pathways. It defines pain, discusses the history of pain theories, and describes the different types of pain receptors and neural pathways involved in pain perception and modulation. Specifically, it outlines fast and slow pain pathways conducted by myelinated and unmyelinated fibers, discusses peripheral and central mechanisms of injury-induced pain, and classification of pain including somatic and visceral pain.
This document provides a brief overview of the history of pain medicine and how views of pain have evolved over time. It discusses how early Christian beliefs viewed pain as a punishment from God. It then outlines how ancient cultures viewed pain as caused by evil spirits. The document traces important developments like the acceptance of anesthesia during childbirth and approvals for its use in surgery. Overall, it establishes the long history of conceptualizing and treating pain.
This document discusses pain management at a San Diego service area. It notes that pain is the most common reason for medical appointments in the US, affecting 50 million people annually and costing $120 billion per year. Patient rights related to pain management are outlined. At-risk populations for under treatment of pain include those with addiction histories, the nonverbal, elderly, infants/children, and ethnic/racial minorities. Several pain scales are presented, including numeric, FACES, FLACC, and N-PASS scales. Pharmacological and non-pharmacological pain treatment options are mentioned.
This document provides an overview of acute pain management in children. It discusses the difficulties in assessing and treating pain in children, as well as the physiological and behavioral effects of acute pain. General principles for managing acute pain in children include anticipating and preventing pain, adequately assessing pain using age-appropriate tools, using a multi-modal approach including pharmacological and non-pharmacological therapies, involving parents, and using non-noxious routes of medication administration when possible. Specific pharmacological therapies for acute pain in children such as acetaminophen, NSAIDs, opioids, and local anesthetics are also reviewed.
Pain Management (General concepts and primary discussions)Saeid Safari
This document provides an overview of pain medicine. It defines pain and discusses its epidemiology, economics, and physiological effects. It describes acute and chronic pain, including their presentations and pathophysiology. Neuropathic and nociceptive pain are major categories discussed. Pain pathways and the gate control theory of pain are also summarized. Psychiatric comorbidities with chronic pain are noted.
Management of acute postoperative pain rcacareyesmd
The document discusses pain assessment and management. It defines pain and describes different types of acute pain. Pain is the fifth vital sign and should be properly assessed. Several self-report scales are presented to assess pain intensity. Preemptive analgesia aims to prevent pain sensitization by providing analgesia before a painful stimulus occurs. Multimodal analgesia using opioids, NSAIDs, and acetaminophen can provide effective pain relief while reducing opioid requirements and side effects. Patient-controlled analgesia safely allows patients to self-administer opioids. Special populations like neonates and the elderly require modified dosing approaches.
postoperative pain assessment and managementpropofol2012
This document provides an overview of acute postoperative pain assessment and management. It defines pain and discusses pain assessment tools and the pathophysiology of pain. It outlines the objectives of treating pain, barriers to effective pain management, and complications of unrelieved pain. Different analgesic drugs are described including opioids, paracetamol, NSAIDs, and NMDA receptor antagonists. Methods of drug administration and non-pharmacological pain management methods are also summarized. Assessment of pain in critical care settings is discussed.
Kurt Lewin originally developed the concept of gatekeeping theory to describe how information is filtered for dissemination through various channels of communication. Gatekeeping refers to the process by which individuals or organizations make decisions about allowing or blocking information to pass through different gates. At each gate, a gatekeeper determines what information is appropriate or inappropriate to pass through based on various influences like social norms, ethics, and policies. Gatekeeping theory is now widely used in fields like journalism and mass media to understand how and why certain information gets selected for publication or broadcasting while other information gets rejected.
The document discusses several theories of pain including:
1) Specificity theory which proposed specialized pain receptors
2) Gate control theory which proposes that pain is modulated by a "gate" in the spinal cord that can be opened or closed by non-painful stimuli
3) Neuromatrix theory which suggests that a person's unique matrix of neurons is shaped by their physical, psychological, and cognitive traits and experiences.
It also discusses pain control mechanisms like endogenous opiates and placebos, and provides examples of how integrating pain theories can guide multimodal pain management strategies.
This document provides information on pain management for internal medicine housestaff. It begins with definitions of pain from the International Association for the Study of Pain. It then covers the basic approach to pain management, including assessing the etiology, classifying pain types, clinically assessing pain, and treating pain. It discusses treating cancer pain specifically and provides guidelines on the WHO analgesic ladder for treating mild, moderate, and severe pain. It also covers adjuvant analgesics, opioid selection, routes of administration, and equianalgesic dosing of common opioids like morphine, oxycodone, fentanyl, hydromorphone, and methadone.
The gate control theory of pain proposes that a "gate" in the spinal cord can open and close to modulate pain perception. It suggests that non-painful stimuli can close the gate and inhibit pain transmission, while painful stimuli open the gate and facilitate pain transmission. Psychological factors are also thought to influence the gating mechanism by modulating the balance of activity between small and large diameter nerve fibers.
The document discusses pain and the nervous system's response to harmful stimuli. It describes two waves of pain - the initial sharp pain from A-delta fibers and the longer-lasting dull pain from C-nerve fibers. It outlines the ascending pathway where pain signals travel from nociceptors to the dorsal horn and then to the brain. Chronic pain can persist after injury healing or for unknown reasons, and can be caused by various physical and neurological conditions.
This document discusses pain and its treatment. It begins by defining pain and classifying common types of pain conditions. It then discusses the body's reflex responses to pain and the endorphin system that modulates pain. It describes the differences between acute and chronic pain and methods of pain measurement. Various treatment options are provided for different types of pain, including NSAIDs, opioids, tramadol, tapentadol, muscle relaxants, and sodium channel blockers. Newer treatments discussed include epirisone and the comparative properties of different NSAIDs, muscle relaxants, tramadol, and tapentadol. Key questions are also provided about comparing treatment effectiveness and safety across patient subgroups.
Pain and Modern Medicine, Stephanie Davies, Head of Service, Pain Medicine Un...ArthritisNT
The document discusses pain and modern medicine. It defines pain and chronic pain. It notes that chronic pain is common, affecting 20% of Australians and costing $34 billion per year. While scans cannot detect pain, medications only help reduce pain in 30-40% of cases. The document discusses how views of pain have changed from being tissue-based to involving brain and spinal cord patterns. It advocates addressing all pain inputs using a biopsychosocial approach.
Response To Pain, Carl Graham, Clinical Psychologist, Pain Medicine Unit, Fre...ArthritisNT
This document discusses various concepts related to chronic pain management including stress response, escape behaviors, central sensitization, attention, mood, inflammation, controllability, expectancy, relaxation, and behavioral neuromodulation. The key goals are pacing oneself, managing distress, learning not to avoid activities due to fear of pain, and incorporating rest while gradually increasing engagement in meaningful and pleasurable activities.
This document provides an overview of pain, including definitions, classifications, physiology, assessment, and management. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is classified based on location, duration (acute vs chronic), and intensity (mild, moderate, severe). The physiology of pain involves transduction, transmission, modulation, and perception of pain signals in the nervous system. Nurses assess pain using scales and treat it using pharmacological and non-pharmacological methods based on the type and severity of the pain.
The document discusses pain, including defining pain, explaining the physiology of pain, types of pain, and managing pain. It defines pain as an unpleasant sensation caused by tissue damage. The physiology of pain involves nociceptors detecting damage and transmitting signals to the spinal cord and brain. Pain types include acute, chronic, and neuropathic. Managing pain requires thorough assessment and treatments like analgesics, relaxation, and diversional therapy.
This document discusses pain and pain management. It begins with definitions of pain from organizations like the IASP and discusses how pain is subjective. It then covers types of pain like acute, chronic, and cancer pain. The document also discusses pain assessment, theories of pain transmission like the gate control theory, and advantages of conscious sedation for procedures. In summary, it provides an overview of perspectives on pain, classifications of pain, assessing pain, and uses of conscious sedation.
Pain as the 5 th vital sign guidelines for doctorsterezacl
This document provides guidelines for doctors on managing adult patients' pain. It includes 5 guidelines and 2 appendices. Guideline 1 discusses pain assessment. Guideline 2 differentiates between acute and chronic pain. Guideline 3 provides a general guide for diagnosing and managing chronic non-cancer pain, including referring patients to a pain clinic. Guideline 4 presents an analgesic ladder for acute pain management using medications from weak to strong opioids. Guideline 5 discusses titrating opioids like morphine for rapid pain relief. The appendices provide notes on analgesic medications and managing side effects.
Pain as the 5 th vital sign guidelines for doctorsterezacl
This document provides guidelines for doctors on the management of adult patients' pain. It includes 5 guidelines and 2 appendices. Guideline 1 discusses pain assessment. Guideline 2 differentiates between acute and chronic pain. Guideline 3 provides a general guide for managing chronic non-cancer pain. Guideline 4 presents an analgesic ladder for acute pain management. Guideline 5 describes a morphine pain protocol for rapid pain relief through opioid titration. The appendices provide notes on analgesic medications and management of side effects. The guidelines aim to help doctors properly assess, diagnose, and treat patients' acute and chronic pain.
11-ADVANCE NURSING MANAGEMENT OF ONCOLOGY.pptShahnazalman
This document discusses the objectives and content of a unit on the nursing management of oncology patients. It aims to teach students how to assess cancer patients' pain using functional health patterns, integrate pathophysiology and pharmacology concepts, and develop teaching plans using evidence-based nursing practices. Specific topics covered include the definition and types of pain, pain assessment tools, nursing diagnoses for acute and chronic pain, and nonpharmacological and pharmacological pain management strategies.
Pain is a complex experience involving biological, psychological, and social factors. It is categorized by duration, location, and cause. Acute pain results from injury and lasts less than 6 months, while chronic pain lasts 6 months or longer and is influenced by emotions. Pain is also classified by location and cause to aid treatment. Nurses play an important role in pain assessment and management, which is a vital sign. They use scales to measure intensity and observe nonverbal cues. Treatment includes pharmacological interventions like opioids, NSAIDs, and antidepressants, as well as nonpharmacological comfort measures and education. The goal is pain relief through comprehensive nursing care.
The document discusses theories of pain from both biological and psychological perspectives. It describes pain as serving an evolutionary purpose of generating behavior change through avoidance or help-seeking. While acute pain has a clear cause and is treated medically, chronic pain has strong psychological components. The Gate Control Theory introduced psychology into pain models, showing pain perception is mediated by interacting physiological and psychological processes. Later sections discuss psychological factors like anxiety, cognition, and behavior that influence pain experience and the role of multidisciplinary treatment including psychotherapy for chronic pain.
Comprehensive description of pain pathways which covers related definitions, benefits, theories, classification and mechanism of pain with factors that affect pain and diagnosis of pain. Also covers assessment and management of pain along with brief description of ascending and descending pain pathways.
This document defines pain and discusses its assessment and management. It defines pain as an unpleasant sensory experience associated with tissue damage. Pain is subjective and multidimensional, consisting of sensory, cognitive, and emotional dimensions. Several pain scales are described for assessing pain intensity, including verbal numeric and visual analog scales. Management of pain involves treating its underlying cause, pharmacological approaches matched to pain severity, and other options like nerve blocks or neuroaugmentation.
assessment and physiotherapy management of pain in elderly sunil JMI
1. Pain assessment in elderly patients requires a comprehensive evaluation of sensory, emotional, functional, and social impacts of pain. It also requires consideration of age-related changes and beliefs about pain.
2. A thorough history and physical exam are needed to identify potential causes of pain and evaluate for comorbidities. The history should address location, intensity, descriptors, relieving/aggravating factors, and impact on sleep, function, mood and quality of life.
3. Physical exam includes general exam, specific pain evaluation, neurological and musculoskeletal exams to identify potential causes and contributing factors. Assessment of psychological and cognitive factors is also important.
This document provides an overview of pain, including its definition, classification, transmission pathways, and management. It begins with defining pain and discussing its incidence and epidemiology. Pain is then classified based on its source, duration, and transmission. The pathways of pain transmission from nociceptors to the central nervous system are explained. Finally, the document discusses pain assessment, management guidelines, and concludes with references.
This document discusses pain management. It defines different types of pain and outlines objectives for learners to understand pain pathophysiology, assessment, and treatment methods. Pain is categorized as acute, chronic, or cancer-related. Factors influencing pain responses are described. Pharmacological interventions like opioids and NSAIDs are compared with non-pharmacological options. The nursing role in a pain management plan utilizing the nursing process is also summarized.
This document discusses assessment and management of pain in the elderly. It defines pain and describes the physiology of pain transmission through nociceptors and nerve fibers. Pain can be acute, chronic, nociceptive, or neuropathic. Chronic pain is common in older adults and has many negative impacts. A comprehensive geriatric pain assessment evaluates multiple factors, including sensory experience, emotional impact, functional status, sleep, attitudes, coping, and goals of treatment. Proper assessment requires a thorough history, physical exam, and diagnostic tests.
Unit no.:3
Unit Name: Nursing care of patients with common sign and symptoms and management
Subject: Adult Health Nursing -I
Topic: PAIN
Prepared by: Misfa Khatun, Nursing Tutor
This document discusses pain and its management. It defines pain and categorizes it based on origin, onset, severity and cause. It describes acute and chronic pain and discusses gate control theory of pain transmission. It outlines non-pharmacologic, pharmacologic and surgical approaches to pain management including electrical stimulation, nerve blocks, acupuncture, behavior modification and hypnosis.
This document discusses pain and its management from a nursing perspective. It defines pain, describes different types of pain, and discusses pain pathways and theories like the gate control theory. It also outlines nursing assessments of patients in pain and pharmacological and non-pharmacological pain management strategies including relaxation techniques, hot/cold therapy, positioning, and medication administration. The nursing process is applied to pain management, including assessment, diagnosis, planning, implementation, and evaluation of pain interventions.
1) Pain is a complex sensory and emotional experience that involves biological, psychological, and social factors. It serves an adaptive purpose but can become chronic and debilitating.
2) Chronic pain is pain that persists beyond normal healing time, often for months or years. It can be recurrent, constant, or progressive depending on its underlying cause. Chronic pain significantly impacts quality of life.
3) Self-report measures are a primary way to assess pain, including structured interviews, rating scales, and pain inventories that evaluate sensory, affective, and evaluative dimensions of the experience.
This document discusses pain management and theories of pain. It defines pain and describes different types such as acute and chronic pain. It discusses various pain assessment methods and management approaches for nociceptive and neuropathic pain. Theories of pain are also summarized, including specificity theory, pattern theory, gate control theory, neuromatrix theory, and endogenous opiates theory. Assessment involves understanding the patient experience, while management prioritizes complete relief through a stepped approach using medications like opioids and adjuvants.
Nursing has evolved from women providing basic care and comfort for the ill and injured to a major healthcare profession. Modern nursing focuses on patient autonomy, doing good for patients, avoiding harm, keeping patient information private, providing care that has both beneficial and harmful effects, loyalty to patients, fairness, avoiding unnecessary paternalism, respecting patients, preserving life, and honesty.
Medical-surgical nursing is concerned with caring for adult patients in various healthcare settings. It is the largest nursing specialty and has evolved into its own area due to advances in medicine and nursing. Medical-surgical nurses now work in many different positions and settings beyond just hospital wards, including clinics, emergency departments, administration, outpatient surgical centers, home health care, and skilled nursing facilities, with some also serving in military medical roles on battlefields.
The document discusses the expanded and extended roles of nurses beyond traditional hospital settings. It outlines several non-traditional nursing roles including school nurse, occupational health nurse, home care nurse, hospice nurse, rehabilitation nurse, nurse epidemiologist, military nurse, aerospace nurse, tele nurse, disaster nurse, and forensic nurse. These roles allow nurses to provide care in schools, workplaces, private homes, hospice facilities, during disasters, and in other environments outside of hospitals. The expanded roles represent an enlargement of nursing practice and responsibilities.
Cardiomyopathy is a disease of the heart muscle where the heart loses its ability to pump blood effectively. There are three main types: dilated cardiomyopathy where the heart chambers enlarge over time and the heart weakens; hypertrophic cardiomyopathy where the heart muscle thickens abnormally; and restrictive cardiomyopathy where the ventricles become stiff. Symptoms include fatigue, edema, arrhythmias, and heart failure. Diagnosis involves tests like echocardiograms, EKGs and cardiac catheterization. Treatments focus on managing symptoms, slowing disease progression, and reducing complications through medications, lifestyle changes, surgery like septal myectomy, or heart transplant in severe cases.
This document discusses different types of valvular heart disease. It begins by explaining that valvular heart disease is characterized by damage or defects to the heart's valves, which normally ensure proper blood flow. Stenotic valves become narrowed and prevent full opening, while incompetent valves do not close completely and allow blood to leak back. Over time, the heart compensates by enlarging and thickening, losing efficiency.
The document then examines specific valve diseases in more detail, outlining their causes, effects on heart function, symptoms, diagnostic tests, and treatment options. Diseases covered include mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation, tricuspid regurgitation
The document discusses the history and development of the electrocardiogram (EKG) from 1842 to present day. It defines an EKG as a representation of the electrical events of the cardiac cycle through distinctive waveforms. The document outlines how electrical impulses in the heart are transmitted to the body surface where electrodes detect them and the electrocardiograph measures them, producing a permanent recording. It provides details on correctly conducting an EKG and interpreting various waves and intervals.
The cardiovascular system consists of the heart, blood vessels, and blood, and its main function is to supply oxygen and nutrients to tissues and remove waste. Coronary artery disease, the most common type of heart disease, is caused by plaque buildup in the coronary arteries which reduces blood flow to the heart. Risk factors include conditions like high cholesterol, hypertension, smoking, diabetes, and lack of exercise. Symptoms of coronary artery disease include chest pain called angina, which occurs when demand for oxygen exceeds supply. Angina is usually relieved by rest. Myocardial infarction occurs when a coronary artery is severely blocked, causing death of heart muscle tissue due to lack of oxygen.
Rheumatic heart disease is a chronic condition that results from damage to the heart valves caused by rheumatic fever. Rheumatic fever is an inflammatory reaction that typically affects the heart, joints, brain and skin and is triggered by a prior streptococcal throat infection. It can cause scarring and deformity of the heart valves over time due to recurrent attacks. Treatment involves controlling streptococcal infections with antibiotics like penicillin to prevent recurrence of rheumatic fever and further heart damage. Patients are also at risk for developing valvular heart disease long-term.
2. • Definition
Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage (Merskey &
Bogduk, 1994)
It is the most common reason for seeking health care. It occurs
with many disorders, diagnostic tests, and treatments
• Nurses encounter patients in pain in a variety of settings, including acute
care, outpatient, and long-term care settings, as well as in the home. Thus,
they must have the knowledge and skills to assess pain, to implement pain
relief strategies, and to evaluate the effectiveness of these strategies,
regardless of setting.
3. • Pain management is considered such an important part of
care that the American Pain Society coined the phrase “Pain:
The 5th Vital Sign” (Campbell, 1995) to emphasize its
significance and to increase the awareness among health care
professionals of the importance of effective pain
management.
• Documentation of pain assessment is now as prominent as
the documentation of the “traditional” vital signs. Pain
assessment and management are also mandated by the Joint
Commission on the Accreditation of Healthcare Organizations
(JCAHO) (2003).
4. • Calling pain the fifth vital sign suggests that the assessment of
pain should be as automatic as taking a patient’s blood
pressure and pulse.
• The JCAHO (2003) has incorporated pain and pain
management into its standards. JCAHO’s standards state that
“pain is assessed in all patients” and that “patients have the
right to appropriate assessment and management of pain.”
These standards reflect the importance of pain management.
5. • In health care, the primary care provider’s role is to assess and manage pain by
administering medications and other treatments.
• In addition, the nurse serves as an educator to the patient and family, teaching
them to manage the pain relief regimen themselves when appropriate
• Although it is important to believe the patient who reports pain, it is equally
important to be alert to patients who deny pain in situations where pain would
be expected.
• A nurse who suspects pain in a patient who denies it should explore with the
patient the reason for suspecting pain, such as the fact that the disorder or
procedure is usually painful or that the patient grimaces when moving or
avoids movement.
• Exploring why the patient may be denying pain is also helpful. Some people
deny pain because they fear the treatment that may result if they report or
admit pain. Others deny pain for fear of becoming addicted to opioids
(previously referred to as narcotics) if these medications are prescribed.
6. Types of Pain
• Pain is categorized according to its duration,
location, severity, nature and etiology.
• Three basic categories of pain are generally
recognized: acute pain, chronic
(nonmalignant) pain, and cancer-related pain.
7. • ACUTE PAIN
• Usually of recent onset and commonly associated with a specific
injury, acute pain indicates that damage or injury has occurred.
• Pain is significant in that it draws attention to its existence and
teaches the person to avoid similar potentially painful situations. If
no lasting damage occurs and no systemic disease exists, acute pain
usually decreases along with healing.
• For purposes of definition, acute pain can be described as lasting
from seconds to 6 months. However, the 6-month time frame has
been criticized (Brookoff, 2000) as inaccurate since many acute
injuries heal within a few weeks and most heal by 6 weeks.
• In a situation where healing is expected in 3 weeks and the patient
continues to suffer pain, it should be considered chronic and
treated with interventions used for chronic pain. Waiting for the full
6-month time frame in this example could cause needless suffering.
8. 2. CHRONIC (NONMALIGNANT) PAIN
• Chronic pain is constant or intermittent pain that persists beyond the expected
healing time and that can seldom (some time) be attributed to a specific cause
or injury.
• It may have a poorly defined onset, and it is often difficult to treat because the
cause or origin may be unclear.
• Although acute pain may be a useful signal that something is wrong, chronic pain
usually becomes a problem in its own right.
• Chronic pain may be defined as pain that lasts for 6 months or longer, although 6
months is an arbitrary period for differentiating between acute and chronic pain.
• An episode of pain may assume the characteristics of chronic pain before 6
months have elapsed (past), or some types of pain may remain primarily acute in
nature for longer than 6 months. Nevertheless, after 6 months, most pain
experiences are accompanied by problems related to the pain itself. Chronic pain
serves no useful purpose. If it persists, it may become the patient’s primary
disorder.
• The nurse may come in contact with patients with chronic pain when they are
admitted to the hospital for treatment or when they are seen out of the hospital
for home care. Frequently the nurse is called on in community-based settings to
assist patients in managing pain.
9. CANCER-RELATED PAIN
Pain associated with cancer may be acute or chronic. Pain in the patient suffering from
cancer can be directly associated with the cancer (eg, bony infiltration with tumor cells
or nerve compression), a result of cancer treatment (eg, surgery or radiation), or not
associated with the cancer (eg, trauma). Most pain associated with cancer, however, is
a direct result of tumor involvement.
PAIN CLASSIFIED BY LOCATION
Pain is sometimes categorized according to location, such as pelvic pain, headache,
and chest pain. This type of categorization is helpful in communicating and treating
pain. For example, chest pain suggests angina or a myocardial infarction and indicates
the need for treatment according to cardiac care standards.
PAIN CLASSIFIED BY ETIOLOGY
Categorizing pain according to etiology is another way to think about pain and its
management. Burn pain and postherpetic neuralgia are examples of pain described by
their etiology.
PAIN CLASSIFIED BY SEVERITY
Mild, Moderate and Sever
10. PATHOPHYSIOLOGY OF PAIN
The sensory experience of pain depends on the interaction between the
nervous system and the environment. The processing of noxious stimuli
and the resulting perception of pain involve the peripheral and central
nervous systems.
PAIN TRANSMISSION
Among the nerve mechanisms and structures involved in the transmission
of pain perceptions to and from the area of the brain that interprets pain
are nociceptors, or pain receptors, and chemical mediators. Nociceptors
are receptors that are preferentially sensitive to a noxious stimulus.
Nociceptors are also called pain receptors.
11. Nociceptors
• Nociceptors are free nerve endings in the skin that respond only to
intense, potentially damaging stimuli. Such stimuli may be mechanical,
thermal, or chemical in nature.
• The joints, skeletal muscle, fascia, tendons, and cornea also have
nociceptors that have the potential to transmit stimuli that produce pain.
• However, the large internal organs (viscera) do not contain nerve endings
that respond only to painful stimuli. Pain originating in these organs
results from intense stimulation of receptors that have other purposes.
For example, inflammation, stretching, ischemia, dilation, and spasm of
the internal organs all cause an intense response in these multipurpose
fibers and can cause severe pain.
12. Peripheral Nervous System
A number of algogenic (pain-causing) substances that affect the
sensitivity of nociceptors are released into the extracellular tissue as a
result of tissue damage.
Histamine, bradykinin, acetylcholine, serotonin, and substance P are
chemicals that increase the transmission of pain. The transmission of
pain is also referred to as nociception. Prostaglandins are chemical
substances thought to increase the sensitivity of pain receptors by
enhancing the pain provoking effect of bradykinin. These chemical
mediators also cause vasodilation and increased vascular permeability,
resulting in redness, warmth, and swelling of the injured area.
Once nociception is initiated, the nociceptive action potentials are
transmitted by the peripheral nervous system (Porth, 2002). The first-
order neurons travel from the periphery (skin, cornea, visceral organs)
to the spinal cord via the dorsal horn.
13. There are two main types of fibers involved in the transmission of
nociception. Smaller, myelinated Aδ (A delta) fibers transmit nociception
rapidly, which produces the initial “fast pain.”
Type C fibers are larger, unmyelinated fibers that transmit what is called
second pain. This type of pain has dull, aching, or burning qualities that last
longer than the initial fast pain. The type and concentration of nerve fibers
to transmit pain vary by tissue type.
If there is repeated C fiber input, a greater response is noted in dorsal horn
neurons, causing the person to perceive more pain. In other words, the same
noxious stimulus produces hyperalgesia, and the person reports greater pain
than was felt at the first stimulus. For this reason, it is important to treat
patients with analgesic agents when they first feel the pain. Patients require
less medication and experience more effective pain relief if analgesia is
administered before the patient becomes sensitized to the pain.
14. Chemicals that reduce or inhibit the transmission or
perception of pain include endorphins and enkephalins.
These morphine like neurotransmitters are endogenous
(produced by the body). They are examples of substances
that reduce nociceptive transmission when applied to certain
nerve fibers. The term “endorphin” is a combination of two
words: endogenous and morphine.
Endorphins and enkephalins are found in heavy
concentrations in the central nervous system, particularly
the spinal and medullary dorsal horn, the periaqueductal
gray matter (gray matter around brain) , hypothalamus, and
amygdala. Morphine and other opioid medications act at
receptor sites to suppress the excitation initiated by noxious
stimuli.
15. Central Nervous System
After tissue injury occurs, nociception (the neurologic transmission of pain impulses)
to the spinal cord via the Aδ and C fibers continues. The fibers enter the dorsal horn.
In the substantia gelatinosa are projections that relay nociception to other parts of the
spinal cord
Nociception continues from the spinal cord to the reticular formation, thalamus,
limbic system, and cerebral cortex.
The involvement of the reticular formation, limbic, and reticular activating systems is
responsible for the individual variations in the perception of noxious stimuli.
Individuals may report the same stimulus differently based on their anxiety, past
experiences, and expectations. This is a result of the conscious perception of pain.
For pain to be consciously perceived, neurons in the ascending system must be
activated. Activation occurs as a result of input from the nociceptors located in the
skin and internal organs. Once activated, the inhibitory interneuronal fibers in the
dorsal horn inhibit or turn off the transmission of noxious stimulating information in
the ascending pathway.
16. Descending Control System
The descending control system is a system of fibers that originate in the
lower and midportion of the brain (specifically the periaqueductal gray
matter) and terminate on the inhibitory interneuronal fibers in the dorsal
horn of the spinal cord.
This system is probably always somewhat active; it prevents continuous
transmission of stimuli as painful, partly through the action of the
endorphins. As nociception occurs, the descending control system is
activated to inhibit pain.
Cognitive processes may stimulate endorphin production in the descending
control system. The effectiveness of this system is illustrated by the effects of
distraction. The distractions of visitors or a favorite TV show may increase
activity in the descending control system. Therefore, the person who has
visitors may not report pain because activation of the descending control
system results in less noxious or painful information being transmitted to
consciousness. Once the distraction by the visitors ends, activity in the
descending control system decreases, resulting in increased transmission of
painful stimuli.
17. The interconnections between the descending neuronal system
and the ascending sensory tract are called inhibitory interneuronal
fibers. These fibers contain enkephalin and are primarily activated
through the activity of non-nociceptor peripheral fibers (fibers
that normally do not transmit painful or noxious stimuli) in the
same receptor field as the pain receptor, and descending fibers,
grouped together in a system called descending control.
18. • First proposed in 1965 by Ronald Melzack and Patrick Wall, The
gate control theory of pain asserts that non-painful input closes
the "gates" to painful input, which prevents pain sensation
from traveling to the central nervous system. Therefore,
stimulation by non-noxious input is able to suppress pain.
• According to the gate control theory, pain signals are not free to
reach the brain as soon as they are generated at the injured
tissues or sites. They need to encounter certain ‘neurological
gates’ at the spinal cord level and these gates determine
whether the pain signals should reach the brain or not.
• In other words, pain is perceived when the gate gives way to
the pain signals and it is less intense or not at all perceived
when the gate closes for the signals to pass through. This
theory gives the explanation for why someone finds relief by
rubbing or massaging an injured or a painful area
GATE CONTROL THEORY
19. Every organ or part of the human body has its own nerve
supply and the nerves carry the electrical impulses
generated in response to various sensations like touch,
temperature, pressure and pain.
These nerves – that constitute the peripheral nervous
system – transmit these impulses to the central nervous
system (the brain and spinal cord) so that these impulses are
interpreted and perceived as sensations.
The peripheral nerves send signals to the dorsal horn of the
spinal cord and from there the sensory signals are
transmitted to the brain through the spinothalamic tract.
Pain is a sensation that alerts a person that a tissue or a
particular part of the human body has been injured or
damaged.
20.
21. According to the axonal diameter and the conduction velocity, nerve
fibers can be classified into three types – A, B and C. The C fibers are the
smallest among all the three types. Among the ‘A’ fibers are four
subtypes: A-alpha, A-beta, A-gamma and A-delta. Among the A subtypes,
the A-alpha fibers are the largest and the A-delta fibers are the smallest.
The A fibers that are larger than the A-delta fibers, carry sensations like
touch, pressure, etc. to the spinal cord. The A-delta fibers and the C
fibers carry pain signals to the spinal cord. A-delta fibers are faster and
carry sharp pain signals while the C fibers are slower and carry diffuse
pain signals.
When considering the conduction velocity, the A-alpha fibers (the large
nerve fibers) have higher conduction velocity when compared to the A-
delta fibers and the C fibers (small nerve fibers). When a tissue is injured,
the A-delta fibers are activated first, followed by the activation of the C
fibers.
22.
23.
24.
25. What does the gate control theory say?
The gate control theory suggests that the signals encounter ‘nerve
gates’ at the level of the spinal cord and they need to get cleared
through these gates to reach the brain. Various factors determine
how the pain signals should be treated at the neurological gates.
They are:
The intensity of the pain signals
The intensity of the other sensory signals (touch, temperature and
pressure), if generated at the site of injury
The message from the brain itself (to send the pain signals or not)
According to the original postulate of Melzack and Wall, the nerve
fibers project to the substantia gelatinosa (SG) of the dorsal horn and
the first central transmission (T) cells of the spinal cord.
The SG consists of inhibitory interneurons that act as the gate and
determine which signals should reach the T cells and then go further
through the spinothalamic tract to reach the brain.
26. When the pain signals carried by the small fibers (A-delta and C
fibers) are less intense compared to the other non-pain sensory
signals like touch, pressure and temperature, the inhibitory
neurons prevent the transmission of the pain signals through the
T cells.
The non-pain signals override the pain signals and thus the pain
is not perceived by the brain. When the pain signals are more
intense compared to the non-pain signals, the inhibitory neurons
are inactivated and the gate is opened.
The T cells transmit the pain signals to the spinothalamic tract
that carries those signals to the brain. As a result, the
neurological gate is influenced by the relative amount of activity
in the large and the small nerve fibers.
27. Emotions and thoughts determine the way how pain is
perceived
• The theory also proposed that the pain signal transmission can
be influenced by emotions and thoughts.
• It is well known that people do not feel a chronic pain or the
pain does not disturb them when they concentrate on other
activities that interest them. Whereas, people who are anxious
or depressed feel intense pain and find it difficult to cope up
with it.
• This is because the brain sends messages through descending
fibers that stop, reduce or amplify the transmission of pain
signals through the gate, depending on the thoughts and
emotions of a person.
28. Gate control theory in pain management
The gate control theory has brought about a drastic revolution in
the field of pain management. The theory suggested that pain
management can be achieved by selectively influencing the larger
nerve fibers that carry non-pain stimuli. The theory has also paved
way for more research on cognitive and behavioral approaches to
achieve pain relief.
One of the tremendous advances in pain management research is
the advent of Transcutaneous Electrical Nerve Stimulation (TENS).
The gate control theory forms the basis of TENS. In this technique,
the selective stimulation of the large diameter nerve fibers carrying
non-pain sensory stimuli from a specific region nullifies or reduces
the effect of pain signals from the region.
29. TENS is a non-invasive and inexpensive pain management approach that
has been widely used for the treatment of chronic and intractable pain
that are otherwise non-responsive to analgesics and surgical
treatments. TENS is highly advantageous over pain medications in the
aspect that it does not have the problem of drug interactions and
toxicity.
Many other invasive and non-invasive electrical stimulation techniques
have been found to be useful in various chronic pain conditions like
arthritic pain, diabetic neuropathy, etc.
The theory has also been extensively studied in the treatment of chronic
back pain and cancer pain. However, favorable results are not attained
in some conditions and the long term efficacy of the techniques based
on the theory is under question.
Nevertheless, the gate control theory has dramatically revolutionized
the field of pain research and it has sown seeds for numerous studies
that aim at presenting a pain-free lifestyle to the patients who suffer
from chronic pain.
30.
31. Harmful Effects of Pain
Regardless of its nature, pattern, or cause, pain that is inadequately treated
has harmful effects beyond the suffering it causes.
EFFECTS OF ACUTE PAIN
Unrelieved acute pain can affect the pulmonary, cardiovascular,
gastrointestinal, endocrine, and immune systems. The stress response
(“neuroendocrine response to stress”) that occurs with trauma also
occurs with other causes of severe pain.
This is particularly harmful in patients compromised by age, illness, or
injury.
The stress response generally consists of increased metabolic rate and
cardiac output, impaired insulin response, increased production of
cortisol, and increased retention of fluids
32. • Increased heart rate and blood Pressure to Better perfusion of vital
organs by Increasing cardiac output due to increased myocardial
contractility
• Increased blood glucose level to increase available energy by increase in
liver and muscle glycogen breakdown and increased breakdown of
adipose tissue triglycerides
• Increase Mental acuity to increase Alert state by Increase in amount of
blood shunted to the brain from the abdominal viscera and skin
• Dilated pupils to Increased awareness by Contraction of radial muscle
of iris
• Increased ventilation (may be rapid and shallow) to Provision of oxygen
for energy by Stimulation of respiratory center in medulla;
bronchodilation
• Increased coagulability of Blood to Prevention of hemorrhage in event
of trauma
33. EFFECTS OF CHRONIC PAIN
Like acute pain, chronic pain also has adverse effects. Suppression of
the immune function associated with chronic pain may promote
tumor growth. Also, chronic pain often results in depression and
disability.
Although health care providers express concern about the large
quantities of opioid medications required to relieve chronic pain in
some patients, it is safe to use large doses of these medications to
control progressive chronic pain. In fact, failure to administer
adequate pain relief may be unsafe because of the consequences of
unrelieved pain (McCracken & Iverson, 2001).
34. Regardless of how the patient copes with chronic pain, pain for an
extended period can result in disability. Patients with a number of
chronic pain syndromes report depression, anger, and fatigue (Meuser,
Pietruck, Radruch et al., 2001; Raymond et al., 2001).
The patient may be unable to continue the activities and interpersonal
relationships he or she engaged in before the pain began. Disabilities
may range from curtailing participation in physical activities to being
unable to take care of personal needs, such as dressing or eating.
The nurse needs to understand the effects of chronic pain on the
patient and family and needs to be knowledgeable about pain relief
strategies and appropriate resources to assist effectively with pain
management.
35. FACTORS INFLUENCING THE PAIN RESPONSE
• Past experiences with pain
• Anxiety
• Culture
• Age
• Gender,
• Expectations about pain relief.
36. Placebo Effect
A placebo effect occurs when a person responds to the
medication or other treatment because of an expectation that the
treatment will work rather than because it actually does so.
Simply receiving a medication or treatment may produce positive
effects.
The placebo effect results from the natural (endogenous)
production of endorphins in the descending control system.
37. A patient’s positive expectations about treatment
may increase the effectiveness of a medication or
other intervention.
A person who is informed that a medication is
expected to relieve pain is more likely to
experience pain relief than one who is told that a
medication is unlikely to have any effect.
38. Nursing Assessment of Pain
The pain assessment begins by observing the patient carefully,
noting the patient’s overall posture and presence or absence of
overt pain behaviors and asking the person to describe, in his or
her own words, the specifics of the pain.
The words used to describe the pain may point toward the
etiology. For example, the classic description of chest pain that
results from a myocardial infarction includes pressure or
squeezing on the chest. A detailed history should follow the
initial description of pain.
39. CHARACTERISTICS OF PAIN
The factors to consider in a complete pain assessment are the:-
1. Intensity (pain tolerance)
2. Timing (the nurse inquires about the onset, duration,
relationship between time and intensity, and whether there
are changes in rhythmic patterns. The patient is asked if the
pain began suddenly or increased gradually
3. Location
4. Quality (burning, aching can be offered )
5. Personal meaning
6. Aggravating and alleviating factors, and
7. Pain behaviors
41. Visual Analogue Scales
Visual analogue scales are useful in assessing the intensity of
pain. One version of the scale includes a horizontal 10-cm line,
with anchors (ends) indicating the extremes of pain. The person
is asked to place a mark indicating where the current pain lies
on the line. The left anchor usually represents “none” or “no
pain,” whereas the right anchor usually represents “severe” or
“worst possible pain.” To score the results, a ruler is placed
along the line and the distance the person marked from the left
or low end is measured and reported in millimeters or
centimeters.
Some patients (eg, children, elderly patients, and visually or
cognitively impaired patients) may find it difficult to use an
unmarked VAS. In those circumstances, ordinal scales (simple
descriptive pain intensity scale, or 0 to 10 numeric pain
intensity scale) may be used.
42.
43.
44. Common Concerns and Misconceptions About Pain and Analgesia
• Complaining about pain will distract my doctor from his primary
responsibility—curing my illness.
• Pain is a natural part of aging.
• I don’t want to bother the nurse—he/she is busy with other patients.
• Pain medicine can’t really control pain.
• People get addicted to pain medicine easily.
• It is easier to put up with pain than with the side effects that come from
pain medicine.
• Good patients avoid talking about pain.
• Pain builds character. It’s good for you.
• Patients should expect to have pain; it’s part of almost every
hospitalization.