Definition of pain, classification of pain based on duration, based on location, based on intensity, classification based on etiology, factor influencing pain, signs and symptoms of pain, impact of pain on patient daily life, medical management, surgical management, non-pharmacological management, complementary and alternative therapies, nursing management.
2. PAIN:
DEFINITION:
“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or
described in terms of such damage”
Pain is a complex and subjective sensory experience that is typically associated with tissue damage or injury. It
can manifest as physical discomfort, distress, or suffering, and it serves as a crucial warning signal to the body,
alerting it to potential harm or danger.
Pain can vary widely in intensity, duration, and quality, and it can be influenced by various factors including
psychological state, cultural background, and individual tolerance levels.
5. BASED ON DURATION:
ACUTE PAIN:
Comes on quickly and can be severe but lasts a relatively short time (i.e. minutes to a few months) such as
related to fractures, surgery, labor and childbirth, or cuts.
Treatment involved NSAIDs, acetaminophen, opioids, physical therapy, exercise.
CHRONIC PAIN:
Refers to pain or recurs for more than three months duration, such as low back pain, fibromyalgia or arthritis.
Patient is characterized by dull, aching, generalized, patient will have a normal vital signs.
Treatment involve non opioid, analgesics, opioids, physical therapy, exercise, rehabilitation.
Chronic pain may be:
• Chronic non cancer pain
• Chronic cancer pain
• Chronic episodic pain – last for hours, days or weeks.( e.g. Migraine headaches)
6. BASED ON LOCATION:
This is based on the site at which the pain is located. Eg:
§ Headache.
§ Back pain.
§ Joint pain
§ Stomach pain
§ Cardiac pain
Pain can be sharp, dull, aching, throbbing, stabbing, burning, and shooting.
7. BASED ON INTENSITY:
Mild pain, Moderate pain, Severe pain;
qMILD PAIN:
Pain scale reading from 1 to 3 is considered as mild pain
qMODERATE PAIN:
Pain scale reading from 4 to 6 is considered as moderate pain
qSEVERE PAIN:
Pain scale reading from 7 to 10 is considered as severe pain
PAIN SCALE
8.
9. CLASSIFICATION BASED ON ETIOLOGY:
NOCICEPTIVE PAIN:
A response to potentially tissue damaging stimuli such as fractures headaches, or arthritis, Nociceptive pain is
either visceral or somatic.
Somatic pain comes from the skin and muscles and is often described as dull and aching.
Visceral pain comes from the internal organs and is often described at generalized aching or squeezing,
cramping, throbbing, pressing.
NEUROPATHIC PAIN:
A lesion or dysfunction in the nervous system such as postherpetic neuralgia or diabetic neuropathy and is
often described as shooting or burning pain.
It is usually chronic.
It tend to be difficult to treat
CENTRAL SENSITIZATION:
Is increased responsiveness and hypersensitivity to stimuli that are not typically painful, which is common in
illness like fibromyalgia, arthritis and spinal pain. Central sensitization is a hallmark of chronic pain
CANCER PAIN:
Can manifest itself in a variety of ways, with distinct underlying processes, and includes nociceptive.
neuropathic and mixed pain.
10. FACTOTRS INFLUENCING PAIN:
FACCTOR
INFLUENCIN
G PAIN
AGE
GENDER
CULTURE
ENVIRON
MENT
PREVIOU
S
EXPERIE
NCE
FAMILY
SUPPORT
OTHERS:
• Psychological factors
• Personality traits
• Health conditions
• Social factor
11. SIGNS AND SYMPTOMS OF PAIN:
§ Physical discomfort.
§ Localized pain
§ Radiating pain
§ Changes in posture or movement
§ Facial expressions - Characterized by grimacing, frowning, or wincing.
§ Changes in behaviour - Restlessness, agitation, irritability, or withdrawal from social activities.
§ Changes in appetite or sleep
§ Changes in vital signs
§ Emotional distress
§ Sensory changes - Numbness, tingling, hypersensitivity, or reduced sensitivity in the affected area.
§ Pallor, diaphoresis
12. IMPACT OF PAIN ON PATIENT DAILY LIFE:
Ø Pain can limit mobility and physical activities, making it difficult to perform routine tasks such as walking,
standing, or lifting objects.
Ø Pain can lead to emotional distress, including feelings of frustration, anger, sadness, anxiety, or depression.
Coping with ongoing pain may also lead to irritability, mood swings, or a sense of hopelessness.
Ø Pain can interfere with sleep quality and duration, leading to insomnia, fragmented sleep, or difficulty
falling and staying asleep.
Ø Pain can disrupt social activities and relationships, as individuals may avoid social gatherings or recreational
activities due to discomfort
Ø Decreased job performance, or limitations in job duties.
Ø Persistent pain can impair cognitive function, including attention, concentration, memory, and decision-
making abilities.
Ø Affecting one's ability to engage in enjoyable activities, pursue personal goals, and maintain independence.
Ø Pain often requires ongoing medical expenses, including doctor visits, medications, therapies, and possibly
surgical interventions. May result in loss of income and financial strain.
Ø Pain can impact self-care activities such as grooming, bathing, dressing, and meal preparation.
Ø The chronic nature of pain can contribute to the development or exacerbation of mental health conditions
such as depression, anxiety disorders, or substance abuse disorders.
13. MEDICAL MANAGEMENT:
qAnalgesics:
Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen, and aspirin, which reduce
inflammation and relieve mild to moderate pain.
Acetaminophen (paracetamol), which is effective for mild to moderate pain and fever
Opioids such as morphine, oxycodone, hydrocodone, and codeine, which are used for moderate to severe pain.
qAdjuvant medications: Particularly neuropathic pain.
Antidepressants (e.g., Amitriptyline, duloxetine) and anticonvulsants (e.g., Gabapentin, pregabalin).
qTopical agents: Creams, gels, patches, or sprays containing analgesic medications such as lidocaine,
capsaicin, or NSAIDS can provide localized pain relief.
qLocal anesthetics or corticosteroids near nerves or nerve clusters to block pain signals.
qEpidural injections: Corticosteroids or local anesthetics into the space around the spinal cord (epidural
space) to reduce inflammation and relieve pain in the back or legs.
qRadiofrequency ablation waves to destroy nerve fibers responsible for transmitting pain signals.
14. SURGICAL MANAGEMENT:
Neurosurgical procedures:Surgery may be recommended to address underlying structural issues contributing to pain,
such as herniated discs, spinal stenosis, or nerve compression.
Implantable devices: Devices such as spinal cord stimulators or intrathecal drug delivery systems may be considered
for patients with chronic, severe pain that is refractory to other treatments.
NON-PHARMACOLOGICAL MANAGEMENT:
Exercise programs, manual techniques, modalities (e.g., heat, cold)
Occupational therapy
Cognitive- behavioural therapy (CBT), relaxation techniques, mindfulness-based stress reduction (MBSR),
biofeedback, and other psychological therapies
15. COMPLEMENTARY AND ALTERNATIVE THERAPIES:
§ Acupuncture:
§ Acupressure
§ Massage therapy
§ Chiropractic care
NURSING MANAGEMENT:
§ Use pain assessment scale to identify intensity of pain
§ Assess and record pain & its characteristics, condition, quality, frequency & duration
§ Administer analgesics as prescribed to promote optimal pain
§ Assess the effectiveness of these interventions.
§ Monitoring for side effects.
§ The nurse should advocate for the patient by clarifying concerns, answering questions, supplying all the
information the patient needs to make decisions about care, and supporting the patient's decisions.
§ Educate patient and family to enable them to manage the prescribed interventions them selves.
§ Document severity of patient pain on chart
