Caring for Clients with Pain

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Caring for Clients with Pain

• Chapter 16

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Pain

• Pain is a privately experienced, unpleasant
  sensation usually associates with disease or
  injury that also has an emotional component
  referred to as suffering.
• Pain is a complex phenomena not yet fully
  understood.

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Specificity Theory

• Specificity theory pain is a separate sensation
  transmitted by specific pain receptors to higher
  centers in the brain. Begins with cellular
  disruption that signals nociceptors, (specialized
  pain receptors)

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Specificity Theory

• Nociceptors transmit pain message to brain via
  spinal cord.
• Pain can be blocked or reduced with naturally
  produced morphine-like substances, endorphins and
  enkephalins

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Specificity Theory

• Endorphins and Enkephalins Produced by CNS
• Natural analgesics
• Act like morphine

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Pattern Theory

• Pain and nonpainful sensations are transmitted
  over common pathway to brain different patterns
  determine whether the sensation is interpreted as
  painful or not painful

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Gate Control Theory

• Gates in spinal cord control transmission of pain
  sensations to brain. Massage other sensations
  will block the gate and keep pain sensation from
  reaching the brain.

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Gate Control Theory

• An example of a gate closing mechanism is
  transcutaneous electrical nerve stimulation
  (TENS)
• Scratching the sheets
• Back rubs
• Efferluge in OB

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Nursing Intervention

• Using distractions along with pain med helps.
  Watching TV, visiting, games all help distract
  from thinking about pain
• Smooth wrinkles in bottom sheet, AM or PM care,
  backrub all help distract

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Nursing Alert

• Following administration of an analgesic the
  nurse should evaluate for relief in 30 to 45
  min.
• Take vitals before and 20 to 30 min after giving
  as most narcotics depress respirations.

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Definitions

• Cutaneous skin
• Epidermis (outer) itching burning
• Dermis (below the epidermis) localized and
  superficial
• Subcutaneous (below the skin) aching
  throbbing pain

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Definitions

• Intractable not relieved by meds
• Deep somatic generated by deeper connective
  tissue structures such as muscles, tendons, and
  joints.
• Visceral large internal organs

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Definitions

• Projected along nerve path
• Radiating extends from area where it starts
• Referred felt other place, not where organ is
  located

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Definitions

• Neuropathic pain, also called functional or
  psychogenic
• Is pain with atypical characteristics.
• Often experienced days, weeks, or even months
  after the source of the pain has been treated
  resolved.

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Neuropathic Pain

• This leads some to speculate that there is a
  dysfunctional chemical message that is being
  transmitted to the brain.

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Neuropathic Pain

• One example is phantom limb painPts with
  amputated limbs still perceive that the limb
  still exists and that sensations of burning,
  itching, and deep pain still exist in area not
  there.

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Acute Pain

• Short duration--under 6 months
• Associated with anxiety
• S/S perspiration, increased heart rate and B/P,
  pallor

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Chronic Pain

• Develops more slowly
• Lasts longer, above 6 months
• May be depressed

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Acute Pain

• Acute pain differs from chronic pain because in
  acute pain the autonomic responses may be present
• In chronic pain the person has adapted to the
  pain may not have these responses

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Definitions

• Pain perception conscious experience of
  discomfort, occurs when pain threshold is reached
• Pain threshold point at which pain-transmitting
  neurochemicals reach brain causing conscious
  awareness

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Definitions

• Pain tolerance the amount of pain a person
  endures once the threshold has been reached.
• Often influenced by learned behaviors that are
  gender, age, ad culture specific.

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Pain Assessment

• Machines and lab cannot measure pain. Must rely
  on subjective info or what Pt. tells you
• Onset,Quality, intensity, location and duration.
  Assess for nausea, dizziness and what makes it
  better or worse

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Pain

• Whatever the person says it is--pain exists when
  he says it does!
• Highly unpleasant
• very personal sensation
• Sign that theres something physiologically wrong

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Suggestive Signs of Pain

• Moaning,crying
• grimacing
• guarded position
• increased vital signs
• emotional irritability
• difficulty concentrating
• changes in eating or sleeping

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Pain Assessment

• Numeric scale, picture scale or word scale all
  used to assess pain
• 0no pain 10worst on a scale from 1 to 10
• Pick the picture that best demonstrates how you
  feel ( see pg.180 figure 16-5

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Pain

• Usually accompanied by other sensations
• pressure
• heat
• cold

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Pain Management

• TENS
• heat and cold
• accupuncture
• accupressure
• Rhizotomy-removing a section of the nerve root
• cordotomy-removing a section of nerve tract in
  spinal cord

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Pain control

• Precutaneous cervical cordotomy-needle inserted
  through the skin into the cervical area of the
  spinal cord
• guided imagery
• hypnosis

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Pain Relief

• Non-narcotics Tylenol, Asa
• NSAIDS naproxen (Anaprox, Naprosyn)
• ibuprofen (Advil, Motrin, Midol
• Narcotics Demerol, Morphine, Dilaudid, Darvocet
• Codeine

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Opioid

• Opioid and opiate analgesics such as Morphine and
  Demerol are controlled substances referred to as
  narcotics
• They relieve pain by altering neurotransmission
  at the peripheral level (site of injury).

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Antidepressants

• Antidepressants are prescribed in some
  circumstances because they increase the amount of
  available serotonin, which blocks pain
  transmission.

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Factors That Influence Pain

• Cultural background
• emotions
• previous experience with pain
• age
• fatigue, physical strength, LOC,
• how pain is viewed

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Effects of Pain

• Can cause physical and emotional changes
• shock
• ulcers
• depression
• pain threshold-pain awareness pain tolerance,
  time of response

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Effects of Pain

• Remember, if the patient says he is hurting--he
  is hurting so medicate!!
• Nurses should not be judgmental!!
• Use other non pharmacological measures to
  potentiate the drugs

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Caution When Administering Opioids

• May cause respiratory depression. Do not give if
  resp are lt12.
• Cough and Deep Breath to avoid atelectasis
• Monitor bowel activity
• Look on pg 182 Table 16-1

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Gerontologic Considerations

• Older adults experience a higher peak effect and
  longer duration of pain relief from an opioid.
• Older adults taking NSAIDs are at increased risk
  for renal toxicity and GI problems