Pain Management

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Pain Management

• NPN 135
• Joyce Smith RN, BSN

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Pain Control

• Define Unpleasant sensory and emotional
  experience associated with actual or potential
  tissue damage.
• Most common problem nurses experience
• Is subjective
• Is influenced by the clients values, beliefs,
  religion, norms, and customs
• Nurses responsibility to assess, give RX, teach
  pain management, and document

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Pain

• Acute pain sudden onset, temporary, easily
  localized, decreases as healing takes place
• Chronic pain lasts longer than 3-6 months and is
  associated with nerve or tissue damage
• Pain threshold level of intensity that causes
  the sensation of pain
• Pain tolerance amount of pain a person is
  willing to endure before taking action to relieve
  pain

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Autonomic Nervous System Responses

• When pain receptors are stimulated, impulses are
  transmitted to the spinal cord and then to the
  brain, where the cortex interprets the signals as
  pain
• According to the gate-control theory, stimulation
  of large-diameter fibers in the spinal cord
  interferes with the transmission of pain impulses
  to the brain

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Responses of Autonomic Nervous System

• B/P, pulse, and respiratory rate
• Dilated pupils
• Perspiration
• Pallor
• Constipation
• Urinary retention

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Influencing Factors

• Age
• Older patients may not report
• Think it is a part of aging
• Physical activity/nervous system
• May help relieve pain
• May also cause pain
• Diabetics have less sensation
• Surgery/Anesthesia
• Type of drugs used may delay pain
• Nerve blocks and CNS catheters

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Psychological Factors

• Culture
• Some cultures deny pain exists and are calm, and
  withdrawn
• Some scream and moan
• Religious beliefs
• Prayer
• Some see pain as a punishment
• Past experiences and anxiety
• Development of coping skills
• Some are unable to cope
• Situational factors
• Reason for pain (cancer or childbirth)

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Pain Assessment

• Vital signs
• Report of the patient where, how much, when
  (have patient describe)
• Use communication skills to evaluate and
  interview
• Is pain old or knew
• Use pain scale (1-10)
• What do you do to relieve the pain
• Document findings

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Interventions

• Non-pharmacologic
• Relaxation
• Imagery
• Music
• Heat
• Cold
• Massage
• Turn from side to side
• Get up out of bed
• Change bed linens
• TENS

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Pharmacologic Interventions

• Assess for type of med needed
• With post-op pain best results come from
  scheduled RX
• If pain unpredictable may need to give prn
• PCA pump

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Categories of Drugs

• Non-opioid
• ASA, Tylenol, NSAIDS
• Used for arthritic pain, back pain, headache,
  cancer, post-op,
• Oral or rectal
• Have side effects
• Stomach irritation
• Fluid retention
• Prolonged bleeding time

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Drug Categories

• Opioid
• Used for severe, acute pain, chronic cancer pain
• Codeine, Morphine, Dilauldid, Demerol, Nubain,
  Stadol, Talwin
• Relieves at the CNS
• May need ot reduce dosage in older adults and
  children
• Addiction versus tolerance
• Side effects
• Constipation, nausea, vomiting, sedation,
  respiratory depression
• Routes of administration
• IM, IV, rectally, sug-q, PCA pump, epidural,
  intrtrathecal

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Drug Categories

• Adjuvant
• Non-analgesics can give pain relief
• Muscle relaxants
• Antidepressants
• Benzodiazepines
• Corticosteriods

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Step therapy

• (Figure 14-7)

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Nursing Management of Pain

• (Figure 14-2)