Chapter 43-Pain Management Part I

1
Chapter 43-Pain ManagementPart I

• Ouch! That hurts! Im hurting! OMG! Its killing
  me. I cant live any longer! Cant you do
  anything?

2
The Concept for this unit is

• comfort  (k m f rt) tr.v. comforted,
  comforting, comforts 1. To soothe in time of
  affliction or distress.2. To ease physically
  relieve.n. 1. A condition or feeling of
  pleasurable ease, well-being, and contentment.2.
  Solace in time of grief or fear.3. Help
  assistance 4. One that brings or provides
  comfort.5. The capacity to give physical ease and
  well-being.

3
Concepts related to Pain

• Pain-symptom of disease
• Pain-now considered a separate disease
• Pain-subjective
• Pain-highly individualized
• Pain-highly feared. The fear of pain is second
  only to the fear of death

4
Causes of pain

• Thermal
• Chemical
• Mechanical

5
Processes of Pain

• Transduction
• Transmission
• Perception
• Modulation

6
Transduction

• Transduction-energy from stimuli converted to
  electrical energy
• Begins in the periphery with stimulus
• Pain impulse via nerve fibers
• Transduction completed results in transmission

7
Transmission

• Transmission involves neurotransmitters
• Intact pain fibers-ECF Spinal Cord
• Message received by cerebral cortex
• Interpretation by CNS

8
Perception

• Message received-awareness
• Limbic system determines how one feels about the
  pain

9
Modulation

• Message interpreted and received
• Release of inhibitory neurotransmitters
• Modulation is the inhibitory/analgesic effect

10
Gate-Control Theory p.1053

• Emotional
• Cognitive
• Gate-keepers
• Pain threshold
• Pain tolerance

11
Types of Pain p.1055

• Acute/Transient
• Chronic/Persistent
• Chronic Episodic
• Cancer
• Idiopathic
• Inferred

12
Misconceptions/Biases

• P. 1056
• The person experiencing the pain is the best
  indicator of the characteristics of pain
• Assess pain
• Believe the person

13
Factors Affecting Painp. 1056-1060

• Age
• Culture
• Gender
• Genetic
• Neurological functioning
• Social
• Spiritual

14
Nursing Assessment

• No pain meter available
• Must rely on patient
• Nurse must ascertain subjective data
• Expression of pain

15
Characteristics of Pain

• Onset/Duration
• Location
• Quality
• Pattern
• Relief measures
• Contributing symptoms
• Behavioral effects
• Effects on ADLs

16
Pain Assessment

• Pain scales p. 1065
• Oucher scale
• Wong-Baker
• Pneumonic-P,Q,R,S,T
• Assessment of pain is considered the fifth vital
  sign!

17
Questions/Statements R/T Pain

• Be a reporter-who, what, when, where, why
• Ask opened-ended questions
• Avoid leading statements
• Observe nonverbal cues
• Congruent nonverbal actions and verbal comments
• Remember to assess drug allergies