pain

PAINDaniel Eshetu

What is Pain?

“…an unpleasant sensory and emotional

experience associated with actual or

potential tissue damage, or described

in terms of such damage.”

International Association for the Study of Pain (IASP) - 1964

Defining Pain

• There is no objective way to measure pain

• When in doubt, believe what the patient says

• Even without objective evidence, pain is very real to the individual

Defining Pain

Pain is highly subjective to the individual experiencing it.

"Pain is whatever the experiencing person says it is, existing whenever he says it does.”

McCaffery M. Nursing Practice Theory UCLA Press,1968.

McCaffery M Pain: Clinical Manual. St. Louis: Mosby, 1999.

Acute Pain

Well defined temporal pain onset

Associated with • subjective and

objective physical signs

Helps in limiting the damage

Pain management - Nurses

Chronic Pain

Pain persisting for > 3 months

Less well defined temporal onset

No known useful biological purpose

Pain management - Nurses

Anil Paleri-Addis-Jul 09 7

PERSISTING+

PHASE 2/Inflamatory

Inflammation

BRIEF

CNSPHASE 1/Nociceptive

ABNORMAL+

PHASE 3/NeuropathicNerve or CNS damage

Different Types of Pain

Cervero, F. & Laird, J. M. A. 1991

Nociceptors: Primary afferent neurons, distinguish btwn noxious & innocuous

events.

External (eg skin) or Internal (eg viscera)Cell bodies are in dorsal root ganglia, outside spinal cord.

Nociception

Nociception & the neurones

Two Types :A-delta fibers: Small, myelinated neurons

Fast conduction 3 to 30 m/sec.

C-fibers: Unmyelinated neuronsSlow 0.3 to 1.5 m/sec.

Contribute to the pain experience differently. A-fibers: First (immediate) sharp pain; C fibers: Mediate the delayed, dull pain.

Neuropathic Pain

• Aberrant processes in PNS or CNS

• Sensitization from prolonged exposure to noxious stimuli or nerve injury, or through peripheral nervous system changes

• Disproportionate to the stimulation of nociceptor

• May occur without nociception

• Serves no protective function

Mechanisms of Pathophysiologic Pain

• Injured or diseased nerves

Eg - Diabetes, peripheral neuropathies, nerve compression or infiltration

• Typically have an unusual burning, tingling or electric shock like quality

Measurement of pain

Numeric Rating Scale

Verbal Rating Scale

Visual Analog Scale

Verbal Descriptor scales

Faces Pain Rating Scale

Pain management - Nurses

Pain management - Nurses

Numeric Scale

Pain management - Nurses

Simple Descriptive Scale

Numerical rating scales

Numerical Rating Scale used at

Hospice Africa Uganda

0

1

2

3

4

5

6

0 1 2 3 4 5 6Visits

Level of pain

Other Numerical rating scales

I do not have any pain 0______1_____2______3______4______5 My pain could not be worse

CHILDREN’S FACES PAIN SCALE

I do not have any pain 0______1_____2______3______4______5 My pain could not be worse

Module 3:Assessing and Managing Pain

19

Features of Acute and Chronic Pain

Pain - Evaluation

• When did pain start? Time

• What is its nature? Character

• Where is the pain? Does it radiate? Location

• What makes it better? Aggravates it?

• Constant or intermittent?

• Does it affect sleep? Severity

• Movement / Mobilization?

• Any medication taken so far? Did it help?

Pain - Evaluation

History takingP– precipitating and reliving factors

»Palliative & Provocative factors

Q– quality of pain

R—radiation

S—site and severity

T—time course

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PAIN

Question?

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