Pain Management

• Patrice Levy, RN• Therapeutics NURS 7724• November 25, 2002

Objectives

• Define pain• Define addiction, physical dependence,

tolerance, and adjuvant analgesic

• Identify the types/classification of pain

• Explain the pain mechanisms

• Identify the barriers to pain management and harmful effects of unrelieved pain

Definition of Pain

• Pain is an unpleasant sensory and emotional experience associated with acute or potential tissue damage, or described in terms of such damage.– IASP, APS - 1992, Mersky, Bogduk - 1994

Definition of Pain

• Pain is whatever the experiencing person says it is, existing whenever he says it does

• McCaffery - 1968

Definitions

• Addiction: Psychologic dependence. A pattern of compulsive drug use characterized by continued craving for an opioid for effects other than pain relief.

• Tolerance: A decrease in one or more effects of the opioid

• Physical Dependence: is the occurrence of withdrawal symptoms when the drug is stopped.

Definitions

• Adjuvant analgesic: A drug that has a primary indication other than pain.

Types of Pain

• Acute Pain- brief pain that subsides as healing takes place

• Cancer Pain

• Chronic Nonmalignant Pain

Classification of Pain

Nociceptive- term used to describe how pain becomes conscious

• Neuropathic- abnormal processing of sensory input by the peripheral or CNS

Nociception Pain Pathway

Transduction- Conversion of one energy from another, begins in the periphery when a noxious stimulus causes tissue damage.

• Transmission- movement of impulses from the site of transduction to the brain.

• Perception- conscious experience of pain.

• Modulation- inhibition of nociceptive impulses.

Nociception - The Process

Nociceptive Pain

• Somatic Pain- arises from bones, joints, muscle, or connective tissue. Usually described as aching or throbbing in quality. Pain is well localized.

• Visceral Pain- arises from the visceral organs, GI tract/pancreas.

Neuropathic Pain

• Centrally Generated- results from injury to• the CNS or peripheral nervous system

• Peripherally Generated- generalized or

• specific pain along a damaged nerve.

Barriers to Pain Management

• Health Care Professionals

• Inadequate knowledge• Lack of education• Poor assessment• Regulatory Constraints

Barriers of Pain Management

• Patients and the Public• Reluctance to report pain• Reluctance to take analgesics• Concerns about addiction• Concerns about tolerance• Desire to be a “good patient”

Barriers to Pain Management

• Health Care System

• Pain assessment and treatment a low priority in daily practice

• Restrictive regulation of controlled substances

Harmful Effects of Unrelieved Pain

• Endocrine System overactivity

• Cardiovascular– Hypercoagulation– Increase Heart Rate– Increase Blood Pressure– Increase Cardiac Workload– Increase Oxygen Demand

• Respiratory– Muscle Spasm– Decrease Tidal Volume– Decrease Vital Capacity– Decrease Alveolar

Ventilation

• Genitourinary– Urinary Retention– Hypokalemia

Harmful Effects of Unrelieved Pain

• Gastrointestinal– Increase intestinal Secretion– Increase smooth muscle tone– Decrease Gastric Emptying– Decrease Intestinal Motility

• Musculoskelatal– Muscle Spasm– Impaired Function– Fatigue– Imobility

• Cognitive Function– Mental Decline

• Immune Function– Decrease Immune Function– Decrease NK Cell Activity

• Developmental Effect– Experience associated with

pain remembered and this can have an effect on future behavior

Harmful Effects of Unrelieved Pain

• Future Pain– Poorly controlled acute

pain can predispose patients to debilitating pain syndromes.

– Phantom Pain– Herpetic Pain

• Quality of Life– Impact of unrelieved

pain on quality of life is significant , ranging from decreased physical activity to hopelessness and suicidal ideations

Conclusion

• The power point presentation on pain management discussed the basic mechanisms underlying the causes and effects of pain.

References

Fanciullo, G, (2000). Acute Pain Management , Symposium Spotlight: The 16th Annual Meeting of the American

Academy of Pain Medicine, New Orleans, La., Feb. 24-27.

Joint Commission on Accreditation of Healthcare Organization, (2000). Pain assessment and management an

organizational approach. Oakbrook, Il.: Joint Commission on Accreditation of Healthcare Organization.

McCaffery, M. & Ferrell, B. (1999). Pain Clinical Manual (2nd ed.). St. Louis: Mosby.

Phillips, D. (2000). JCAHO pain management standards are unveiled, JAMA, 284 (4).

Rubinger, H, & Gardner, Richard, (2002). Pain and Suffering, Continuing Care, 21, (4), 22.

Smith,Rita, Curi, M., Silverman, A, (2002). Pain Management: The global connection, Nursing Management, 33 (6), 27.

Stratton, L. (1999). Evaluating the effectiveness of a hospital pain management program, Journal of Nursing Care

Quality, 13 (4), 8-18.

U.S. Department of Health and Human Services, Agency for Health Care Policy and Research: Acute Pain Management

in Adults: Operative Procedures. Pub 92-0019.

•