pain module (e) lecture cont
TRANSCRIPT
Pain Management
Module E (Lecture)
Objectives
Identify types and categories of pain to location,etiology, and duration
Identify subjective and objective data to collect and analyze when assessing pain
Identify examples of nursing diagnosis for clients with pain
State outcome criteria by which to evaluate a clients response to interventions for pain.
Objectives
Identify barriers to effective pain management
Describe non-pharmacologic pain control interventions
Describe pharmacologic interventions for pain
Nature of Pain
“An unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage” (International Association for the Study of Pain, 1979).
Types of Pain Acute Pain- pain lasting only through
the expected recovery period.
Chronic Pain- lasts beyond the usual course for recovery (six months duration).
Continued Pain can be categorized according to
its origin: Cutaneous Deep somatic Visceral
Continued Radiating Referred Intractable Neuropathic Phantom
Pain Syndromes Central Pain Syndromes
Trigeminal neuralgia Peripheral Pain Syndromes
Post-herpetic Neuralgia Phantom Limb Pain
Pain with Underlying Pathology Syndromes Headache- common somatic pain either
intracranial or extra-cranial. Cancer Pain Syndrome – Progressionof the disease or from efforts to cure or
control disease. Myofacial Pain Syndrome
Concepts Associated with Pain
Pain Threshold Pain Sensation Pain Reaction Pain Tolerance
Gate Control Theory According to theory, peripheral nerve
fibers carrying pain to the spinal cord can have their input modified at the spinal cord level before transmission to the brain.
Continued Ascending Modulation
Large diameter sensory fibers, message, heat and cold applications
Transcutaneous electrical nerve stimulation (TENS) unit, electrical stimulation is applied to skin
Descending modulation
Factors Affecting the Pain Experience
Ethnic and Cultural Values
Developmental Stage
Environment and Support People
Continued Past Pain Experience
Meaning of Pain
Anxiety and Stress
Why clients may be reluctant to report pain Unwillingness to trouble staff Fear of injectable route of analgesic
administration Belief that pain is to be expected as
part of recovery Concern about addiction
Continued Fear about cause of pain or that reporting
pain will lead to further tests and expenses Concern about unwanted side effects,
especially of opioid drugs Difficulty expressing personal discomfort
Pain Assessment Accurate pain assessment is essential
for effective pain management. Pain is subjective and experienced uniquely by every individual, nurses need to assess all factors affecting the pain experience.
Pain History Previous pain treatment and
effectiveness When and what analgesics were last
taken Allergies to medications, other
medications being taken
Continued Location (abdomen) Intensity (scale of 0-10)See figures 43-
7 and 43-8, pgs 1090-1091) Quality (perceiving like a knife) Pattern (onset, duration, and
recurrence of intervals without pain.
Continued Precipitating Factors (Environmental factors,
heat or cold) Alleviating factors (herbal teas, rest, t.v., prayer) Associated Symptoms (N/V, dizziness, diarrhea) Effects on ADL’S (Sleep, appetite,
concentration, school, work, driving, walking)
Continued Coping resources (prayer or other
religious practices) Affective Responses (nurse to explore
feelings) Observation of Behavioral and
Physiologic Responses
Barriers to Pain Misconceptions and biases Clients respond to pain based on their culture,
personal experiences and the meaning the pain has for them.
Clients may not report pain because they expect nothing to be done, they think it is not severe enough, or because they feel it would distract or prejudice the healthcare provider.
Key Factors in Pain Management
Acknowledging and accepting Assisting Support Persons Reduce misconceptions about pain Reducing fear and anxiety Preventing Pain
Individualizing Care for Clients with Pain Establish a trusting relationship Consider the clients ability and willingness
to participate actively in pain relief measures
Use a variety of pain relief measures Provide measures to relieve pain before it
becomes severe.
Continued Use pain relieving measures that the client
believes are effective Base the choice of pain relief measure on
the client’s report of he severity of the pain If a pain relief measure is ineffective
encourage the client to try it once or twice before abandoning it
Continued Maintain an unbiased attitude about
what might relief the pain Keep trying Prevent harm to the client Educate the client and support people
about pain.
Pharmacologic Pain Management Involves the use of opioids (narcotics) Nonopioids/NSAIDS (nonsteroidal
antiinflammatory drugs) Adjuvants or Coanalgesic Drugs (See box
on pg 1098)
Opioid Analgesics Opium derivatives (M.S., and Codeine) Relieve pain and provide a sense of
euphoria binding to opiate receptors and activating endogenous pain suppression in the CNS.
MU, Delta, and Kappa receptors (opiate receptors)
Types of Opioids Full agonist- MS, Demerol, Codeine,
Darvon, Dilaudid- their doses can be increased to relieve pain.
Mixed agonist-antagonist Partial agonists
NONPHARMOCOLOGIC PAIN MANAGEMENT Physical Interventions-Provide Comfort Cutaneous Stimulation-Massage,
application of heat or cold, acupressure Contralateral Stimulation Immobilization Distraction (visual, auditory, tactile,
intellectual)
Transcutaneous Electrical Nerve Stimulation TENS is a method of applying low voltage
electrical stimulation directly over identified pain areas, at an acupressure point, along peripheral nerve areas that innervate the pain area, or along the spinal column.
Pain Evaluation The nurse and client must determine if
overall goals and outcomes are achieved. Flow sheet records and diaries are helpful
in this process, to evaluate the effectiveness of an analgesic.