Pain

INTRODUCTION
■ Pain is a major problem that causes suffering and reduces quality

of life span.
■ Pain one of the most reasons that people seek health care.
■ A thorough understanding of the physiological and psychological
dimensions of the pain is important for effective assessment and
management of patients with pain.
Nurses have a central role in pain assessment and
management.
DEFINITION
■ According to Carpenito “ Pain is defined as a state in which an
individual experience and report the presence of severe
discomfort or an uncomfortable sensation. ”
■ The international Association for the Study of Pain

(IASP) defines pain as “an unpleasant sensory and emotional
experience associated with actual or potential tissue damage or
described in terms of such damage. ”
CLASSIFICATION OF PAIN
■ According to duration, location and etiology
1. GENERAL TYPE OF PAIN

a) ACUTE PAIN
Acute pain is an episode of pain that lasts for seconds to less than
6 months
b) CHRONIC PAIN
Chronic pain is an episode of pain that lasts for 6 months or
longer.
2. SPECIFIC TYPE OF PAIN
A) NOCICEPTIVE PAIN
Normal processing of stimulus that damages normal tissue or has the
potential to do so if prolonged. Usually responsive to nonopioid/drugs.
TYPES
1. Somatic pain - arises from bone, muscle, joint, skin or connective
tissue;usually aching or throbbing in quality and is well localized.
2. Visceral pain - arises from visceral organs, such as the
gastrointestinal tract and bladder.
B)NEUROPATHIC PAIN
It is an abnormal processing of sensory input by the peripheral or
central nervous system.
TYPES
1. Centrally generated Pain
Injury to either the peripheral or central nervous
System.Sympathetically maintained pain.
2. Peripherally generated pain
Usually associated with a known peripheral nerve injury and pain is
felt at least partly along the distribution of the damaged nerve.
C) REFERRED PAIN
D) PSYCHOGENIC PAIN
E) PHANTOM PAIN
F) SUPERFICIAL OR CUTANEOUS PAIN

PATHOPHYSIOLOGY
Multiple types of stimuli(heat, cold, chemical changes)
Specific fibers react to any of these stimuli

Multiplethermal,
(mechanical, types of chemical nociceptors)
Nerve receptors of pain to be activated
chemical mediator (serotonin, histamine, prostaglandin)

Stimulate pain sensation Fibers
These fibers enters the dorsal horn of spinal cord which transmit pain
Impulses
Impulses and electric activity passed to the spinal cord and to the brain
Pain
PAIN ASSESSMENT
1. SUBJECTIVE DATA
■ Important health information
Health history_ pain history includes onset, location, intensity, quality,
patterns and expression of pain; past treatments and their
effectiveness;pain triggers; review of health care utilization related to
pain problem.
Medications_ use of any prescription or over the counter, herbal
products for pain relief, alcohol use.
■ Functional health patterns
Social and work history, mental health history, smoking history,
effect of pain on emotions, relationships, sleep and activities,
interviews with family members , records from psychiatric
treatment related to pain
2. OBJECTIVE DATA
Physical examination, including evaluation of functional limitations.
PRINCIPLES OF PAIN ASSESSMENT
■ Patients have the right to appropriate assessment and

management of pain.
■ Pain is always subjective.
■ Physiologic and behavior signs of pain are not specific for pain.
■ Pain can exist even when no physical cause can be found
■ Different patients experience different levels of pain in response
to comparable stimuli.
■ Unrelieved pain has adverse physical and psychological
consequences.
■ Patients with chronic pain maybe more sensitive to pain and other
stimuli.
MEDICAL MANAGEMENT
PHARMACOLOGIC PAIN MANAGEMENT
Pharmacologic pain management involves the use of opioids
( narcotics), nonopioids such as nonsteroidal anti-inflammatory drugs
(NSAIDs) , and Coanalgesic drugs.
1. NONOPIOID ANALGESIC FOR MILD PAIN

■ Acetaminophen( Tylenol, datril)
■ Acetylsalicylic acid (Aspirin)
■ Piroxicam( Feldene)
■ Choline magnesium trisalicylate
■ Meloxicam
2. OPIOID ANALGESICS FOR MODERATE PAIN
■ Hydrocodone
■ Codeine
■ Tramadol
■ Pentazocine
3. COANALGESICS
■ Tricylic antidepressants
■ Anticonvulsants
■ Topical local anesthetic
NONPHARMACOLOGIC PAIN MANAGEMENT
Nonpharmacologic pain management consists of a variety of
strategies that target the body, mind, spirit and social
interactions.
1. BODY
■ Promoting comfort massage, applying heat or cold, positioning,
diet, nutritional supplements, exercise, proper sleep, bracing.
2. MIND
■ Relaxation; reducing fear, anxiety, stress; reducing sadness
and helplessness;attitude adjustment.
3. SPIRIT
■ Prayer, medication, spiritual healing, self- reflection regarding
life and pain, energy work, meaningful rituals.
4. SOCIAL INTERACTIONS
■ Improved communication, family therapies, pet therapy, problem
solving, volunteering, support groups
NURSING MANAGEMENT
1. Perform a comprehensive assessment of pain to include location
, characteristics, duration, frequency, severity of pain. Pain is a
subjective experience and must be described by the client in order
to plan effective treatment.
2. Assess to what degree cultural, environmental, interpersonal and
Intrapsychic factors may contribute to pain relief.
NURSING MANAGEMENT ( cont........)
3. Eliminate additional stressors or sources of discomfort

whenever possible
4. Provide rest periods to facilitate comfort, sleep and relaxation.
5. Teach the use of nonpharmacologic techniques before, after
and if possible during painful activities.
6. Evaluate the administration of analgesic at regular , frequent
intervals after each administration and especially after the
initial dose, also observing for any signs and symptoms of
effects. (Eg: vomiting, nausea)
TREATMENT
■ Follow principles of pain assessment.
■ Every patient deserves adequate pain management.
■ Prevent or manage medication side effects.
■ Evaluate effectiveness of all therapies to ensure that they
are meeting the patients goal.
■ Use both drug and nondrug therapies.
■ Base the treatment plan on patient‘s goal.
BIBLIOGRAPHY
1. LEWIS , BUCHER - TEXT BOOK OF MEDICAL SURGICAL

NURSING. PAGE NO. 126-149
2. JAVED ANSARI – TEXT BOOK OF MEDICAL SURGICAL
NURSING, PAGE NO. 43-45
3. BRUNNER & SIDDARTH’S - TEXT BOOK OF MEDICAL
SURGICAL NURSING
4. KOZIER AND ERB’S - TEXT BOOK OF FUNDAMENTALS OF
NURSING, PAGE NO- 1250-1261

Pain

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Pain

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INTRODUCTION

■ Pain is a major problem that causes suffering and reduces quality

■ The international Association for the Study of Pain

1. GENERAL TYPE OF PAIN

F) SUPERFICIAL OR CUTANEOUS PAIN

Specific fibers react to any of these stimuli

Nerve receptors of pain to be activated

chemical mediator (serotonin, histamine, prostaglandin)

■ Patients have the right to appropriate assessment and

1. NONOPIOID ANALGESIC FOR MILD PAIN

3. Eliminate additional stressors or sources of discomfort

1. LEWIS , BUCHER - TEXT BOOK OF MEDICAL SURGICAL

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