Pain management
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Pain Management. What is pain?. One of the most common reasons people seek healthcare One of the most widely under-treated health problems. Pathophysiology. A sensation caused by some type of noxious stimulation A pattern of responses that function to protect the individual from harm

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Pain Management

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Pain Management


What is pain?

  • One of the most common reasons people seek healthcare

  • One of the most widely under-treated health problems


Pathophysiology

  • A sensation caused by some type of noxious stimulation

  • A pattern of responses that function to protect the individual from harm

  • Whatever the experiencing person says it is whenever he says it does


Components of Pain

  • Physical

    • Caused by some kind of noxious stimulant

  • Emotional

    • Results of combination of thoughts, feelings, and beliefs

  • Behavioral

    • Pattern of responses that function to protect the individual from further harm


  • Causes of Pain

    • Cutaneous

      • Direct stimulation to skin (cut)

    • Somatic

      • From musculo-skeletal system (sprained muscle)

    • Visceral

      • Arising from hollow organs (appendicitis)


    • Neuropathic

      • Damage to nervous system

    • Referred

      • Pain arising from someplace else in body


    Descriptions of pain

    • Chronic: occurring over a long period of time

    • Acute: sudden, brief onset


    Visual Analog Scale

    This is a line 10 cm. long (about 4 inches) that is divided into ten divisions. Patients are asked to show the amount of pain on a 1-10 scale.

    Researchers say that patients cannot function with a scale with more than ten points.


    PQRST

    This mnemonic is devised to show the steps in pain assessment:

    • Provoking factors

    • Quality

    • Region/Radiation

    • Severity/Symptoms

    • Timing


    • Provoking factors include what caused the pain and what might be making it worse

    • Quality questions refer to how the pain feels…let the patient tell but offer suggestions if necessary, like sharp, dull, throbbing, burning, etc.


    • Region….have patient point to area that hurts

    • Severity can be measured with the pain rating scales

    • Symptoms may accompany the pain….nausea, vomiting, etc

    • Timing refers to when the pain started, how long it lasts


    Be aware

    • Just because a patient cannot respond to pain doesn’t mean there is no pain

    • Activities of daily living (ADLs) may be effected

    • Neurological status will alter the response to pain


    Pain Management

    Management must be timely,

    individualized,

    and bring the pain to an acceptable level of tolerance


    Pharmacologic interventions

    Must be individualized

    • Three main categories:

      • Non-opioids

      • Opioids

      • Adjuvants


    • Non-opioids:

      • Acetominophen (Tylenol)

      • Aspirin

      • NSAIDs (Advil)

    • Opioids

      • Weak Strong

        • Codeine  Hydromorhone

        • Oxycodone  Morphine

        • Vicodin  Merperidine

    • Adjuvants

      • Primary function is not pain relief but provide relief

        • May modify mood so patient feels better


    Precautions to giving pain medications

    • Medication choice may depend on practitioner’s preference, however:

      • Should not give two analgesics from same class at same time

      • Must be aware of effects of medications

      • Must watch for allergic reactions


    Routes of medication administration

    • Oral

    • Injection

    • Intravenous (includes PCA)

    • Epidural

    • Rectal

    • Topical


    WHO Pain Ladder

    SEVERE PAIN: Keep giving mild pain medication and add a strong opioid such as morphine or Fentanyl

    MODERATE PAIN:

    Keep giving mild pain

    medication and add a mild

    Opioid such as codeine

    MILD PAIN:

    Aspirin, ibuprophen

    Acetominophen,

    naprosyn


    Concepts of WHO Pain Ladder

    • By the mouth

    • By the clock

    • By the ladder

    • For the individual

    • With attention to detail


    Placebos

    Controversial use of an inactive substance to satisfy the demand for medication


    Non-pharmacologic interventions

    Pain control without using medications

    • Alter the environment

    • Relaxation and guided imagery

      • Meditation

    • Cutaneous stimulation

      • Massage, acupressure, acupuncture, TENS

    • Biofeedback

    • Therapeutic touch

    • Education


    JCAHO Standards for Pain Management

    • Address care at the end of life

    • Assess and manage pain appropriately

    • Assess pain in all patients

    • Support safe medication ordering and administration


    • Monitor patient during post-procedure period

    • Rehabilitate for optimal level of function

    • Educate about pain an managing pain

    • Plan for discharge continued care if needed

    • Collect data to monitor performance


    Nurses spend more time with patients than any other provider. They must stay informed in order to give the best care to their patients.


    • References:

      • Falk. Kim Marie. Pain Management. National Center of Continuing Education. Catalog 98 TX.

      • http://www.fxbcenter.org/caring/painladder.html

      • http://www.harcourthealth.com/Mosby/Wong/fyi_03.html


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