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