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Pain Management

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  1. Pain Management

  2. What is pain? • One of the most common reasons people seek healthcare • One of the most widely under-treated health problems

  3. 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

  4. 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

  5. Causes of Pain • Cutaneous • Direct stimulation to skin (cut) • Somatic • From musculo-skeletal system (sprained muscle) • Visceral • Arising from hollow organs (appendicitis)

  6. Neuropathic • Damage to nervous system • Referred • Pain arising from someplace else in body

  7. Descriptions of pain • Chronic: occurring over a long period of time • Acute: sudden, brief onset

  8. 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.

  9. PQRST This mnemonic is devised to show the steps in pain assessment: • Provoking factors • Quality • Region/Radiation • Severity/Symptoms • Timing

  10. 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.

  11. 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

  12. 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

  13. Pain Management Management must be timely, individualized, and bring the pain to an acceptable level of tolerance

  14. Pharmacologic interventions Must be individualized • Three main categories: • Non-opioids • Opioids • Adjuvants

  15. 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

  16. 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

  17. Routes of medication administration • Oral • Injection • Intravenous (includes PCA) • Epidural • Rectal • Topical

  18. 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

  19. Concepts of WHO Pain Ladder • By the mouth • By the clock • By the ladder • For the individual • With attention to detail

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

  21. 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

  22. 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

  23. 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

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

  25. 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