Concept of Pain management presentation .pptx

concept of pain

1. C oncept of Pain Sidra Komal BSN,RN,Mphil (TQM)

2. Introduction P ain is the fifth Vital sign and is regarded as a symptom of an underlying condition Pain is a complex experience consisting of physiological and a psychological response to a noxious stimulus . Pain is a warning mechanism that protects an organism by influencing it to withdraw from harmful stimuli; it is primarily associated with injury or the threat of injury . Pain is subjective and difficult to quantify, because it has both an affective and a sensory component

3. Objectives At the end of this unit, learners will be able to: Define the process of pain (physiological changes) Describe the different theories of pain theory. Differentiate between acute and chronic pain Discuss the non-pharmacologic interventions pain management. Identify pharmacologic interventions for pain management

4. Definition of Pain The International Association for the Study of Pain (IASP) defines pain as " an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage , or described in terms of such damage.

5. Pain Process A nociceptor is a receptor of a sensory neuron (nerve cell) that responds to potentially damaging stimuli by sending signals to the spinal cord and brain. This process , called nociception, usually causes the perception of pain Distributed throughout the body (skin, viscera, muscles , joints, meninges) they can be stimulated by mechanical, thermal or chemical stimuli.

6. Pain Process There are four major processes: transduction, transmission, modulation, and perception

7. Transduction Transduction refers to the process by which a painful physical or chemical stimulus is transformed into a signal that can be carried (via transmission) to the central nervous system and perceived as pain.

8. Transmission Once transduction is complete transmission of pain begins, Painful stimuli produce nerve impulses that travel along efferent nerve fibers. A-delta fiber (fast myelinated ) Send sharp localized and distinct sensation C-fiber (Slow unmyelinated ) Slow impulses e.g needle stick,

9. Perception Perception of pain occurs when the pain impulse has been transmitted to the cortex and the person develops conscious awareness of the intensity, location, and quality of pain

10. Modulation Modulation of pain refers to activation of neural pathways that inhibit transmission of pain The periaqueductal gray (PAG), dorsolateral pontine tegmentum ( DLPT), and rostroventral medulla ( RVM) are the key regions of the brain involved in this descending pain modulation

11. Theories of Pain Several theoretical frameworks have been proposed to explain the physiological basis of pain, although none yet completely accounts for all aspects of pain perception. A number of theories have been postulated to describe mechanisms underlying pain perception. Some of which are:

12. Theories of Pain Intensive Theory ( Erb , 1874) Strong's Theory (Strong, 1895)  Specificity Theory (Von Frey, 1895 ) Pattern Theory( Goldschneider  (1920) Central Summation Theory (Livingstone, 1943 ) Sensory Interaction Theory ( Noordenbos , 1959 ) Gate Control Theory ( Melzack and Wall, 1965)

13. Gate Control Theory  Ronald Melzack and Patrick Wall proposed the Gate Control Theory in 1965. The gate control theory of pain asserts that non-painful input closes the "gates" to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation by non-noxious input is able to suppress pain.

14. Types of Pain There are several ways to categorize pain. One is to separate it into acute and  chronic pain . Acute pain typically comes on suddenly and has a limited duration. It's frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress . Chronic pain lasts longer than acute pain and is generally somewhat resistant to medical treatment. It's usually associated with a long-term illness, such as osteoarthritis

15. Types of Pain Pain is often classified by the kind of damage that causes it. The two main categories are pain caused by tissue damage, also called nociceptive pain , and pain caused by nerve damage, also called  neuropathic pain . A third category is psychogenic pain , which is pain that is affected by psychological factors

16. Types of Pain Somatic pain, visceral pain and Cutaneous is another classification of pain based on origin Somatic pain comes from the skin. muscles, and soft tissues, while visceral pain comes from the internal organs. Cutaneous pain : is caused by stimulation of the cutaneous nerve endings in the skin.

17. Non-pharmacological interventions Non-pharmacological pain therapy refers to interventions that do not involve the use of medications to treat pain. The goals of non-pharmacological interventions are to decrease fear, distress and anxiety, and to reduce pain and provide patients with a sense of control. The advantage of non-pharmacological treatments is that they are relatively inexpensive and safe

18. Non-pharmacological interventions Non-pharmacological therapies are typically categorized into: Physical (sensory) interventions Psychological interventions

19. Physical (sensory) interventions Physical (sensory) interventions typically are patient-specific and inhibit nociceptive input and pain perception. Some measures that can reduce pain intensity and improve the patient quality of life such as massage, positioning, hot and cold treatment, transcutaneous electrical nerve stimulation (TENS), acupuncture and progressive muscle relaxation

20. Psychological interventions Continuous pain may lead to development of maladaptive status and behavior that worsen day to day function, increase distress, or enhancing the experience of pain Most commonly used psychological interventions are: cognitive behavioral therapy, mindfulness-based stress reduction, acceptance and commitment therapy (ACT), meditation, guided imagery and biofeedback. Others: Spirituality and religion in pain management and music therapy.

21. Pharmacological interventions P harmacological pain therapy refers to interventions that involve the use of medications to treat pain. A wide range of drugs are used to manage  pain resulting from inflammation in response to tissue damage, chemical agents/pathogens (nociceptive pain) or nerve damage (neuropathic pain).

22. Pharmacological interventions W HO Analgesic Ladder Step 1-3 Originally developed by the World Health Organization (WHO) to improve management of cancer pain The 3 step WHO analgesic ladder is also used for providing stepwise pain relief for pain due to other causes.

23. Pharmacological interventions Non-opioid medications: Step 1 - WHO Analgesic ladder Mild to Moderate pain: Non-steroidal anti-inflammatory drugs (NSAIDs ) Paracetamol also known as acetaminophen Aspirin also known as acetylsalicylic acid (ASA)

24. Pharmacological interventions Compound analgesics: Step 2 on the WHO analgesic ladder – mild to moderate pain Compound analgesics are a combination of drugs in a single tablet usually including codeine (a weak opiate) and aspirin or paracetamol . Examples include co- codamol and co- dydramol which contain codeine and paracetamol in various formulas (8/500, 10/500, 15/500, 30/500) where the first number refers to the amount of codeine and the second to paracetamol

25. Pharmacological interventions Opioid medications: Step 3 on the WHO analgesic ladder – severe pain Medications derived from morphine (or synthetic analogs)  mimic the body’s own analgesic system and are strongest and most effective painkillers currently available. Opioid medications include morphine, oxycodone, codeine, tramadol, buprenorphine, fentanyl and diamorphine (heroin)

26. Pharmacological interventions Adjuvants: The WHO analgesic ladder recommends that patients are prescribed additional medication to manage the symptoms of neuropathic pain.  These drugs include tricyclic antidepressants and antiepileptic drugs Topical analgesics: Topical analgesics can provide localized pain relief and are used to treat acute and chronic pain, such as musculoskeletal and neuropathic pain, as well as muscle pain related to trauma. Topical analgesics include  rubefacients , topical NSAIDs and local anaesthetics .

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