pain and its management

here is the description of the management of pain

1. Pain and its management MS. SAHELI C 1 ST YEAR M.Sc NURSING MSRINER

2. Introduction:- Everyone has experienced some type or degree of pain. Pain is the most common reason why people seek healthcare. A person in pain feels distress or suffering and seeks relief. Pain is a phenomenon that crosses all specialities of nursing. No matter the setting a nurse practices in, including Neonatal ICU, intra-operative, home care or clinics ,the nurse will be exposed to challenges in pain management and it is the nurse who spends the most time with the client experiencing pain. It is for this reason the nurse is often called as ‘ backbone’ or ‘corner stone’ of pain management.

3. Definition of pain :- Pain defined as an unpleasant, sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. (American Pain Society, 2003) Three parts of this definition have important implications for nurses. First- Pain is a physical, and emotional experience, not all in the body or all in the mind. Second- it is in response to actual or potential tissue damage, so there may not be abnormal lab or radiographic reports despite real pain. Third- pain is described in terms of such damage.

4. Nature of pain Pain is much more than a physical sensation caused by a specific stimulus. The pain experience is complex, involving physician, emotional and cognitive components. Pain is subjective, and highly individualized. Pain can not be objectively measured, only the client knows whether pain is present and the experience is like. PURPOSE OF PAIN:- Serves as a protective mechanism. Can be a diagnostic tool.

5. PHYSIOLOGY OF PAIN The neural mechanism by which pain is perceived consists of 4 steps : Transduction. Transmission. Perception Modulation. 1. Transduction: It is the conversion of a mechanical, thermal, or chemical stimulus into neuronal action potential. The noxious stimuli causes cell damage with the release of sensitizing chemicals like prostaglandins, bradykinin , serotonin, histamin etc. These substances activate nociceptors and lead to generation of action potential.

6. 2. Transmission: It is the movement of pain impulses from the site of tranduction to the brain. Action potential continues from- Site of injury to spinal cord. Spinal cord to brain stem and thalamus. Thalamus to cortex for processing. 3. Perception: It occurs when pain is recognized, defined and responded to by the individual experiencing the pain. It is the conscious experience of the pain. 4. Modulation : It involves the activation of descending pathways. Descending modulatory fibers release chemicals such as serotonin, norepinephrine , gamma aminobutyric acid, at the site of pain that can inhibit pain transmission.

7. Specificity theory This theory proposed that pain is perceived following injury, because there is a single, dedicated, afferent nerve which carries message from the site of injury to the brain. The specific nerve endings in the skin and other tissues respond to nociceptive stimuli. Then the afferent nerves carry this information to the spinal cord and then to the thalamus or pain centre in the brain and to the relevant part of the sensory cortex.

8. Pattern theory This theory is based on the perception of pain to pattern of impulses in the nervous system rather than activation of dedicated pain pathways. Pattern theories may explain some chronic or recurrent pains which occur when there are nerve lesions.

9. Gate control theory : In 1965, Melzack and Wall proposed the gate control pain theory, which was the first one recognizing the psychological aspects of pain are as important as physiological aspects. The theory suggest that the nerve fibers that contribute to pain transmission to the brain , converge at a site in the dorsal horn of the spinal cord. If the gate is closed, the signal is stopped before it reaches the brain, where perception of pain occurs. If the gate is open , the signal will continuously transmit through the spino -thalamic tract to the cortex of brain and thalamus and client will feel the pain.

10. TYPES OF PAIN:- 1. On the basis of origin, pain can be classified as- Cutaneous pain. Somatic pain and deep somatic pain. Visceral or Splanchnic pain. Referred pain. 2. On the basis of nature, pain is divided into- Acute pain. Recurrent acute pain. Chronic pain.

11. Cutaneous pain : This is caused by stimulating the cutaneous nerve endings in the skin and results in a ‘burning’ or ‘prickling sensation’. Eg . Tangled hair that is pulled during combing. Somatic pain : Somatic pain is also referred to as skin pain, tissue pain, or muscle pain. This is non localized and originates in supporting structure. Eg Pain from lumbar disc is felt along with the sciatic nerve. Deep somatic pain : It may be accompanied by nausea and vomiting and may be described as sickening, deep, squeezing, and dull.  Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain. Examples include sprains and broken bones.

12. Visceral or Splanchnic pain : Visceral pain is associated with viscera and internal organs and is less localized and more slowly transmitted (through sympathetic and parasympathetic nerve) than cutaneous pain. Difficult to assess because the location may not be directly related to the cause. Eg . Appendicitis pain. Referred pain : Pain felt in a part of the body other than its actual source. Eg . pain in internal organs is often referred to sites distant from them. Acute pain : Acute pain has a sudden onset, relatively short duration, mild to severe intensity with a steady decrease in intensity over a period of days to weeks. Once stimuli is resolved the pain usually disappears.

13. Recurrent acute pain : It is repetitive painful episodes that reoccur over a prolonged period or throughout the client’s lifetime. Chronic pain :- Persistent pain that lasts weeks to years. Chronic pain usually falls into two categories: Nociceptive pain is caused by damage to body tissue and usually described as a sharp, aching, or throbbing pain. Eg Rheumatoid arthritis, gout, osteoarthritis. Neuropathic pain occurs when there is actual peripheral or central nerve damage. Eg painful diabetic peripheral neuropathy.

14. Causes of pain A) Neuropathic pain 1. Central : Nerve compression. Multiple sclerosis. Parkinson’s disease. Post stroke pain. Post traumatic spinal cord injury. 2. Peripheral: Rediculopathy . Peripheral diabetic neuropathy. Post hepatic neuralgia. Phantomb limb pain. Alcoholic poly neuropathy Carpel tunnel syndrome B) Nociceptive pain 1. Somatic pain: Ligament strain. Cartilage degeneration. Fracture Fibromyalgia Chronic myofacial pain. 2. Visceral pain: Renal colic pain. Biliary colic pain. Dyspepsia Pleuritic pain Pericarditis Ureteric colic pain

15. Symptoms of pain:- Restriction of movement. Muscular weakness. Delayed wound healing. Increased blood pressure. Increased heart rate. Anxiety Depression Feeling of worthlessness. Loss of appetite. Lack of sleep, insomnia. Renal or GI dysfunction.

16. Common pain disorder:- Low back pain. Osteoarthritis . Growing pain. Fibromyalgia. Chest pain. Shoulder pain. Neck pain. Sciatica pain. Migraine . Abdominal pain. Eye pain. Temporo mandibular pain.

17. PHASES OF PAIN EXPERIENCE:- It has 3 phases:- The anticipation or fear of pain. The sensation of pain. The aftermath of pain

18. ASSESSMENT OF PAIN : Pain can be assessed by 3 method. They include- WHATSUP PQRST OLDCART WHATSUP method include- W - where is the pain? Be specific. Use drawing of body if necessary. H – how does the pain feel? Is it shooting, burning, dull, sharp? A – aggravating and alleviating factors. What makes the pain better? Worse? T – timing. When did the pain start? Is it intermittent? Continuous? S – severity. How bad is the pain on a 0 to 10 faces scale. U – useful other data. Are you experiencing any other symptoms associated with the pain or pain treatment? Itching, nausea, sedation, constipation? P – perception. What is the client’s perception of what caused the pain?

19. PQRST method include- P – provoked Q - quality R – region/radiation S – severity T – timing OLDCART method include- O – onset L – location D – duration C – characteristic A – aggravating factors R – radiation T – treatment

20. PAIN ASSESSMENT SCALES:-

21. MANAGEMENT OF PAIN: Management of pain include – 1 ) Pharmacological management. Non- opioids . Opioids Adjuvant drugs 2) Surgical management. 3) Physical therapy or Chiropractic therapy. 4) Complementary and alternative medicine.

22. Surgical management 1. Nerve blocks: Nerve blocks are used to reduced pain by temporarily or permanently interrupting transmission of nociceptive input by application of neulolytic agent on the spinal cord. 2. Neuro ablative techniques : this techniques destroys nerves (peripheral or spinal nerve ) , thereby interrupting pain transmission. 3. Neuro augmentation : It involves electrical stimulation of brain and spinal cord.

23. Chiropractice therapy It is the non surgical method which include spinal manipulation, removal of tension from every cell in the body ,which results in the relief from pain.

24. alternative medicine: Distraction therapy. Aroma therapy. Exercise and yoga. Music therapy. Acupressure therapy Massage therapy.

25. Cutaneous stimulation : Cutaneous stimulation involves stimulation of nerves via skin contact in an effort to reduce pain impulses to the brain, based on the "gate control" theory of pain.

26. Hypnosis therapy. Meditation Relaxation therapy. Reiki healing Guided imagery. Tai chi technique.

27. NURSING MANAGEMENT . NURSING DIAGNOSIS.