Pain pharmacotherapy mamagmenrt fdKsu.ppt

clinical

1. PAIN

2. Pain
Is unpleasant sensory and emotional
experience associated with actual and
potential tissue damage.
It is considered the fifth vital sign.
It is one of the human body defense
mechanisms that indicates the person is
experiencing problem.

3. Sources of Pain
Nociceptive: pain that is usually transmitted
after normal processing of noxious stimuli
–Cutaneous (superficial): usually involves the
skin or the subcutaneous tissue
–Somatic: is diffuse or scattered and originates in
tendons.
–Visceral: is poorly localized and originates in
body organs
Neuropathic: results from injury or abnormal
functioning of peripheral nerves or CNS
Psychogenic: unknown physical cause

4. PHYSIOLOGY OF PAIN
SOURCES
Chemical/Thermal
Injury, Inflammation Heat, Cold
PAIN RECEPTORS
(Nociceptors)
Histamine, Bradykinin, Serotonin, E-prostaglandin
DISCHARGE IMPULSES
Electrical Activity to spinal cord and onto the Brain
BRAIN = Electrical activity becomes the
experience of
PAIN

5. Duration of pain
Acute pain: generally rapid in onset, varies
in intensity from mild to severe, lasts from
brief period to less than 6 months
Chronic pain: may be limited, intermittent or
persistent but lasts for 6 months or longer
and interferes with normal functioning.
–Remission: when the pain present but the
patient does experience symptoms
–Exacerbation: reappear of symptoms
–Intractable pain: resistant pain to therapy, and
persists despite a variety of interventions

6. Origin of Pain
Physical cause —cause of pain can be
identified
Psychogenic —cause of pain cannot be
identified
Referred —pain is perceived in an area
distant from its point of origin

7. Perception of Pain
Pain threshold: is the lowest intinsity of
stimulus that causes the subject to
recognize pain
Adaptation
Modulation of pain
–Neuromodulators
–Endorphins, dynorphins enkephalins

8. Common Responses to Pain
Physiologic: ↑BP, ↑HR,↑RR, pupil dilation,
muscle tension and tension rigidity, pallor,
↑adrenaline level, ↑blood glucose
Behavioral: moving from painful stimuli,
grimacing, moaning, crying, restlessness,
protecting painful area
Affective: exaggerated weeping, withdrawal,
anxiety, depression, fear, anger, anorexia,
fatigue, hopelessness, powerlessness.

9. Factors Affecting Pain
Experience
Culture
Ethnic variables
Family, gender, and age variables
Religious beliefs
Environment and support people
Anxiety and other stressors
Past pain experience

10. General Assessments of Pain
Patient’s verbalization and description of pain
Duration of pain
Location of pain
Quantity and intensity of pain
Quality of pain
Chronology of pain
Aggravating and alleviating factors
Physiologic indicators of pain
Behavioral responses
Effect of pain on activities and lifestyle

11. Pain Assessment Tools

12. Pain assessment tools
WILDA Scale
–Words that describe the pain
–Intensity of pain
–Location of pain
–Duration of pain
–Aggravating or alleviating factors

13. Diagnosing Pain
Type of pain
Etiologic factors
Behavioral, physiological, affective response
Other factors affecting pain process

14. Nursing Interventions for Pain
Establishing trusting nurse-patient
relationship
Initiating nonpharmacologic pain relief
measures
Considering ethical and legal responsibility
to relieve pain
Teaching patient about pain

15. Manipulating Pain Experience
Factors
Remove or alter cause of pain
Alter factors affecting pain tolerance
Initiate nonpharmacologic relief measures

16. Nonpharmacologic Pain Relief Measures
Distraction
Humor
Music
Imagery
Relaxation
Cutaneous stimulation
Acupuncture
Hypnosis
Therapeutic touch

17. Pharmacologic Pain Relief
Measures
Analgesic administration
Nonopiod analgesics e.g. NSAIDs
Opioids or narcotic analgesics
Adjuvant drugs e.g. anticonvulsants,
antidepressants, ..

18. Why clients may be reluctant to
reportpain:
Unwillingness to trouble staff who are perceived as
busy
Fear of injectable route of analgesic administration
Belief that pain is to be expected as apart of the
recovery process
Belief that pain is a normal part of aging
Belief that expression of pain reveal weakness
Concerns about side effects and risks especially of
opioid drugs

19. Additional Methods for
Administering Analgesics
Patient controlled analgesia
Epidural analgesia
Local anesthesia