Acute Pain Management Flashcards
What is Pain?
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”
What are the barriers to pain relief?
- Clinical barriers
- System barriers
- Patient barriers
Pain relief: Clinical Barriers
- Inadequate assessment or underestimate of patients pain by clinicians
- Inappropriate prescribing or under-administration of analgesia
- Lack of awareness and education of health care professionals
- Misconceptions about analgesic side effects (particularly opiods)
Pain relief: System Barriers
- Lack of institutional commitment or resources
- Regulatory concerns
- Insufficient access to (or reimbursement) for interdisciplinary care
- Issues around professional territory
Pain relief: Patient Barriers
- Inadequate knowledge
- Cognitive or language communication barriers
- Patient reluctance to report pain or to take analgesia
- Fear of addiction, side effects from analgesics or injections
- Misconception that pain indicates disease progression or that pain is inevitable
- Patients not wanting to complain or interrupt staff
Physiological Effects of pain
- General stress response- Increase in adrenaline and noradrenaline; decrease in insulin→ delay in wound healing
- Respiratory→ Decrease in residual capacity→ atelectasis and pneumonia
- Cardiovascular→ coronary vasoconstriction→ MI, decrease in limb blood flow→ DVT
- GIT→ Decreased mobility→ constipation
- Urinary→ Increased sphincter activity and urinary retention
- Musculoskeletal→ muscle spasm, decreased mobility→ muscle atrophy
Psychological Effects of Pain
- Increasing anxiety,
- Helplessness,
- Depression,
- Inability to sleep; 4 times more likely to suffer from depression/anxiety
Social Consequences of Pain
- Pain has social consequences for people experiencing it and often also for their caregivers, who may face sleep deprivation and other problems as a result, inability to work, care for children or other family members, and participate in social activities
Nurses central role and responsibility in the assessment and management of pain means they are required to be knowledgeable about:
- Pain mechanisms
- The epidemiology of pain
- Barriers to effective pain control
- Frequently encountered pain conditions
- Variables which influence the patient’s perception of and responses to valid and reliable methods of clinical pain assessment, and a range of available methods for the alleviation of pain
Acute Pain
- The cause is usually clear, it is usually easy to ‘see’ the pain, such as injury or infection
- A complex unpleasant experience that occurs in response to body trauma. It can affect the body and the mind
- Acute pain associated with trauma, surgery or acute medical conditions
- It lasts few days or weeks until healing has occurred
- Acute pain is pain that has been present for less than 3 months
- WIth acute pain the biological factors may predominate but over time, psychological and social factors may assume a disproportionate role in accounting or symptoms and disability
- High fear avoidance beliefs in patients
- Association between anxiety, pain, depression, psychological vulnerability and stress
- Preoperative anxiety and depression are associated with higher postoperative pain intensity
- The severity of acute pain is a risk factor for progression to chronic pain
Chronic Pain
- Pain that has been present for longer than 3 months
- Pain which persists beyond the usual duration of an acute injury or disease of beyond healing time
- It is persistent pain that can disrupt sleep, mood and normal living
- The cause is not always clear
- Most, but not all, chronic pain starts as acute pain
- Injury/infection
- Arthritis- ongoing
- However some people suffer chronic pain in the absence of any past injury or evidence of disease
- Chronic pain is like any other chronic condition (like diabetes) it can have a big effect on people’s lives and often needs long term management
Pain is a symptom to the type of pain it describes
- We do not have nerves that are specific to pain, but we have nerve receptors that are sensitive to heat and cold, pressure and chemicals
- Pain threshold is the point at which you notice pain
- Pain tolerance is how much pain you can stand before you run away
Nociceptive
- The ability of the body to detect toxins (harmful) and potentially tissue- damaging stimuli is an important protective mechanisms
- Nociceptive pain is pain arising from activation of nociceptors- a peripheral nerve ending or sensory receptor that is capable of transducing and encoding noxious stimuli
- Nociceptive afferents nerves) are widely distributed throughout the body (skin, muscle, joints, viscera, meninges)
Neuropathic Pain
- Is pain initiated or caused by a primary lesion or dysfunction in the nervous system
- Following nerve injury structural and functional changes to the pain pathways occur
Pain assessment- PQRSTU
P→ Provoking/palliative factors- what makes the pain better or worse
Q→ Quality- Describe what the pain feels like in your own words
R→ Region and radiation- where is it> Does it radiate> Does it occur anywhere else? Have the client point to the body area that is painful
S→ Severity- Have the client rate their pain intensity using a pain rating scale. How much pain do you have at rest? How much pain do you have with movement/coughing
T→ Time of onset/duration- When did the pain begin? How long does the pain last?
U→ Clients understanding- What is the client’s understanding of the cause of pain? What treatments have they tried to relive it?
