Module 8A Pain management Flashcards
Physiologic Mechanism of Noxious Pain
Transduction
Transmission
Perception
Modulation
PAIN
Pain is complex and has physical, emotional, and cognitive components
Depletes energy
Interferes with relationships
If not treated or treated appropriately, pain can have serious consequences, affecting many or all aspects of a person’s life.
‘It is not the responsibility of the patient to prove that he or she is in pain; it is a nurse’s responsibility to assess a patient’s condition and accept his or her subjective account.”
PAIN MANAGEMENT
Should be patient centered and have a team approach
Compassion and communication are essential in managing pain effectively
Benefits of effective pain management :
Improves quality of life
Reduces physical discomfort
Promotes earlier mobilization and return to previous baseline functional activity
Results in fewer hospital and clinic visits
Decreases hospital length of stay
PAIN CLASSIFICATION
Nociceptive Pain
Normal stimulation of special peripheral nerve endings (nociceptors). Pain results from activity in neural pathways secondary to actual tissue damage, or potentially tissue-damaging stimuli.
Somatic
Visceral
Neuropathic Pain
Abnormal processing of sensory input by the peripheral or central nervous system. Pain initiated by nervous system lesions or dysfunction.
Neuropathies
Phantom pain
TYPES OF PAIN
Acute Chronic Chronic Episodic Cancer Idiopathic Somatic Visceral
Acute pain
Transient, protective, Usually has an identifiable cause, Short duration, Limited tissue damage and emotional response, Common after acute injury, disease or surgery, Eventually resolves, with or without treatment
Chronic pain
prolonged, not protective, has a dramatic effect on quality of life, varies in intensity, usually lasts longer than expected (at least 6 months), does not always have an identifiable cause, major cause of psychological and physical disability
Cancer pain
usually caused by tumor progression, invasive procedures, chemo, infection. Not all patients with cancer have pain.
Chronic Episodic pain
pain that occurs sporadically over an extended period of time. Pain episodes can last for hours, days, or weeks
Idiopathic pain
chronic pain without an identifiable physical or psychological cause or pain perceived as excessive for a pathological condition.
Somatic pain
-musculoskeletal pain comes from bone, joint, muscle tissue, connective tissue, usually well localized
Visceral pain
-arises from internal organs-can be well localized or poorly localized, depending on the organ and what is occurring.
ASSESSMENT OF PAIN
Numeric Pain Intensity Scale: 0-10
Simple Descriptive Pain Intensity Scale
Visual Analogue Scale (Thermometer Scale)
FLACC (Face, Legs, Activity, Cry, Consolability)
FACES (Wong-Baker Faces Scale)
There are many more!
These are the most commonly used.
PQRSTU
P=Provocative/Palliative
What causes your pain? What makes it better/worse?
Q=Quality
What does it feel like?
Is it sharp/dull/stabbing/burning/crushing/aching…etc
Always try to let the patient describe first, only give suggestions if they struggle
R=Radiates or Region (location)
Does the pain go anywhere else? Does it radiate?
S=Severity
0-10 scale, faces scale
T= Time
When did the pain start? How long did it last? Constant or intermittent?
U= Understanding
How does this pain affect you?
Does it make it difficult to: move, breathe, eat, sleep, etc.?
Do you know what is causing this pain, have you had pain like this before?
PHYSIOLOGIC AND BEHAVIORAL INDICATORS OF PAIN
Increased heart rate Change in Respiratory pattern and/or rate Increase in blood pressure Decrease in SpO2 Moaning, crying Grimacing Restlessness Reduced attention span Protective movements of body parts
Remember: The MOST reliable indicator of pain is always the subjective report from the patient! However, we also do objective pain assessments as well (non verbal scale).
