Pain Flashcards
Pain; definition
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Different definitions of pain
-Whatever and wherever the person experiencing pain says it is.
-Unpleasant sensory and emotional experience associated with actual or potential tissue damage.
-Multidimensional and entirely subjective.
-Pain can be experienced in the absence of identifiable tissue damage.
-Pain is not synonymous with suffering.
-Pain is subjective - it is entirely the clients experience and self report is essential.
Pain
-A major problem that causes suffering and reduces quality of life.
-One major reason why people seek health care.
-Nurses have a central role in assessment and management of pain.
-Effective pain relief is a basic human right.
Pain Management; an individuals rights
-Their pain to be acknowledged and expected.
-The best possible personalized evidence-based pain assessment and management including relevant bio-psychosocial components.
-Ongoing information and education about the assessment and management of pain.
-Involvement as an active participant in their own care in collaboration with the inter professional team.
-Communication and documentation among interprofessional team members involved in their care to monitor and manage their pain.
Nursing intervention; pain
-Assess pain, document it, and communicate with other health care providers.
-Ensure delivery of adequate pain relief measures.
-Evaluate effectiveness of interventions.
-Monitor ongoing effectiveness of pain management strategies.
-Provide education to clients and their families.
Consequences of untreated pain…
-Unnecessary suffering.
-Physical and psychosocial dysfunction.
-Impaired recovery from acute illness and surgery.
-Immuno-Suppression
-Sleep disturbances
Dimensions of pain
-Physiological
-Sensory-Discriminative
-Motivational-affective
-Cognitive-evaluative
-Sociocultural
Causes and types of pain; by underlying pathology
Nociceptive
-Somatic
-Visceral
Neuropathic
Causes and types of pain; by duration
-Acute
-Persistent
Acute pain
-Sudden onset
-Usually within the normal time for healing
-Mild to severe
-In general, a precipitating illness or event can be identified
-Lowers over time and goes away as recovery occurs
-Manifestations reflect sympathetic nervous system activation:
•Increased HR
•Increased RR
•Increased BP
•Diaphoresis, Pallor
•Anxiety, agitation, confusion
NOTE: responses normalize quickly owing to adaptation
-Goal is pain control with eventual elimination.
Persistent Pain
-Gradual or sudden
-May start as acute injury but continues past the normal time for healing to occur
-Mild to severe
-cause may not be known; original cause of pain may differ from mechanisms that maintain the pain
-Typically, pain persists and may be ongoing, episodic, or both -predominantly behavioural manifestations:
•Changes in affect
•Decrease in physical movement and activity
•Fatigue
•Withdraw from other people and social interaction
-Goal is minimizing pain to the extent possible; focusing on enhancing function and quality of life
Nursing assessment of pain
Assess for the presence or risk of pain
•on initial assessment and all subsequent assessments
• Each time vital signs are completed
•Prior to, during and after a procedure
•Prior to and following using pharmacological and non-pharmacological treatment for pain
Assessment: the patients pain goal or expectations of comfort and pain relief
Characteristics: intensity, timing, location, quality
Aggravating or reliving factors
Behaviours associated with the pain
Assesment
-PQRST
-Wong-baker FACES pain rating scale
Pain assessment; components
-Effects of pain on clients sleep and daily activities, relationships, physical activity, and emotional well-being should be assessed.
-Past pain experiences, meaning of pain for the client, ways client expresses the pain, and clients pain-Control strategies should all be included.
Pain Treatment: basic principles
-Routine assessment is essential for effective management
-Unrelieved acute pain complicates recovery
-Clients self-report of pain should be used whenever possible
-Health providers have a responsibility to assess pain routinely, to accept clients pain reports, to document them, and to intervene in order to manage pain.
-The best approach to pain management involves clients, families, and health providers.
Pain treatment: basic principles continued
-Many clients at high risk for suboptimal pain management - all clients should have assailants pain relief
-Treatment based on clients and family’s goals for pain treatment
-Combination of drug and non drug therapies
-Multidimensional and interdisciplinary approach
-Evaluation of therapies
-Prevent or manage adverse effects
-Client and caregiver teaching is the cornerstone of the treatment plan.
Drug therapy for pain
-Equianalgesic dose
-Scheduling analgesics
-Titration
Drug therapy for pain: analgesic ladder 1-3
Mild pain
-1-3 on a scale of 1-10
“Step 1” drugs
•nonopioid analgesics (aspirin and other salicylates, other NSAIDs, and acetaminophen (Tylenol))
-ceiling effect: increasing the dose beyond and upper limit provides no greater analgesia, no tolerance or physical dependence, many available without a prescription.
Drug therapy for pain: analgesic ladder 4-6
Mild to moderate pain
-4-6 on a scale of 1-10, or mild but Presistent despite nonopoid therapy
-“step 2” drugs
•Mu: morphine, oxycodone, hydromorohone, methadone
•opioid agonists (morphine)
•antagonists (naloxone)
•mixed (pentazocine, butorphanol)
Drug therapy for pain: analgesic ladder (severe pain)
Opioid analgesics commonly used for severe pain
-Morphine
-Morphine-like agonists (hydromorohone (dilaudid), methadone (metadol), fentanyl (duragesic), meperidine (Demerol) (not recommended))
-Mixed agonists - antagonists (butorphanol (stadol))
Adjuvant analgesic therapy
-used in conjunction with opioids and nonopioids
-Sometimes called coanalgesics
-Enhance pain therapy through one of three mechanisms:
1.enhancing the effects of opioids and non opioids
2.possessing analgesic properties of their own
3. Counteracting adverse effects of other analgesics
Non-pharmacological therapy
-Massage
-Therapeutic exercise
-TENS
-Application of heat
-Application of cold
-Cognitive techniques
•Distraction
•Relaxation strategies
•Self-management
Tolerance
A persons diminished response to a drug, which occurs when the drug is used repeatedly and the body adapts to the continued presence of the drug
Addicition
Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and sue despite adverse reactions
Dependence
Use of drugs of alcohol that continues even when significant problems related tot here use have developed
Trends and changes in the treatment of pain
-Clinicians confuse physical dependence, tolerance, and addiction and are more likely to assess pain by observing behaviours rather than believing or eliciting a clients report.
-Growing interest in inter professional educational intervention trials for practicing health care providers that target common pain-related misconceptions.
Trends and changes in the treatment of pain continued
-International association of the study of pain has published a core curriculum plan
-Provincial organizations such as the RNAO have also developed evidence informed practice guidelines on pain
-Opioid crisis and recent legal outcomes for pharmaceutical companies.
