Caring for Caring for Individuals Individuals

Experiencing PainExperiencing Pain

NURS 2016NURS 2016

PainPain

• An unpleasant An unpleasant sensory and sensory and emotional emotional experienceexperience

• Associated with Associated with actual or potential actual or potential tissue damagetissue damage

• Tells us that Tells us that something is wrong something is wrong with our boddywith our boddy

Pain PerceptionPain Perception

Subjective Subjective ExperienceExperience

• Past experiencePast experience• Anxiety/depressionAnxiety/depression• Culture and Culture and

ethnicityethnicity• AgeAge

Categorizing PainCategorizing Pain

ByBy• DurationDuration• LocationLocation• EtiologyEtiology

PainPain

• Pain is now considered another VITAL Pain is now considered another VITAL SIGNSIGN

• 3 main types of pain3 main types of pain– AcuteAcute– ChronicChronic– Chronic (malignant)Chronic (malignant)

• It is important to listen to what It is important to listen to what patients tell you about their painpatients tell you about their pain– VerballyVerbally– NonverballyNonverbally

Acute PainAcute Pain

• Recent onsetRecent onset• Associated with a specific causeAssociated with a specific cause• Decreased with healingDecreased with healing• Duration of seconds to 6 monthsDuration of seconds to 6 months

Chronic PainChronic Pain

• Constant or intermittentConstant or intermittent• Last beyond expected healing timeLast beyond expected healing time• Origin is unclear: person can not Origin is unclear: person can not

easily identify where pain is coming easily identify where pain is coming fromfrom

• Duration longer than 6 monthsDuration longer than 6 months• No useful purposeNo useful purpose

Malignant or Cancer-Malignant or Cancer-related Painrelated Pain

• Acute or chronicAcute or chronic• Associated with tumor formation, Associated with tumor formation,

treatment or traumatreatment or trauma• 22ndnd most common fear for people dx most common fear for people dx

with cancerwith cancer• Cyclic: pain, anxiety, fear, . . . painCyclic: pain, anxiety, fear, . . . pain

Breakthrough Pain

Drug Addiction

Drug Dependence

Drug Tolerance Analgesic

Analgesia

Opioids

Pain Threshold

Pain Tolerance

Painful Terms

Physiological Basis of Physiological Basis of PainPain

• Nociceptive System: the system involved Nociceptive System: the system involved in the transmission and perceptions of in the transmission and perceptions of painpain

• Nociceptors: free nerve endings in the Nociceptors: free nerve endings in the skin that respond only to intense, skin that respond only to intense, potentially damaging stimuli potentially damaging stimuli (mechanical, thermal, chemical)(mechanical, thermal, chemical)– Joints, skeletal muscle, fascia, tendons, and Joints, skeletal muscle, fascia, tendons, and

cornea also have pain receptors.cornea also have pain receptors.

Physiology of PainPhysiology of Pain

• Referred PainReferred Pain– Results from intense stimulation of the Results from intense stimulation of the

visceral branch of a nerve fibre, leading visceral branch of a nerve fibre, leading to vasodilation and pain in the area of the to vasodilation and pain in the area of the body associated with that fibre.body associated with that fibre.

• Chemical mediators of painChemical mediators of pain– Prostoglandins increase the sensitivity to Prostoglandins increase the sensitivity to

painpain– Endorphins or enkephalins decrease the Endorphins or enkephalins decrease the

sensitivity to painsensitivity to pain

Nursing Process related Nursing Process related to Painto Pain

• AssessmentAssessment• PlanningPlanning• InterventionIntervention• EvaluationEvaluation

Assessing PainAssessing Pain

Perception of PainPerception of Pain• Verbal descriptionVerbal description

– IntensityIntensity– LocationLocation– Timing: onset, durationTiming: onset, duration– Factors that relieveFactors that relieve– Personal meaningPersonal meaning

• Impact on activitiesImpact on activities• Concerns about painConcerns about pain

Pain Assessment ToolsPain Assessment Tools

• Pain Intensity Pain Intensity ScalesScales– Visual analoguesVisual analogues– Rating 1-10Rating 1-10– Smiley facesSmiley faces

Physiological Responses Physiological Responses to Painto Pain

Very individualVery individual• Increased heart rateIncreased heart rate• Increased BPIncreased BP• PallorPallor• DiaphoresisDiaphoresis

Chronic pain sufferers may show no Chronic pain sufferers may show no phys signs of painphys signs of pain

Behavioural Responses Behavioural Responses to Painto Pain

• Facial expressionsFacial expressions• Body movementsBody movements• MoaningMoaning• Clenching fistsClenching fists• WithdrawingWithdrawing• Etc.Etc.

Factors Influencing Pain Factors Influencing Pain ResponseResponse

• Past ExperiencePast Experience• CultureCulture• AgeAge• Anxiety & DepressionAnxiety & Depression

PlanningPlanning

• Consider Consider assessment dataassessment data

• Nursing DiagnosisNursing Diagnosis

• In collaboration In collaboration with clientwith client

Develop Pain Develop Pain Management GoalsManagement Goals

Pain Management Pain Management Strategies and Nursing Strategies and Nursing

InterventionsInterventions• Non-pharmacolgicalNon-pharmacolgical

– Cutaneous Stimulation and MassageCutaneous Stimulation and Massage– Transcutaeous Electrical Nerve StimulationTranscutaeous Electrical Nerve Stimulation– Ice and HeatIce and Heat– Relaxation techniquesRelaxation techniques– DistractionDistraction– HypnosisHypnosis– Emotional supportEmotional support– Trusting relationship: encourage Trusting relationship: encourage

communicationcommunication

Pain Management Pain Management Strategies and Nursing Strategies and Nursing

InterventionsInterventionsPharmacologicalPharmacological• Balanced Analgesia: opioids, NSAID, Balanced Analgesia: opioids, NSAID,

anestheticsanesthetics• Regular medication administration: Regular medication administration:

maintain steady reliefmaintain steady relief• Pro Re Nata: traditional standard – Pro Re Nata: traditional standard –

often leaves clients sedated or in painoften leaves clients sedated or in pain

*Preventative approaches**Preventative approaches*

Pain Management Pain Management Strategies and Nursing Strategies and Nursing

InterventionsInterventionsPharmacologicalPharmacological• Local Anesthetics: block nerve Local Anesthetics: block nerve

conductionconduction• NSAIDs: inhibit production of NSAIDs: inhibit production of

prostoglandins from inflamed or prostoglandins from inflamed or injured tissue.injured tissue.

• Opioids: act as agonists at specific Opioids: act as agonists at specific opioid receptors in the CNS. Mimick opioid receptors in the CNS. Mimick endorphinsendorphins

Evaluation of Pain Evaluation of Pain ManagementManagement

Intervention

Post-intervention data

Pre-intervention data

Triple Whammy EffectTriple Whammy Effect

• Clients under-Clients under-report their painreport their pain

• Physicians under-Physicians under-prescribeprescribe

• Nurses under-Nurses under-administeradminister

What impact does What impact does unrelieved pain have on unrelieved pain have on

people?people?PositivePositive NegativeNegative

Final words . . .Final words . . .

• Use the Nursing Process in caring Use the Nursing Process in caring for your clients experiencing painfor your clients experiencing pain

• Listen and value client perceptionListen and value client perception• Provide supportProvide support