Understanding Pain and Pain Management

Understanding Pain and Pain Management

Pain management is a critical area of healthcare that deals with the assessment and treatment of pain. Pain is a complex sensory and emotional experience that is often associated with tissue damage or potential tissue damage.

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Slide1Pain ManagementC. Calzolari 2014

Slide2What is Pain?

Slide3Why Do We Experience Pain? It is protective. How?  It is a signal. What?

Slide4Cause of Pain Nociceptive pain(pain receptors) – most common. Respond to stimulation.  Visceral – organs , linings of cavities  Somatic – Skin, muscles, bones, connective tissue  Neuropathic pain – complex and often chronic.

Slide5Classification of PainAcute  Can Identify Cause  Temporary  Activates SNS  -     BP, HR, RR, more blood to brain, dilates pupils

Slide6Classification of PainChronic  Longer Duration – lasts beyond healing phase  Interferes with ADLs  Remissions & exacerbations  Stimulates PNS -         or normal Vital Signs  Affective Responses

Slide7Classification of PainIntractable Chronic Resistant to pain relief Multi-Disciplinary Approach

Slide8Descriptions of Pain Based on site, cause, duration and quality.

Slide9Site of Pain Cutaneous or superficial pain  Visceral pain  Deep somatic pain  Radiating pain  Referred pain  Phantom pain  Psychogenic pain

Slide10Duration of Pain Acute  Chronic  Intractable

Slide11Take the Vocabulary Quiz

Slide12Application How would you classify the pain that the following patients are experiencing?  ●  A patient with metastatic cancer

Slide13A patient with back pain that was the result of an automobile injury a year ago

Slide14A patient with a broken leg

Slide15Quality of Pain Only the patient can describe the quality of their pain.  They may use words such as:  Sharp  Dull  Throbbing  Stabbing  Burning  Ripping  Tingling  Intermittent  Constant  Mild  Intense  Severe

Slide16Factors Which Influence Pain Emotions  Developmental Stage  Communication Impairments  Pain Threshold  Culture

Slide17Factors Which Influence Pain Emotions:  Anxiety  Fear  Guilt  Anger  Helplessness  Exhaustion  Irritability  Depression

Slide18Factors Which Influence Pain Developmental Stage:  Infants and children  Adults  Older Adults

Slide19Factors Which Influence Pain Communication Impairment:  Those who have had a CVA, speak another language or are cognitively impaired.  You will need to observe nonverbal cues for pain.  Facial expressions  Vocalizations  Changes in physical activity  Change in vital signs  Change in routines  Mental status changes

Slide20Factors Which Influence Pain Culture:  Involves the patient’s expression of pain, the family’s response to the situation and the nurse’s attitude.  William & Hopper: Box 10.2 – page 143- 144

Slide21Factors Which Influence Pain Pain Threshold:  The point at which the receptors in the frontal cortex recognizes and defines a stimulus as pain.  Varies from person to person.  Pain Tolerance:  The duration or intensity of pain that a person is willing to endure.

Slide22Pharmacological Pain ReliefMeasures  Analgesics  Nonopioids – acetaminophen, salicylates, NSAIDS and COX -2 inhibitors  Opioids  -  morphine, codeine, hydromorphone, methadone, meperdine, oxycodone, sublimaze patch


Slide24Routes of Administration Oral – preferred route  Nasal  Transdermal  Rectal  Subcutaneous  Intramuscular – least preferred  Intravenous  PCA – patient controlled analgesia  Intraspinal analgesics

Slide25Adverse Affects of Pain Medications Nonopioids – GIB, inhibition of platelet aggregation, renal insufficiency, hypersensitive reactions in persons with asthma, liver necrosis with OD of Tylenol.  Opioids – respiratory depression, hypotension, drowsiness, constipation, nausea, vomiting, constricted pupils.

Slide26Analgesic Adjuvants These medications may potentiate the effects of opioids or nonopioids.  Examples: steroids, benzodiazepines, tricyclic antidepressants, and anticonvulsants.  Able to use less opioid doses when used with these adjuvants.

Slide27Antidote Narcan ( naloxone )- counteracts the effect of opioids.

Slide28Interpreting MD Orders Morphine Sulfate 2 mg. IM q 4 hours prn for surgical pain.  Percocet one tab po q 6 hours prn for foot pain  Duragesic patch 25mcg/hr transdermal q 72 hours at 0800.  Oxycontin 20 mg. po BID  OxyIR 5 mg. po q 6 hours prn for breakthrough pain

Slide29Evaluation Always re-assess your patient after administering pain medications.  At what time interval?

Slide30Special Considerations The Elderly  The Person with Substance Abuse or Addiction  Unrelieved Pain

Slide31Nonpharmacological Pain Relief Measures Cutaneous Stimulation  TENS – Trancutaneous Electrical Nerve Stimulator  Acupuncture  Acupressure  Massage  Hot and Cold TX

Slide32Transelectrical Nerve Stimulation



Slide35Acupressure Based on the same principles as acupuncture, (but using pressure instead of needles), acupressure works by stimulating specific reflex points located along the lines of energy which run through the body, called meridians.


Slide37Hot & Cold Therapies

Slide38Nonpharmacological Pain ReliefMeasures  Surgery  Immobilization  Splints, slings, braces  Cognitive-Behavioral Interventions  Distraction  Relaxation Techniques  Guided Imagery  Hypnosis  Therapeutic Touch  Humor

Slide39Guided Imagery start the day meditation - guided imagery – YouTube  Guided Imagery - Bubble Release - YouTube


Slide41Biofeedback Biofeedback Session Demo – YouTube  http://www.youtube.com/watch?v=a53LA 7aL2Og

Slide42The Nursing Process Lets Start With You, as a student nurse and health care providers.

Slide43The HCW’s Perception of Pain What are some myths associated with pain management that you have witnessed in the healthcare setting?

Slide44Nursing Process: Collect Data The fifth vital sign .  Accept the patient’s report of pain.  Obtain a pain history.  Perform a physical assessment.  Observe for nonverbal indicators of pain.  Use WHAT”S UP format and pain scales.

Slide45WHAT”S UP? W here is the pain?  H ow does the pain feel?  A ggravating & alleviating factors.  T iming.  S everity.  U seful other data.  P erception.

Slide46Pain Scales Visual Analog Scale  Numerical Rating Scale  The Wong-Baker FACES pain Rating Scale

Slide47Analgesic Administration Use resources to check on purposes and actions of pharmacological agents  Reconcile & maintain MAR +/or Patient’s list of medications.  Identify patient’s allergies and intervene as appropriate.

Slide48Identify a contraindication to administration of a prescribed medication.  Acetaminophen Caution and Guidance

Slide49Case Study: Mr. Lewis Answer ONLY these questions for Now:  1.  2.  4.

Slide50Planning Use data collected to plan action with patient’s input.  Teach patient to use pain scales.  Set goals for acceptable pain levels.  Example: you will ask your patient who is in pain, “What is an acceptable level of pain for you after we have helped you relieve your pain?”  “What has helped in the past to relieve your pain?”

Slide51Drug Calculations

Slide52Nursing Diagnoses Nursing Diagnosis:   Pain, acute or chronic,    Impaired Comfort  Others: Self-Care Deficit, Impaired Mobility, Sleep Deprivation, Ineffective Airway Clearance, Ineffective Coping.

Slide53Interventions Apply therapies for comfort.  Use alternative/complementary therapies for pain management.  Administer pain medication as prescribed.  Identify patient expected response to pain medication.   Reinforce client teaching on possible effects of medication.     

Slide54Follow rights of medication administration.   Maintain medication safety practice.   Follow protocol for handling controlled substances.  Monitor patient use of medication over time.  Maintain pain control devices.

Slide55Evaluation Monitor and document patient’s response to pharmacological and non – pharmacological interventions.   Notify primary healthcare provider of actual/potential adverse effects of pain medications.

Slide56 Explain the protocol for withholding pain medication if patient experiences an adverse reaction.    Discuss actions used in the event of adverse reactions with the use of opioids.

Slide57What Happens When SomeoneHas Pain?  Transduction -  Stimuli: mechanical, thermal, chemical  Transmission-  A-Delta Fibers & C Fibers  Pain Perception-  Cerebral Cortex & Limbic System  Pain Modulation-  Endogenous opioids, neurotransmitters  http://youtu.be/n2Jzt3zd8vQ

Slide58Case study: Mr. Lewis Finish the case study with your partner(s)

Slide59Role Playing & Case Scenarios Utilize your Medication Research cards and The Joint Commission Handout, “SpeakUP” to perform these excercises.