CONCEPT OF PAIN

Objectives:
 Identify appropriate pain assessment
tool for a given age group.
 Statesrelevant priority nursing
diagnosis with a given set of cues.
 Utilizes
appropriate non
pharmacological interventions to
reduce client’s pain.
 Administer prescribed pain
medication.
Definition:
It is an unpleasant sensory &
emotional experience with actual or
potential tissue damage.
It is an abstract concept referring to a
personal , private & impending tissue
damage.
It is a pattern of responses to protect
an organism to harm.
It is whatever the experiencing person
say it is & existing whenever the
person say it does.
It is the 5th vital sign.
Theories of Pain

1.Specificity theory
a. Pain is viewed a s a specified
sensory modality.
b. Brain as the single pain center in the
body.
2.Pattern theory

a. There is no specific fibers or

specific nerve endings for pain. All
nerve fiber endings are alike.
b. The nerve impulse pattern for pain
is produced by intensive stimulation
of non- specific receptors.
c. Concept of Central Summation.
3. Gate Control Theory
a. Substancia gelatinosa in the
dorsal horn of the spinal cord acts as
a gate mechanism that can close to
keep the pain impulses from
reaching the brain or cam open to
allow pain impulses to ascend the
brain.
b. Most pain impulses are conducted
over small- diameter nerve fibers.
Types of pain
A. Duration
1. Acute Pain
 Short duration(< 6 months)
 Identifiable, Immediate & Limited onset
 Reversible with adequate treatment
 Subsides as healing occurs
 Observable signs & symptoms
 Symptoms are related to sympathetic
nerve system stimulation as part of
“fight-flight response”
 2.Chronic Pain
 Longer duration (>6 months)
 Constant, continuous and difficult to
bear
 Limitsnormal functioning and not
readily treatable
 Persists long after injury has healed.
 Rarely
accompanied by the autonomic
nervous system activity.
 3.Cancer-Related Pain
 Acute or Chronic Pain
 Directly associated with the
cancer disease, result of cancer
treatment or not associated with
cancer.

B. Location
C. Etiology
Factors Influencing Pain
Response
 Past experiences
 Anxiety and Depression
 Culture
 Age
 Gender
 Placebo Effect
 Pain Perception
 Pain Threshold
 Pain Tolerance
Assessment of Pain

a. Highly subjective nature of

pain
b. Reviews the patient’s
description of pain and other
factors that influences pain &
pain responses.
c. Documentation of pain level
through assessment tools.
Characteristics of Pain
1. Intensity
 Intensity
is influenced by the person’s
pain threshold and pain tolerance.
2. Timing
 Inquiry
about the time onset, duration,
frequency and pattern
3. Location
 Area of involvement or affected
 4. Quality
 Personal description of pain
5. Personal meaning
 How pain has affected the patient’s
daily life.
6.Aggravating and Alleviating Factors
7. Pain Behaviors
 Behavioral & nonverbal expression of
pain
 Physiologic responses to pain
Pain Assessment Scales &
Tools
 Purpose of Assessment tools
-To document the need for intervention
 Characteristics of Assessment Tools
1. Little effort on the part of the patient
2. Easy to understand & use
3. Easily Scored
4. Sensitive to changes
Types of Assessment Tools
1. Visual Analogue Scales
 Useful in the assessment of the intensity
of pain
 A horizon 10cm line with anchors or ends
indicating the extremes of pain.
2. Revised Faces Pain Scale
 Seven faces depicting expressions that
range from contented to obvious distress.
 Suited for helping children describe pain
3. Simple Descriptive Pain
Intensity Scale
4. Numeric Pain Intensity Scale
Primary Nursing Diagnosis for
Patients with Pain
 Activity Intolerance related to unrelieved pain.
 Ineffective coping strategies related to lack of
knowledge of the coping methods
 Powerlessness related to lack of participation
in decision making process
 Sleep pattern disturbance related to
unrelieved pain at night.
 Knowledge deficit related to lack of exposure
to information resources
 Fear related to anticipation of a pain
experience
Objectives of Nursing Care for Patients in Pain

Report freedom from pain

Request Analgesia
Perform daily activities
with limitation related to
pain
Nurse’s Role in Pain Management
1. General Role of Nurses in Pain
Management
 Administers pain relieving interventions.
 Assesses effectiveness of implemented
interventions.
 Monitors for adverse effects of interventions.
 Serves as advocate for patient when
prescribed intervention is ineffective.
 Serves as educator to patient and family to
manage prescribed intervention.
 2.Specific Role of Nurses in Pain
Management
 Identifyinggoals for Pain
Management
-Factors to be considered in order
to identify goals
a. Severity of pain
b. Anticipated harmful effects of
pain
c. Anticipated duration of pain
 Establishing
Nurse-Patient Relationship
and Teaching
 Elements in Nurse-Patient Relationship
 A. Open communication
 B. patient Cooperation
 C. Trust
 Teaching Content of Pain Management
 A. Pain
 B. Pain Strategies
 C. Pain Control
 Providing Physical Care
 Managing Anxiety Related to Pain
 A.Anxiety affects patient’s response tp
pain.
 B. Teaching patient about nature of
impending painful experience and ways to
reduce pain often decrease anxiety.
 C. Patient’s anxiety may be reduced by
explanation that point out to the degree
of pain relief that can be expected from
each Measure.
 Evaluation
 A. Client Response
 B. Changes in pain
 C. Client’s perception of the effectiveness
of the therapy
1. Achieves pain relief
2. Patient and family administer prescribed
analgesia medications correctly
3. Uses Nonpharmacologic strategies
4. Reports minimal effect of pain and
minimal side effects of intervention.
Non pharmacologic Interventions
 Guided Imagery
 Thought stopping
 Hypnosis
 Aromatherapy, essential oils
 Magnet Therapy
 Music Therapy
 Yoga and Meditation
 Acupuncture
 Crystal and gemstone therapy
 Herbal Therapies
 Biofeedback
 Therapeutic touch and massage
 TENS
 Heat and Cold Application
 Pharmacologic Pain Relief
ANALGESIC
A. Classification
*Narcotic
*Non-narcotic analgesic

B. Method of Administration
*Topical *Oral
*IM * IV
*PCA * Conscious Sedation
* Intranasal * Local Injection
*Epidural
C. Surgical Destruction of Painful
Stimuli
 Rhizotomy
 Nerve Block
 Continuous
 Extravascular Infusion
 Neurectomy
 Sympathectomy
 Establishing Nurse Patient Relationship
and Teaching
- Elements in Nurse- Patient Relationship
a. Open Communication
b. Patient Cooperation
c. Trust
- Teaching Content in Pain Management
a. Pain
b. Pain Strategies
c. Pain Control
 Providing Physical Care
 Managing Anxiety Related to Pain
a. Anxiety affects patient’s response to
pain.
b. Teaching patient about nature of
impending painful experience & ways
to reduce pain often decreases anxiety.
c. Patient’s anxiety may be reduced by
explanations that point out the degree
of pain relief that can be expected from
each measure.
Evaluation

 Client Response
 Changes in pain
 Client’s Perception of the
effectiveness of the
therapy
1. Achieves Pain Relief
a. Rates pain at a lower intensity
after intervention
b. Rates pain at a lower intensity for
longer periods.
2. Patient and family administer
prescribed analgesia as in dicated
3. Uses non- pharmacological
strategies
4. Reports minimal effects of pain and
minimal side effects of interventions