Pain Managment.pptx

 FOUZIA BATOOL

 AYESHA MUZAFAR

 MARIA MUNIR

 MARI A TUFAIL

PRESENTED TO SIR TANZEEL ur REHMAN

 By the end of this presentation.

We will be able to learn:

 _{Definition of pain}  Types of pain

 Classification of pain  _{Assessment of pain}

 _{Pain management Scale}  _{Pain pathway}

 Physiology of pain

Pathology of pain

Management of pain

Definition:

“PAIN Is an unpleasant sensory and

emotional experience associated with

actual and potential tissue damage, or

described in terms of such damage”

It is always subjective.

(American Pailn Society) APS,2003; Gordon 2002.

Types of pain:

 Acute pain

 Chronic pain

Acute Pain

Acute pain often starts suddenly and feels sharp.

Examples: Renal pain, Stomach Pain, Acute appendix Pain Chronic Pain

Chronic pain lasts for a longer period of time. Examples: Joints pain, Oral cancer pain

 Nociceptive Pain

 Neuropathic pain

 Mixed pain

Nociceptive Pain :

Physiologic Process

Normal Processing of Stimuli damage tissues Somatic pain

Visceral pain

•

_{Neuropathic pain}

Abnormal processing of sensory input by the peripheral or

central system or both

Centrally Generated pain

Peripherally Generated pain

•

_{Mixed Pain}

PHYSIOLOGY OF PAIN

How

pain is transmitted and perceived is

a complex in part because of the nature

of the fully integrated constantly changing

structure of the central nervous system,

and

the

symphony

of

chemical

mediators, only a fraction of which are

understood

 _{Nociceptors (pain receptors)}

 Transmission of pain (nocicetion)

 _{Acute pain travels via A-delta fibers}  _{Chronic pain travels via C fibers}

 _{Nociceptors most abundant receptors}

 _{Mechanical stimuli}  _{Chemical stimuli}  _{Thermal stimuli}

 _{Chemical substances}

 _{Prostaglandins (increase sensitivity of pain receptors)}

 _{Endorphins, enkephalins (suppress pain reception)}

NURSING MANAGEMANT ASSESSING PAIN



Location

Duration



pain intensity

Etiology



DIAGNOSING- acute or chronic pain.

LOCATION

Classifications of pain based on where it is in the body

may be useful in determining the patient’s underlying

problems

or needs. Complicating the categorization

of pain by location is the fact that some pains

radiate(spread or extend) to other areas.

DURATION



Acute Pain

lasts only through the expected recovery period

whether it has a sudden or slow onset and regardless of

intensity.



Chronic pain

is prolonged, usually recurring or persisting

over 6 months or longer, and interferes with functioning. Mild

to severe, constant or recurring without an anticipated or

predictable end and a duration of greater than 6 months.

(Ackley&Ladwig, 2006)

PAIN INTENSITY

Classified using a standard

0 (no pain) to 10 (worst possible pain) Scale .



Mild pain- rating of 1-3



Moderate pain- rating of 4-6



Severe pain- reaching 7-10 and is associated with

worst outcome.

ETIOLOGY

Physiological pain- experienced when an intact, properly functioning nervous system sends signals that tissue are damaged, requiring attention and proper care.

Somatic pain- originates in the skin, muscles, bones or connective tissue with sharp sensation of a paper cut or aching of sprained ankle.

Visceral pain- poorly located and may have cramping, throbbing, pressing, or aching quality. Often associated with feeling sick.

Neuropathic pain- experienced by people with damaged or malfunctioning nerves. Low back pain

DIAGNOSING OF ACUTE AND CHORINIC PAIN

Acute pain can be mild and last just a moment,

Or it might be severe and last for weeks or months.

Chronic pain is pain that is ongoing and usually

lasts

Longer than six months.

PAIN PATHWAY

There are four process of pain pathway

Perception

Modulation

Transmission

PAIN MANAGEMENT SCALE

SUBJECTIVE ASSESSMENT TOOLS



Characteristics of pain

COLDERA COLDSPA

COLDERA

Character , Onset, Location , Duration , Exacerbation , Relieving factors , Associated Sign and Symptoms.

COLDSPA

Character , Onset, Location , Duration , Severity , Pattern , Association

OBJECTIVE ASSESSMENT TOOLS

 For patients who cannot communicate , objective tool completely reflects patients pain level

 Examples

Critical-Care pain observation tool

Checklist of nonverbal pain indicators

Faces Scale, Series of faces from

happy to distressed

VISUAL ANALOG SCALE

The VAS is a horizontal ( sometimes vertical) 10-cmline with word anchors at the extremes such as no pain on one end and pain as bad as it could be or worst possible pain on the other end.

Quality:

Onset and duration:

Aggravating and reliving factors:

Effect of pain on function and quality of life:

FACTORS AFFECTING PAIN

 Ethnic and cultural values  Developmental stage

 Environment and support people  Past-pain experience

 Meaning of pain  Anxiety

 Depression  Culture

 Age  Gender

MANAGEMENT OF PAIN



PHARMACOLOGICAL



NON-PHARMACOLOGICAL



TREATMENT OF PAIN ON BASIS OF

SEVERITY OF PAIN

 Mild pain: Paracetamol (acetaminophen), or a non steroidal anti-inflammatory drug

(NSAID) such as ibuprofen or aspirin. NSAIDS have antiinflammatory, analgesic and antipyretic effects. The antiinflammatory action relieves pain by interfering with

cyclooxygenase.

 Mild to moderate pain: Paracetamol, an NSAID and/or paracetamol in a combination

product with a weak opioid such as hydrocodone, may provide greater relief than their separate use.

 Moderate to severe pain: When treating moderate to severe pain, the type of the pain,

acute or chronic, needs to be considered. The type of pain can result in different

medications being prescribed. Certain medications may work better for acute pain, others for chronic pain, and some may work equally well on both. Acute pain medication is for

NON-PHARMACOLOGICAL



Non-pharmacological

pain

management

is

the

management of pain without medications. This method

utilizes ways to alter thoughts and focus concentration to

better manage and reduce pain. Methods of

non-pharmacological pain include:



Body-based physical modalities



Mind-body methods



Biologically based therapies

REFERENCES

 Bruner & Suddarth’s 13th Edition. Medical & Surgical Nursing.

 Porth’s Pathophysiology 9th Ed. Vol-01

 www.slideshare.net/painmanagement

 American Pain Foundation: Position Statement on Access to Care. [July 11, 2011]; Available at:

http://www.painfoundation.org/about/position-statements/access-to-pain-care-august2010.html.

 American Pain Society, Organizing Committee of the Pain and Disparities Special Interest Group:

Racial and Ethnic Identifiers in Pain Management. The Importance to Research, Clinical Practice, and Public Health Policy. APS Bulletin. 2005:7–10. [Google Scholar]

 Amtmann D, Cook KF, Jensen MP, Chen WH, Choi S, Revicki D, Cella D, Rothrock N, Keefe F,

Callahan L, Lai JS. Development of a PROMIS item bank to measure pain interference. Pain. 2010;150:173–182. [PMC free article] [PubMed] [Google Scholar]

 Anders R, Olson T, Robinson K, Wiebe J, DiGregorio R, Solis G, Albrechtsen J, Bean N, Ortiz M.

A health survey of a colonia located on the West Texas, US/Mexico border. J Immigr Minor