Pain Management

Pain (definition)
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
Whatever the person experiencing pain says it is
Name three consequences of untreated pain
Pain (function)
Pain (descriptive terminology)
Duration: Acute – Chronic – Chronic Malignant
Source: Cutaneous – Somatic – Visceral – referred
Etiology: Neuropathic – intractable-phantom – psychogenic
Examine neurophysiologic factors related to the pain experience.
Anxiety and stress
Explore psychocultural factors affecting the pain experience and health care givers’ responses to persons in pain.
Culture
Ethnic variables
Religious beliefs
Support level
Healthcare providers’ reaction
Past personal experiences
Hierarchy of Importance of Basic Measures of Pain Intensity
1. Patient self-report
2. Pathologic Conditions or procedures
3. Behaviors
4. Report of pain from caregiver
5. Physiological measures. These are the least sensitive indicators of pain
5 Steps of Pain Assessment
Step 1 Patient’s Self Report
Step 2 Pathologic Conditions – Cancer/Surgery
Step 3 Behavioral Cues
– crying, moaning
Step 4 Family/Sig other Report
Step 5 Physiologic Signs – change in VS
Pain Assessment – WILDA
WILDA
Words
Intensity
Location
Duration
Aggravating/Alleviating Factors
Types of Pain Scales
1) Simple descriptive Pain Intensity Scale
2) 0-10 Numeric Pain Intensity Scale
3) Visual Analog Scale
4) Faces
When to assess pain
1) At the beginning of each shift
2) After any significant known pain-producing event
3) At each new report of pain
4) At a suitable interval after administration of medication
5) Throughout the continuum
Nociceptive Pain (define, examples, 2 kinds, tx)
Definition: Normal processing of stimulus that damages tissue.

Examples: Surgical incision, broken bone, or arthritis

2 Kinds:
1)Somatic: described as aching or throbbing , well localized – know where it is coming from, arises from bone, joint, muscle, skin, or connective tissue
2) Visceral: arises from internal organs such as the intestine and bladder, tumor involvement or obstruction

Tx: Usually responsive to opioids and nonopioid medications

Neuropathic Pain (define, examples, S&S, tx)
Define: damage to the central or peripheral nervous system.

Examples: Diabetic neuropathy, Guillain-Barre Syndrome

S&S: described as burning, shooting, stabbing, or electrical in nature; sudden, intense, short-lived, or lingering

Tx: usually includes adjuvant analgesics

Acute Pain (behavioral signs, goals)
Behavioral manifestation: anxiety, agitation, confusion

Goal of management: relief at the expense of temporary side effects, pain control with eventual elimination, prevention of development of chronic pain

Chronic Pain (behavioral signs, goals)
Behavioral manifestation: flat affect, decreased movement/activity, fatigue, withdrawal from others and social interaction

Goal of pain management is: assist the client to set a functional goal, improving quality of life by balancing pain control and side effects, best control of pain is by using routine dosing so there is always pain medicine in circulation

Formulate relevant prioritized nursing diagnoses that address physical, psychosocial, and learning needs of patients experiencing pain.
Goal of Pain Management
Reaching the patient’s acceptable level of pain (achieve the patient’s pain rating required to perform activities related to satisfactory recovery and/or improved quality of life)
NSAIDS and opioid analgesic medications
Non-pharmacological measures for pain relief
Safe use of pain management strategies
Collaborate with interdisciplinary health care team when providing patient-centered care.
Evaluate and revise goals and modify the nursing care plan.
Integrate associated issues, trends, and informatics into nursing practice.
a. legal and ethical concerns related to pain management.
b. Evidence based practice
Complementary medicine
Patient teaching related to:
-how pain will be assessed and managed
-how pain interferes with healing and recovery
-concerns about the use of opioids which cause patients to be reluctant to use them
Ethical Issues (Triple Whammy effect)
1) Physicians underprescribe
2) Nurses underadminister: fear of hastening death.
3) Patients underreport their pain
Ethical Issues (The ANA position statement)
The ANA, in its position statement The Promotion of Comfort and Relief of Pain in Dying Patients, states that “nurses should not hesitate to use full and effective doses of pain medication for the proper management of pain in the dying patient. The increasing titration of medication to achieve adequate symptom relief, even at the expense of life, thus hastening death secondarily, is ethically justified.