Pain- 5th vital sign

Unpleasant, sensory and emotional experience associated with damage tissue.

A physiological response that warns us of danger

• The process that involves the nociception 
• *transduction
• *transmission
• *perception
• *modulation

Stimulus detected by nociceptive receptors'

pain receptors that are exposed to stimuli when tissue damage and inflammation occurs as a result from trauma, surgery, inflammation, infection and ischemia

found int skin, muscle, connective tissue, bone, joints, visceral organs-liver, GI tract.

• *primary afferent fibres
• *Small diameter
• *Unmyelinated
• *slow conducting

Receptor respond to more than one types of stimuli

• *primary afferent fibres
• *large diameter
• *myelinated 
• *fast conducting

high-threshold receptor that respond to stimuli over a certain intensity

Messages relayed from receptors to CNS

Brain perceives the sensation of pain

Messages modified by other activity

Involved changing or inhibiting transmission of pain impulse in spinal cord by the release of neurotransmitters that act by inhibiting pain sensation at the opioid receptor sites.

Pain that continues beyond the expected time of healing (3-6mths) and has a major impact on quality of life. Sometimes a specific cause cannot be found and it can be difficult to treat.

*Pain from muscle, soft tissue or ones and is described as sharp, hot or stinging

• *Usually well localized
• *surrounding tissue is often tender

• *pain from organs or surrounding tissues
• *often less localised and can radiate
• *described as deep aching, cramping or squeezing pain
• *may be associated with symptoms

Where nerve transmit pain signals in a normal way to the brain in response to tissue damage.


Stimili - extremes temperature, pressure and chemicals.

• *abnormal stimulation of the nerves, which can originate from a dysfunction
• * described as burning, shooting or prickling pain
• * often accompanied other sensations - pins and needls, allodynia, hyperalgesia

eg. post-herpetic neuralgia or peripheral neurophathy.

Using noticing to see how the client is reacting. Observe what is different in mobilising, facial expression and  behaviour

Provoking , palliating- what starts the pain?

Quality- what does the pain feel like?

Region/radiation - where is the pain?

Severity- how strong is the pain on a scale 1-10?

Time and duration - when did the pain start?, how long have you had the pain?

The RN ask the mother questions regarding the child and observe the child reaction, movement, facial expressions and behaviours.

Location- where does it hurt?

Intensity- on a scale of 1-10 how much does it hurt?

Quality- Can you describe the pain to me?

Onset- What were you doing when pain started?

Effects- How does it affect you?

Treatment- What treatment did you have or used?

Paracetamol, Ibuprofen and asprin

Any NSAID's (non-steroidal anti-inflammatory drug)

Pain is a warning of potentially health threatening condition

Pain is the most common reason people seek medical healthcare

Pain affects the whole body

unwelcome and uncomfortable

Pain management is essential as people with bipolar experience sleep deprivation which is a contributing factor of relapse.

Stress, pain, and sleep deprivation can trigger a relapse

• Previous experience
• age
• gender
• meaning of pain
• attention to pain
• peer influence
• stress
• anxiety 
• personality

• used to treat moderate to severe pain
• Binds to mu receptors, and inhibits reuptake of norepinephrine and serotonin
• Nausea, vomiting, headache, constipation, drowsiness, dizziness