N200 Pain Management

• an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
• **it is whatever the experiencing person says it is, existing when he says it does

nociceptors are stimulated by direct damage to the cell or local release of biochemicals following cell injury

• *Transduction
• *Transmission
• *Perception
• *Modulation

• conversion of thermal chemical or mechanical stimulus to electrical energy
• ****Transduction begins in the periphery when a pain-producing stimulus sends an impulse across a sensory peripheral pain nerve fiber (nociceptor), initiating an action potential

Transport of nerve impulse from the site of injury to the brain via the spinal cord

The point at which a person is aware of pain

release of inhibitory neurotransmitters (ex-endorphins) to hinder transmission of pain

• Example:
• Pneumonia

Arthritis

• Example:
• Angina

• Example:
• Sprained ligament

• Example
• Any bone

Gallstone

Skin Rash

• *Sympathetic stimulation (tachycardia, increased BP, sweating, pallor etc)
• Most persons reach a period of adaptation where vitals return back to normal

• Crying, moaning
• *untreated pain reduced QOL

• *Acute/Transient
• *Chronic/Persistent
• *Chronic/ Episodic
• *Cancer pain
• *Idiopathic pain
• *Nociceptive vs Neuropathic

• Identifiable cause
• *Rapid onset, varies in intensity, and lasts briefly
• *Warns people of impending injury or disease
• *Complication
• -can prolong hospitalization, delay rehabitalization
• *Can progress to chronic pain

• *Prolonged, varies in intensity, and usually lasts longer than is typically expected or predicted
• *Intractrable pain
• *Often no identifiable cause
• *Ongoing and often does not respond to treatment
• *Endorphins either cease to function or are reduced

• *Nociceptors
• *Somatic
• *Visceral
• *Responds well to opioids and/ or non-opiods

• Nerves that sense and responds to parts of the body which suffer damage.
• *Signal tissue irritation, impending injury, or actual injury

• Sprains, bone fractures, burns, bumps, bruises, inflammation
• *Aching or throbbing and well localized

Arises from visceral organs

• *Results from damage to nerves caused by infection or disease
• *Central
• *Peripheral
• *Often chronic
• *May not respond well to opioids and may respond better to anti-seizure and antidepressant medications

From brain or spinal cord (ex. phantom limb pain)

• *From peripheral nervous system
• *Described as burning, tingling, pins and needles

• *Physiological Factors (age, fatigue, genes,)
• *Social (Attention, previous experience, family/social support)
• *Spiritual
• *Psychological (Anxiety, coping style)
• *Cultural (meaning or pain, ethnicity)

• *Healthcare professionals
• *Healthcare system
• *Patients

inadequate/inaccurate information about pain management

• *Low priority given to pain treatment
• *Restrictive regulation of controlled substances

• *Reluctance to report pain or take meds- fear of becoming dependent
• *Fear that pain means disease process is progressing

• *Patients' pain needs to be assessed on a regular bases (6th vital sign)
• *Patients expression of pain
• - most reliable indicator of existence and intensity
• *ABCDE
• *COLDSPA
• *PQRST

• *Pain history
• -tolerance, influence on ADLs
• *Pain characteristics
• - Onset, duration, quality, intensity, pattern, non-verbal/behavioral effects
• *Client expectations

• Sympathetic Stimulation
• ***Provides increased oxygen intake

• Sympathetic Stimulation
• ***Provides increased oxygen transport

• Sympathetic Stimulation
• ****Elevates blood pressure with shift of blood supply from periphery and viscera to skeletal muscles and brain

• Sympathetic Stimulaton
• ***Provides additional energy

• Sympathetic Stimulation
• ****Controls body temperature during stress

• Sympathetic Stimulation
• ***Prepares muscles for action

• Sympathetic Stimulation
• ****Affords better vision

• Sympathetic Stimulation
• ***Frees energy for more immediate activity

• Parasympathetic Stimulation
• ***Causes blood supply to shift away from periphery

• Parasympathetic Stimulation
• ***Results from fatigue

• Parasympathetic Stimulation
• ***Results from vagal stimulation

• Parasympathetic Stimulation
• ***Causes body defenses to fail under prolonged stress of pain

Severe or deep pain.

Pain of low to moderate intensity and superficial pain.