Download Pain OVERVIEW Pain is a universal, complex, and subjective

Pain
OVERVIEW
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Pain is a universal, complex, and subjective experience.
Chronic pain is the most common cause of long-term disability, affecting millions of Americans and others
throughout the world.
The nurse is legally and ethically responsible for acting as an advocate for patients experiencing pain.
In 2000, The Joint Commission published pain standards that were approved by the American Pain Society.
This document states that patients in all health care settings, including home care, have a right to effective
pain management.
Multidisciplinary pain teams, consisting of one or more nurses, pharmacists, case managers, and physicians,
consult with staff and prescribers on how best to control the patient’s pain.
Coordinate the patient’s plan of care as he or she transfers between health care agencies. Be sure that the
plan of care is communicated clearly.
Provide information to the patient and family about complementary and alternative therapies as needed.
These modalities are additions to, not replacements for, the established plan of care.
Consider the special needs of older adults when assessing and managing their pain.
Be aware that some nurses and physicians have biases about pain assessment and management. Be
objective when caring for any patient in pain.
Provide information to patients who have misperceptions about pain and pain management.
PATIENT-CENTERED COLLABORATIVE CARE
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Pain is what the patient says it is. Self-report is always the most reliable indication of pain.
Factors that affect pain and its management include age, gender, genetics, and culture.
Effects of unrelieved pain: increased RR, HR, BP, increased stress response, urinary retention, fluid
overload, electrolyte imbalance, glucose intolerance, hyperglycemia, pneumonia, atelectasis, anorexia,
paralytic ileus, constipation, weakness, confusion and infection
Three major types of pain have been identified—acute, chronic cancer, and chronic noncancer.
Categorizing Pain
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The two major types of pain are acute and chronic.
o Acute pain often results from sudden, accidental trauma (e.g., fractures, burns, lacerations) or
from surgery, ischemia, or acute inflammation.
o Chronic pain or persistent pain is further divided into two subtypes.
 Chronic cancer pain is pain associated with cancer or another progressive disease such
as acquired immune deficiency syndrome (AIDS). The cause of pain is usually life
threatening.
 Chronic non-cancer pain is associated with tissue injury that has healed or is not
associated with cancer, such as arthritis or chronic back pain. This type of pain is the
most common.
o Acute pain serves as a warning to the body, causing sympathetic responses such as increased
heart rate, increased blood pressure and pulse, dilated pupils, and sweating.
o Both types of chronic pain do not cause sympathetic reactions. Therefore some patients do not
appear to be in pain, even when they are.
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Somatic Pain- Pain arising from tissues such as skin, muscle, tendon, joint capsules, fasciae, and bone
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Visceral Pain-pain, usually arising from the internal organs, that feels like squeezing, cramping or pressure.
Neuropathic Pain- otherwise known as nerve pain - is a type of chronic pain that occurs when nerves in the
central nervous system become injured or damaged
Theoretical Bases for Pain
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Painful stimuli often originate in the periphery of the body.
o To be perceived, the stimuli must be transmitted from the periphery to the spinal cord and then to
the central areas of the brain.
o The gate control theory involves a gating mechanism in the spinal cord. When the gate is
opened, pain impulses ascend to the brain; when closed, the impulses do not get through and pain
is not perceived. (covered in Dr. Campbells videos)
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Tolerance implies that the patient has adapted to a drug and over time, its effects decline.
Physical dependence is manifested by a withdrawal reaction.:
Early symptoms of withdrawal include:
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Agitation
Anxiety
Muscle aches
Increased tearing
Insomnia
Runny nose
Sweating
Yawning
Late symptoms of withdrawal include:
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Abdominal cramping
Diarrhea
Dilated pupils
Goose bumps
Nausea
Vomiting
Addiction is a primary, chronic disease that occurs over a long period. Behaviors in addiction include
craving, compulsive drug use, and continued use despite harm.
Assessment
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Nurses are responsible for thorough pain assessment.
o Perform a complete pain assessment, including duration, location, intensity, and quality of pain.
Initial and ongoing pain assessments are required.
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o The American Pain Society refers to pain as the fifth vital sign.
o Ask the patient about the pain experience, including precipitating, aggravating, and relieving
factors, the nature of adjustments in life or family responsibilities, localization, character and
quality, duration, and beliefs.
o Pain may be described as localized, projected, radiating, and referred pain. Although physiologic
changes occur in response to acute noxious stimuli, these are usually not reliable indicators of
pain.
o Pain intensity scales assess and measure pain and determine the effectiveness of pain relief
interventions in the clinical or home setting.
o Nonverbal, intubated, and cognitively impaired patients do feel pain that needs to be managed.
Never use placebos for any patient; their use in non–research-based practice is unethical.
MEDICATION
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Non-opioid drugs are the first-line therapy for mild to moderate pain.
o NSAIDs and acetaminophen (Tylenol) are commonly used drugs in this category.
o NSAIDs should be used with caution in older adults because of adverse effects, such as GI
disturbances, bleeding, and sodium and water retention.
o Acetaminophen can cause hepatotoxicity and nephrotoxicity with long-term use.
 Most NSAIDs are used to decrease inflammation and pain for clients who have some type of arthritic
condition.
*** Describe acetaminophen as:
1. Nonopioid that is not an NSAID
2. No antiinflammatory properties
3. Acts weakly inhibiting prostaglandin synthesis which decreases pain sensation.
Antidote is acetylcysteine (Mucomyst)
OPIOIDS
The opioids are most effective for both acute and chronic pain management.
** Prescribed for moderate and severe pain
1. Controlled substance
2. Addiction possible
3. Morphine prototype opioid
4. Codeine another drug obtained from opium
5. Opioids act directly on the CNS causing analgesia, respiratory depression, coughing, euphoria, and
sedation
6. Meperidine (Demerol) has no antitussive action
7. Some opioids possess antidiarrheal effects.
8. Common side effects include nausea and vomiting, constipation, moderate decrease of BP, and
orthostatic hypotension.
*** Side effects include respiratory depression, orthostatic hypotension, urinary retention, constipation, cough
suppression.
Antidote is naloxone (Narcan).
 High doses of opioids may cause respiratory depression, urinary retention, antitussive effects.
o Equianalgesic charts are useful when changing from one opioid to another. A morphine dose of
10 mg is the standard dose against which other opioids are measured.
o Morphine is the gold standard drugs for both acute and chronic pain and are available in many
forms, both short acting and long acting.
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o Other opioids include: oxycodone, hydromorphone, and fentanyl.
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o Meperidine is an outdated drug and is rarely used. Its toxic metabolite (normeperidine) can
accumulate, especially in the older adult or someone with decreased renal clearance, and can
cause seizures and confusion.
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o Observe for and prevent common side effects of opioids including nausea and vomiting,
constipation, sedation, and respiratory depression.
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MULTIMODAL ANALGESIA
Multimodal (balanced) analgesia for epidural pain management is a combination of opioids, non-opioids,
and/or local anesthetics to relieve acute pain, usually postoperative pain.
Assess for sedation in patients receiving PCA or epidural medication.
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NONPHARMACOLOGIC PAIN MANAGMENT
Nonpharmacologic therapies for pain management may be used in place of or in combination with drug
therapy. These therapies are classified as physical measures or cognitive-behavioral therapies.
Examples of physical measures to manage pain are transcutaneous electrical nerve stimulation (TENS),
heat, cold, and massage.
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Distraction, imagery,
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relaxation techniques, and hypnosis are examples of cognitive-behavioral therapies.
Acupuncture, magnet therapy, and herbal supplements are examples of other complementary and alternative
therapies used for chronic pain management.
Pain can be managed in any setting, including the home. Some patients require parenteral pain medications
at home; therefore provide health teaching to ensure continuity of care.
Refer patients whose pain is difficult to manage to pain specialists and/or pain centers.
As will all disease/disorders use ADPIE to apply these concepts.
Common Nursing DX?
Common Nursing Interventions
Prototype Meds(action, side effect, nursing interventions , teaching)
Diagnostic/Lab Test