Concept 29: Pain

Describe psychosocial consequence of pain

• Fear, anger, depression, anxiety • Reduced ability to maintain relationships • Not engage in normal activity *Psychological and social consequences

Incident pain

breakthrough pain is brief and precipitated by a voluntary action

Identify the scope of pain which it ranges from

No pain---Minimal pain---Moderate pain---Severe pain ***Pain also ranges across several descriptive continuums, including location, intensity, frequency, and duration

Describe pain classification

Nociceptive pain or Neuropathic pain

Describe the normal physiological process of pain

Transduction - Release of chemical mediators from damaged cells that activate nociceptors Transmission - action potential subsequently moves from the site of nociceptor activation along specialized afferent nerve fibers that carry pain impulses Perception - Fibers from the thalamus send nociceptive message to the somatosensory cortex Modulation -Release of substances that descend to the lower areas of the brain and spinal cord, stimulating release of endogenous opioids that inhibit transmission of pain impulses at the dorsal horns

Describe breakthrough pain

Transitory exacerbation of pain in a patient who has relatively stable and adequately controlled baseline pain • Fast onset, short acting formulation of a first line analgesic is used to manage breakthrough pain - Ex. Morphine, oxycodone, hydromorphoone, or fentanyl

Describe what is pain

Unpleasant sensory and emotional experience associated with actual or potential tissue damage. • Pain is highly personal; and subjective experience □ Pain is whatever the experiencing person say it is

End-of-dose failure pain

episodes of pain that occur before the next analgesic dose

Idiopathic pain

not assoc. with any known cause and often lasts linger than incident pain

Nociceptive Pain

refers to normal functioning of the somatosensory system in response to tissue injury that is perceived as being painful - Ex. Pain from sunburns, surgery, or trauma - Describe as aching, cramping, or throbbing -Characterized as somatic or visceral

Neuropathic Pain

results from a pathology or disease of the somatosensory system - Ex. Postherpetic neuralgia, diabetic neuropathy, and phantom pain -Describe as burning, sharp, and shooting

Identify the difference between acute and chronic pain

• Acute Pain - Sudden onset - Typically linked to a specific event of injury or illness □ Ex. Tissue damage as result of surgery, trauma, or burns produces acute pain • Chronic Pain - Lasting more than 3 months and may last for years -May result from underlying medical conditions

Identify individual at risk for pain

• Communication Barriers • Cognitive impairment or developmentally disabled ® Disabled children and adults • Mental health conditions ® History or current use of illicit substances ® Psychiatric illness • Injury or conditions associated with pain ® Traumatic injury critical illness, surgical procedures *Fractures, cluster headaches, passing kidney stones, shingles, late stage cancer

Describe physiological consequence of pain

• Increased endocrine activity in turn initiates a number of metabolic processes, particularly accelerated carbohydrate, protein, and fat destruction • Immune system is affect • Unrelieved pain impacts the respiratory system • Effects on the cardiovascular system include increased postoperative blood loss and hypercoagulation *Affect patient's level of physical functioning

Identify populations at risk for pain

• Infants and children ® Neonates primarily from procedures ◊ Ex. Heel sticks, venipuncture, and circumcision ® Infants, toddlers, children do not have the cognitive skills to report and describe pain • Older Adults ® Pain increases with age ® Many conditions associated with pain ® frequent recipients of surgical procedures and increase risk of injury • Other Population groups ® Include sex, race, and ethnicity ® Women report higher prevalence of chronic pain *Cultural and/or religious convictions may pose barrier

Describe how to conduct a pain assessment

• Location of pain - Ask the patient to point of pain on the body • Intensity - Rate it by a reliable and valid pain assessment tool - Numeric rating - Faces pain scale - Wong-baker FACES pain - Verbal descriptor scale • Quality - Describe how the pain feels - Ex. Burning, shooting • Onset and Duration - When it started - Is it constant or intermittent • Alleviating and Relieving Factors - What makes it better or worse • Effect of pain on function and quality of life - Important to ask patient with chronic pain - How has pain affected their lives - What could they do before the pain began that they can no longer do - What do they want to do but cannot do because of pain • Comfort function goal - Ask quality of life goals -Ask about a pain goal that they wish to reach

Give examples of multiple conditions that affect pain

• Osteoarthritis pain • Trigeminal Neuralgia (pain arising from cranial nerve) • Postherpetic Neuralgia (develop after a case of shingles cause by herpes zoster virus) • Poststroke Pain • Complex Regional Pain Syndrome (form of neuropathic pain that affects one of the limbs) • Fibromyalgia (wide spread musculoskeletal pain, fatigue, sleep disturbances, and cognitive and mood disorder) *Phantom Pain

Provide appropriate nursing and collaborative interventions to effectively manage pain.

• Pharmacologic Strategies - Analgesics (nonopioid analgesics, opioid analgesics, adjuvant analgesics) - Routes of administration • Invasive or surgical strategies - Epidural steroid injection - Spinal cord stimulators • Nonpharmacologic strategies - Massage, acupuncture, and application of heat and cold - Guided imagery, relaxation breathing, meditation -Proper body alignment, thermal measures, mind body therapies