ACUTE PAIN

Definition of Pain:

The International Association for the Study of Pain (IASP) defines pain as “an pleasant
sensory and emotional experience, which we primarily associate with tissue damage or
describe in terms of such damage, or both.”

It is a higly unpleasant and very personal sensation that cannot be shared with others,
no two people experience pain in exactly the same way.

McCaffery defines pain as “whatever the experiencing person says it is, existing
whenever he (or she) says it does”.

Acute Pain:

usually associated with an injury with a recent onset and duration of less than 6 months
and usually less than a month, it has a sudden or slow onset regardless of the intensity.

TIPS FOR COLLECTING SUBJECTIVE DATA:

 Maintain a quiet and calm environment that is comfortable for the patient being
itnerviewed.
 Maintain the client’s privacy and ensure confidentiality.
 Ask the questions in an open ended format.
 Listen carefully to the client’s verbal descriptions and quote the terms used.
 Watch for the clien’ys facial expressions and grimaces during the interview.
 DO NOT put words in the client’s mouth.

TIPS FOR COLLECTING OBJECTIVE DATA

 In the preparation of the client for the interview, they should be seated in a quiet,
comfortable and calm environment with minimal interruption.
 Explain that the interview will entail questions to clarify the picture of the pain
experienced in order to develop the plan of care.
 Explain to the client the purpose of rating the intensity of pain.
 Choose an assessment tool reliable and valid to your culture.
 Ensure the client’s privacy and confidentiality.
 Respect the client’s behaviour towards pain and the terms used to express it.

EQUIPMENT / TOOLS

 Verbal Descriptor Scale (VDS)

-Ranges pain on a scale between mild, moderate and severe.

 Wong – Baker Faces Scale (FACES)

-Shows different facial expression where the client is asked to choose the face
that best describes the intensity or level of pain being experienced; this works
well with pediatric clients.
  Numeric Rating Scale (NRS)
-Rates pain on a scale from 0 to 10 where 0 reflects no pain and 10 reflects pain
at its worst.

ACUTE PAIN CAN BE CAUSED BY:

 Sugery
 Diagnostic procedures
 Burns
 Trauma
 Disease Condition

PHYSIOLOGIC RESPONSES TO PAIN:

 Anxiety, fear, hopelessness, sleeplessness, thoughts of suicide

 Focus on pain, reports of pain, cries and moans of, frowns and facial grimaces
 Decrease in cognitive function, mental confusion, altered temperament, high
somatization, and dilated pupils.
 Increased heart rate, peripheral, systemic, and coronary vascular resistance,
blood pressure
 Increased respiratory rate and sputum retention resulting in infection and
atelectasis
 Decreased gastric and intestinal motility
 Decreased urinary output resulting in urinary retention, fluid overload, depression
of all immune responses
 Increased antidiuretic hormone, epinephrine, norepineprhine, aldosterone,
glucagons, decreased insulin, testosterone
 Hyperglycemia, glucose intolerance, insulin resistance, protein catabolism
 Muscle spasm resulting in impaired muscle function and immobility, perspiration

ANALGESIA AND THE PAIN PATHWAY:

JCAHO STANDARDS FOR PAIN MANAGEMENT:

 Recognize patient’s rights to appropriate assessment and management of pain.

 Screen for pain and assess the nature and intensity of pain in all patients.
 Record asssessment results in a way that allows regular assessment and follow
up.
 Determine and ensure that staff is competent in assessing and managing pain.
Address pain assessment and management when orienting new clinical staff.
 Establish policies and procedures that support appropriate prescribing of pain
medications.
 Ensure that pain doesn’t interfere with a patient’s participation and rehabilitation.
 Educate patients and there families about effective pain management.
 Address patient needs for symptom management in the discharge planning
process.
 Establish a way to collect facility-wide data to monitor the appropriateness and
effectiveness of the pain management plan.

PAIN MANAGEMENT:

 Pharmacologic Pain Management

-use of opioids (narcotics) such as morphine and codeine
-use of non-opioids (non-narcotic analgesics) include NSAIDS such as aspirin
and ibuprofen
-use of adjuvant analgesics

 Non Pharmacologic Pain Management

CUTANEOUS STIMULATION TECHNIQUES

 Transcutaneous Electrical Nerve Stimulation (TENS)

-applies low-voltage electrical stimulation directly over identified areas, at an
acupressure poin, along peripheral nerve areas that innervate the pain area,
or along the spinal column.
-purpose: (1) reducing chronic or acute pain, (2) decreasing opioid
requirements and reducing the chances of depressed respiratory function
from narcotic usage, (3) faciliatating client involvement in managing pain
control
 Massage
-distracts the client and focuses attention on the tactile stimuli, away from the
painful sensation, thus reducing pain perception
 Heat and Cold Applications
-aids relaxation, decrease muscle tension and may ease anxiety
 Acupressure
-form of healing in which the therapist exerts finger pressure on specific sites
 Contralateral Stimulation
-stimulating the skin in an area opposite to the painful area, method is useful
when the painful area cannot be touched because it is hypersensitive,
inaccessible by a cast or when the pain is felt in a missing part (phantom
pain)
  Cognitive – Behavioral Pain Management
 Distraction Activities
 Relaxation Techniques
 Guided Imagery
 Meditation
 Hypnosis
 Therapeutic Touch

NURSING DIAGNOSIS: Acute Pain related to disease process, injury, or surgical

procedure
DESIRED OUTCOME: Patient’s subjective report of pain using a pain scale, family’s
report, and behavioral and/or physiologic indicators reflect that
pain is either reduced or at an acceptable level within 1-2 hr.

NURSING INTERVENTIONS:

 Obtain history about ongoing/previous pain experiences and previously used

methods of pain control.
 Consider whether pain is acute or acute with an underlying component.
 Teach patients that pain assessment and management are not only a part of
their treatment but also their right.
 Use formal patient-specific method of assessing self-reported pain when
possible, including description, location, intensity and aggrevating/alleviating
factors.
 Evaluate patient’s health history for alcohol and drug use, which would effect
doses of analgesics.
 Assess for behavioral and physiologic indicators of pain at frequent intervals.
Document responses.
 Develop a systematic and collaborative approach to pain management for each
patient, using information gathered from pain history and the hierarchy of pain
measurement.
 Use at least two identifiers (e.g patient’s name, medical record number) before
administering medications.
 Use preventive approach: administer prn pain medications before pain becomes
severe as well as before painful procedures, ambulation and bedtime.
 Administer analgesics accoridng to the World Health Organization three-step
analgesic ladder: level one – nonopiod + adjuvant; level two – opioid for mild to
moderate pain + nonopioid + adjuvant; level three – opioid for moderate to
severe pain + nonopioid + adjuvant
 Recognize that choice of analgesic agent is based on three general
considerations: therapeutic goal, patient’s medical condiction, and drug cost. The
right drug is one that works with the fewest side effects.
 Consider convience, anticipated analgesic requirements, side effects, and
patient’s previous experience with a specifc agent or patient’s recall of side
effects experienced with a specific agent, including route.
 Provide patient controlled analgesia (PCA) as prescribed.
 Assess for and report analgesia side effects.
 Augment action of the medication by using non-pharmacologic methods of pain
control, including weight reduction, physical therapy, cognitive behavioral
therapies, acupunture, and massage.
 Maintain a quite environment and plan nursing activities to enable long periods of
uninterrupted rest at night.
  Evaulate for and correct noneoperative sources of discomfort.
 Carefully evaluate patient if sudden or unexpected changes in pain intensity
occurs, and notify health care provider immediately should this occur.
 Document efficacy of analgesics and other pain control interventions using a pain
scale or other formalized method.

REFERENCES:

All-in one, Care Planning Resource (Medical-Surgical, Pediatric, Maternity & Psychiatric
Nursing Care Plans, 2nd Edition by Pamela L. Swearingen

Focus on Pathophysiology by Barbara L. Bullock

Basic to Intermediate Skills, 5th Edition by Barbara Kozier

Pathophysiology, Concepts of Altered Health States, 7th Edition by Carol Matthson

Porth

REPORTER: JHIA C. ENAD

TOPIC: ACUTE PAIN IN
CRITICALLY ILL PATIENTS
COURSE: MSN – MSN