NAVAL STATE UNIVERSITY

College of Arts and Sciences

NURSING AND HEALTH SCIENCES

DEPARTMENT

COURSE : NCM 314

Care of Clients Across the Lifespan with Problems in Oxygenation,
Fluid and Electrolyte Balance, Metabolism and Endocrine

CONCEPT OF P A
I N
Prepared by:

JAVESON ROY C. BATUTO, RN, MAN

cand.

Revised: June

PAIN

SENSATION REACTION

DEFINITION OF TERMS
TOLERANCE

THRESHOLD

HYPERALGESI
A

PHYSIOLOGY OF PAIN
Pain is a complex unpleasant phenomenon composed
of sensory experiences that include time, space,
intensity, emotion, cognition, and motivation
Pain is an unpleasant or emotional experience
originating in real or potential damaged tissue
Pain is an unpleasant phenomenon that is uniquely
experienced by each individual; it cannot be
adequately defined, identified, or measured
by an observer.

PHYSIOLOGY OF PAIN
PAIN THRESHOLD
the point at which a stimulus causes pain. It
varies widely among individuals.
PAIN TOLERANCE
the maximum pain level an individual is able to
withstand.
PAIN REACTION
the ability of the body to percieved pain
HYPERALGESIA
hypersensitivity to pain

PHYSIOLOGY OF PAIN
SENSATION
Physical feeling or perception from something
that comes into contact with body
NOCICEPTOR
Is a sensory neuron that responds to potentially
damaging stimuli by sending nerve signals to
the spinal cord and barin

PHYSIOLOGY OF PAIN

PHYSIOLOGY OF PAIN
TRANSDUCTION
The primary sensory structure that accomplishes
transduction is the nociceptor. Most nociceptors are
free nerve endings that sense heat, mechanical and
chemical tissue damage.
Several types are described:
1. Mechanoreceptors, which respond to pinch and
pinprick
2. Silent nociceptors, which respond only in the
presence of inflammation

PHYSIOLOGY OF PAIN
3. Polymodal Mechanoheat Nociceptors is the most
prevalent and respond to excessive pressure, extremes of
temperatures (>42 oC and < 18 oC), and algogens
Polymodal nociceptors are slow to adapt to strong pressure
and display heat sensitization.

PHYSIOLOGY OF PAIN
TRANSMISSION
Pain impulses are transmitted by two fibre
systems. The presence of two pain pathways
explains the existence of two components of pain:
fast, sharp and well localized sensation (first
pain) which is conducted by A fibres; and a
duller slower onset and often poorly localized
sensation (second pain) which is conducted by
C fibres. A fibres are myelinated, Both fibre groups
end in the dorsal horn of the spinal cord. The
synaptic junctions between these first order neurons
and the dorsal horn cells in the spinal cord are sites

PHYSIOLOGY OF PAIN
PERCEPTION
The third order neurons are located in the thalamus
and project to somatosensory areas II and I in the
post-central gyrus and superior wall of the sylvian
fissure. Perception and discrete localization of pain
take place in these cortical areas. Some fibres project
to the anterior cingulated gyrus and are likely to
mediate the suffering and emotional components of
pain.

PHYSIOLOGY OF PAIN
MODULATION
The third order neurons are located in the thalamus
and project to somatosensory areas II and I in the
post-central gyrus and superior wall of the sylvian
fissure. Perception and discrete localization of pain
take place in these cortical areas. Some fibres project
to the anterior cingulated gyrus and are likely to
mediate the suffering and emotional components of
pain.

TYPES OF PAIN

TYPES
PAIN
TYPES OF
OF PAIN
1. ACUTE PAIN is usually temporary, has a sudden onset
and is localized. It is the pain that lasts for less than 6
months and has an identified cause. It most often results
from tissue injury, from trauma.
. It serves as a warning of actual or potential injury to
tissues. It initiates the fight or flight autonomic stress
response. Characteristic physical responses occur
including tachycardia, rapid and shallow respirations,
increased BP, dilated pupils, sweating and pallor.

TYPES OF PAIN
a. Somatic pain arises from nerve receptors originating
in the skin or close to the surface of the body. It may be
either sharp and well localized, or dull and diffuse.

TYPES
PAIN
TYPES OF
OF PAIN
b. Visceral Pain arises from body organs. It is dull and
poorly localized because of the low number of
nociceptors. The viscera are sensitive to stretching,
inflammation and ischemia but relatively insensitive to
cutting and temperature extremes.

TYPES
PAIN
TYPES OF
OF PAIN
c. Referred Pain is pain that is perceived in an area
distant from the site of the stimuli. It commonly occurs
with visceral pain as visceral fibers synapse at the level of
the spinal cord, close to fibers innervating other
subcutaneous tissue organs of the body. Pain in the
spinal nerve may be left cutaneously in any body area
innervated by sensory neurons that share the same nerve
route. Body areas defined by spinal nerve route are
called dermatomes.

TYPES
PAIN
TYPES OF
OF PAIN
2. CHRONIC PAIN is prolonged pain, usually lasting
longer than 6 months. It is not often associated with an
identifiable cause and is often unresponsive to
conventional medical treatment. Unlike acute pain,
chronic pain has a much more complex and poorly
understood purpose.
The client with chronic pain is often depressed,
withdrawn, immobile, irritable and/or controlling.

TYPES
PAIN
TYPES OF
OF PAIN
a. Recurrent Acute Pain
characterized by relatively
well-defined episodes of pain
interspersed with pain-free
episodes.

TYPES
PAIN
TYPES OF
OF PAIN
b. Ongoing Time-Limited Pain is identified by a defined
time period.

TYPES
PAIN
TYPES OF
OF PAIN
c. Chronic Nonmalignant Pain
also known as chronic
benign pain, is non-life
threatening
pain
that
nevertheless persists beyond
the expected time for healing.
Ex. Chronic lower back pain.

TYPES
PAIN
TYPES OF
OF PAIN
d. Chronic Intractable Nonmalignant Pain Syndrome
is similar to simple chronic nonmalignant pain but is
characterized by the persons ability to cope well with
pain and sometimes by physical, social, and/or
psychological disability resulting from the pain.

TYPES
PAIN
TYPES OF
OF PAIN
d. Others:
1. Neuralgias are painful conditions that result from
damage to a peripheral nerve caused by infection or
disease.
2. Reflex Sympathetic Dystrophies characterized by
continuous severe burning pain. These conditions follow
peripheral nerve damage and present the symptom of
pain, vasospasm, muscle wasting and vasomotor
changes.

TYPES
PAIN
TYPES OF
OF PAIN
3. Hyperesthesias are conditions of oversensitivity to
tactile and painful stimuli. Hyperesthesias result in diffuse
pain that is usually increased by fatigue and emotional
lability.
4. Myofascial Pain Syndrome a common condition
marked by injury to or disease of muscle and fascial
tissue. Pain results from muscle spasm, stiffness and
collection of lactic acid in the muscle. Ex. fibromyalgia

TYPES
PAIN
TYPES OF
OF PAIN
e. CA often produces chronic pain usually due to factors
associated with the advancing disease. These factors
include a growing tumor pressing on nerves or other
structures, stretching of viscera, obstruction of ducts or
metastases to bones. May also be associated with
chemotherapy and radiation therapy.
f. Chronic Postoperative Pain rare but may occur
following incision in the chest wall, radical mastectomy,
radical neck dissection and surgical amputation

TYPES
PAIN
TYPES OF
OF PAIN
3. CENTRAL PAIN is related to a lesion in the brain that
may spontaneously produce high frequency bursts of
impulses that are perceived as pain. Thalamic pain is the
most common type. It is severe, spontaneous and often
continuous. It may be caused by a vascular lesion, tumor,
trauma or inflammation.

TYPES
PAIN
TYPES OF
OF PAIN
4. PHANTOM PAIN is a confusing pain syndrome that
occurs following surgical or traumatic amputation of limb.
The client experiences pain in the missing body part even
though there is complete mental awareness that the limb
is gone. This may include itching, tingling or pressure
sensations.
5. PSYCHOGENIC PAIN experienced in the absence
of any diagnosed physiologic event or cause.

TYPES OF PAIN STIMULI

TYPES OF PAIN STIMULI

1. Mechanical
. Trauma to body tissues (e.g., surgery): Tissue damage;
direct irritation of the pain receptors; inflammation
. Alterations in body tissues (e.g., edema):Pressure on pain
receptors
. Blockage of a body duct: Distention of the lumen of the
duct
. Tumor Pressure on pain receptors; irritation of nerve
endings
. Muscle spasm: Stimulation of pain receptors

TYPES OF PAIN
2. Thermal
Extreme heat or cold (e.g., burns): Tissue destruction;
stimulation of thermosensitive pain receptors
3. Chemical
1. Tissue ischemia (e.g., blocked coronary artery):
Stimulation of pain receptors because of accumulated
lactic acid (and other chemicals, such as bradykinin and
enzymes) in tissues
2. Muscle spasm: Tissue ischemia secondary to mechanical
stimulation

THEORIES OF PAIN

THEORIES OF PAIN
SPECIFICITY THEORY the most widely accepted
theory of pain transmission through the end of 19th
century.
It advances the idea that the bodys neurons and
pathways for pain transmission are as specific and
unique as those for other body senses, such as taste
or touch.

THEORIES
OFPAIN
PAIN
THEORIES OF
It proposes that free nerve endings in the skin act as
pain receptors, accept sensory input, and transmit this
input along highly specific nerve fibers. These fibers
synapse in the dorsal horns of the spinal cord, and
cross-over to the anterior and lateral spinothalamic
tracts. The pain impulses then ascend to the thalamus
and cerebral cortex, where painful sensations are
perceived.

THEORIES
OFPAIN
PAIN
THEORIES OF
It does not explain the differences in pain perception
among individuals, nor does it satisfactorily account for
the effect of physiologic variables, the effect of
previous experience with pain, phantom limb pain, or
peripheral neuralgias.

THEORIES
OFPAIN
PAIN
THEORIES OF
PATTERN THEORY proposed in the early 1900s.
It identifies two (2) major types of pain fibers, rapidly
conducting and slowly conducting fibers (A-delta and
C-fibers). The stimulation of these fibers forms a
pattern.
The theory also introduces the concept of central
summation. Peripheral impulses from many fibers of
both types are combined at the level of the spinal cord,
and from there, a summation of these impulses
ascends to the brain for interpretation.

THEORIES
OFPAIN
PAIN
THEORIES OF
This theory does not account for individual perceptual
differences and psychologic factors.

THEORIES
OFPAIN
PAIN
THEORIES OF
GATE CONTROL THEORY suggests that pain and its
perception are determined by interaction of two (2)
systems. The 1st of these interrelated system is the
substantia gelatinosa in the dorsal horns of the spinal
cord. The substantia gelatinosa regulates impulses
entering or leaving the spinal cord. The 2nd system is an
inhibitory system within the brainstem.

FACTORS INFLUENCING
REACTION TO PAIN

FACTORS
REACTION TO
TOPAIN
PAIN
FACTORSINFLUENCING
INFLUENCING REACTION
Pain Tolerance is the amount of pain a person can
endure before outwardly responding to it. The ability to
tolerate pain may be decreased by repeated episodes of
pain, fatigue, anger, anxiety and sleep deprivation. It may
be increased by medications, alcohol, hypnosis, warmth,
distraction and spiritual practices.

FACTORS
REACTION TO
TOPAIN
PAIN
FACTORSINFLUENCING
INFLUENCING REACTION
1. Age the older adult with normal age-related changes
in neurophysiology may have decreased perception of
sensory stimuli and a higher pain threshold.
2. Sociocultural Influences persons response to pain
is strongly influenced by the family, community and
culture. Sociocultural influences affect the way in which
a client tolerates pain, interprets the meaning of pain
and reacts verbally and nonverbally.

FACTORS
REACTION TO
TOPAIN
PAIN
FACTORSINFLUENCING
INFLUENCING REACTION
3. Emotional status the sensation of pain may be
blocked by intense concentration (during sports act) or
may be increased by anxiety or fear. Pain often is
increased when it occurs in conjunction with other
illness or physiological discomforts such as nausea
and vomiting.

FACTORS
REACTION TO
TOPAIN
PAIN
FACTORSINFLUENCING
INFLUENCING REACTION
3. Emotional status
Depression is clearly linked to pain: serotonin, a
neurotransmitter involved in the modulation of pain
in the CNS. In clinically depressed clients, serotonin
is decreased leading to an increase pain sensation.
A client who perceives advantages from the sick
role may be motivated to maintain pain. These
advantages called secondary gain may include
support from others or avoidance of disagreeable
work.

FACTORS
REACTION TO
TOPAIN
PAIN
FACTORSINFLUENCING
INFLUENCING REACTION
4. Past experiences with pain if the persons childhood
experiences with pain were responded appropriately by
supportive adults, the adult usually will have a healthy
attitude.
5. Source and Meaning if the client perceives the pain
as deserved (ex. Just punishments for sins), the client
may actually feel relief that the punishment has
commenced.

FACTORS
REACTION TO
TOPAIN
PAIN
FACTORSINFLUENCING
INFLUENCING REACTION
6. Knowledge Deficit if the client has a clear and
accurate perception of pain, it is far easier for
professionals to increase the clients knowledge of both
the significance of the pain and the strategies the client
can use to diminish discomfort in a timely way.

PAIN ASSESSMENT

PAIN
PAINASSESSMENT
ASSESSMENT
FOUR (4) ASSESSMENT AREAS:
1. Client Perceptions
- it is the most reliable indicator of pain because it
is based on the clients own statement.
- Ask the client to locate the pain, to describe the
quality of the pain, to indicate how the pain
changes with time, and to rate the intensity of the
pain.

PAIN
PAINASSESSMENT
ASSESSMENT

P
Q
R
S
T

- The clients perception of pain can also be

assessed by using the PQRST technique:
-precipitated (triggered, stimulated), palliated
(relieved), pattern
-quality and quantity. Is it sharp, stabbing, aching,
burning, stinging, deep, crushing, viselike, gnawing
-region (location), radiating
-severity
-timing

(The most common method to assess the severity of pain is

PAIN
PAINASSESSMENT
ASSESSMENT
COLDERRA
C Characteristics Dull, achy sharp, stabbing, pressure?
O Onset When did it start?
L Location Where does it hurts?
D Duration How long does it lasts? Frequency?
E Exacerbation What makes it worse?
R Radiation Does it travel to another part of the body?
R Relief What provides relief?
A Associated s/s Nausea, anxiety, autonomic response?

PAIN
PAINASSESSMENT
ASSESSMENT
Commonly Used Pain Rating Scale
1. Visual Analogue Scales are useful in
assessing the intensity of pain. This scale
includes a horizontal 10 cm line, with ends
indicating the extremes of pain. The person is
asked to place a mark indicating where the
current pain lies on the line. To score the results,
a ruler is placed along the line and the distance
the person marked the line from the bottom
extreme is measured and reported in cms.

PAIN
PAINASSESSMENT
ASSESSMENT
Commonly Used Pain Rating Scale
2. 0 -10 Numeric Pain Intensity Scale is used
for children, elderly and visually or cognitively
impaired patient. The person will be asked to
rate the pain from 0-10 with 0 signifying no pain
and 10 signifying the worst pain.

PAIN
PAINASSESSMENT
ASSESSMENT
Commonly Used Pain Rating Scale
3. Simple Descriptive Pain Intensity Scale the
patient may be asked to rate the pain on a verbal
scale (e.g., none, slight, moderate, severe, or very
severe)

PAIN
PAINASSESSMENT
ASSESSMENT
Commonly Used Pain Rating Scale
4. FACES Pain Rating Scale is a useful alternative
particularly for children and for patients with
language problems or low literacy.
- This tool presents a series of cartoon-like faces
ranging from a happy to a crying face. The person
experiencing pain is asked to point to the face that
best represents how he/she feels.

PAIN
PAINASSESSMENT
ASSESSMENT
FOUR (4) ASSESSMENT AREAS:
2. Physiologic Responses
predictable physiologic changes do occur in the
presence of acute pain. These may include muscle
tension, tachycardia, rapid shallow respirations,
increased BP, dilated pupils, sweating, and pallor.
Overtime however, the body will adapt to the pain
stimulus. Thus, these physiologic changes may be
extinguished in clients with chronic pain.

PAIN
PAINASSESSMENT
ASSESSMENT
FOUR (4) ASSESSMENT AREAS:
3. Behavioral Responses
there is a group of behaviors so typical of persons
in pain that the behavior are referred to as pain
behaviors. They include bracing or guarding the
painful part, taking medication, crying, moaning,
grimacing,
withdrawing
from
activity
and
socialization, becoming immobile, talking about
pain, holding the painful area, breathing with
increased effort, exhibiting a sad facial expression
and being restless.

PAIN
PAINASSESSMENT
ASSESSMENT
FOUR (4) ASSESSMENT AREAS:
4. Clients Attempt at Pain Management
this information is individualized and client
specific including many factors such as culture,
age, and client knowledge. The nurse should obtain
detailed descriptions of actions the client or SO
took, when and how these measures were applied,
and how well they worked.

CONCEPTS ASSOCIATED
WITH PAIN

CONCEPTS
ASSOCIATED
PAIN
ASSESSMENT TO PAIN
1. The experience of pain
Personal, subjective experience of painful sensations
known only to the person with pain. Includes a mental
and emotional component in addition to awareness of
painful physical sensations
Cannot be objectively measured, confirmed, or
disconfirmed by another person. May or may not be
associated with physical injury or disease; i.e., it is
possible to honestly experience painful physical
sensations in the absence of any current physical
damage; it is also possible to have physical damage and
yet have no experience of pain

CONCEPTS
ASSOCIATED
PAIN
ASSESSMENT TO PAIN
2. Pain behavior
Outward, observable expressions of pain and actions
taken to cope with pain. Includes complaints of pain,
non-verbal expressions of pain (e.g., limping, slow and
guarded movements, grimacing, groaning, taking pain
medication, laying in bed, withdrawing in silence, etc.),
and pain coping behaviors (e.g., taking medication,
reclining in bed, trying to ignore pain through
distracting activities)
Relationship with the experience of pain is variable; can
be pain experience with little pain behavior or minimal
pain experience with much pain behavior

CONCEPTS
ASSOCIATED
PAIN
ASSESSMENT TO PAIN
3. Physical injury/damage
Assumed cause of both acute and chronic pain
Normally associated with an immediate experience
of pain in the area where the injury has occurred
Relationship with chronic pain is variable. There may
or may not be identifiable physical damage, or the
nervous system may be sending faulty messages
regarding the nature or location of the injury

CONCEPTS
ASSOCIATED
PAIN
ASSESSMENT TO PAIN
4. Medical Test Findings
Results of the physical examination and medical test
procedures (e.g., lab tests, x-ray, CT scan, MRI,
electrodiagnostic tests, etc.)
Represents the doctor's attempts to identify the
nature and origin of the pain problem
Medical test findings may or may not be correlated
with the experience of pain; i.e., some people report
painful physical sensations in the absence of any
medical test findings, and other people have
positive medical test findings indicating disease or

CONCEPTS
ASSOCIATED
PAIN
ASSESSMENT TO PAIN
5. Disability
Refers to perceived inability or difficulties in
performing certain valued physical activities
Usually refers to inability to do the things that you
used to do
Caused by many factors in addition to actual
physical impairments, e.g., degree of motivation or
effort, attitudes, mood states, general physical
health, etc.
Distinguish subjective perception of disability from
definitions and criteria used by various disability

CONCEPTS
ASSOCIATED
PAIN
ASSESSMENT TO PAIN
6.Suffering
Refers to negative emotions and thoughts
commonly associated with pain and disability, e.g.,
anxiety, fear, frustration, anger, depression, and
general misery
It is not always the pain per se that produces
suffering, rather it is the way you see and react to
pain that determines the degree of suffering; i.e.,
some people have significant pain, but very little
suffering, whereas others have little pain and
significant suffering

CONCEPTS
ASSOCIATED
PAIN
ASSESSMENT TO PAIN
7.Chronic Pain Syndrome
Refers to the collection of additional problems which
frequently accompany chronic pain conditions. They
may include any combination of the following:
1. Interference with work and leisure-time activities
2. Decreased income, increased financial pressures
3. Activity intolerance
4. Reduced social activities, social withdrawal
5. Feelings of depression & discouragement, anger
& irritability, tension & worry

CONCEPTS
ASSOCIATED
PAIN
ASSESSMENT TO PAIN

6. Decreased interest in previously enjoyed activities

combined with increased preoccupation with pain
7. Interference with concentration and memory
8. Decreased self-confidence and self-esteem
9. Negative attitudes regarding self, others, and life in
general
10. Misuse of pain medications or alcohol
11. Development of secondary physical problems and
complaints
12. Sleep difficulties
13. Decreased sexual interest and/or problems with sexual
performance

PAIN MANAGEMENT

PAIN MANAGEMENT
Nurses Role

PAIN MANAGEMENT:
NURSES
PAIN MANAGEMENT (Nurses
Role) ROLE

The nurse helps relieve pain by administering

pain-relieving interventions including both
pharmacologic and nonpharmacologic
approaches.

PAIN MANAGEMENT:
NURSES
PAIN MANAGEMENT (Nurses
Role) ROLE
1. Identifying Goals for Pain Management the information obtained from the assessment is
used to identify goals for managing pain. The
goals identified are shared or validated with the
patient
2. Establishing Nurse-Patient Relationship a
positive N-P relationship and teaching are keys
to managing analgesia in the patient with pain,
because open communication and patient
cooperation are essential to success.

PAIN MANAGEMENT (Nurses

Role) ROLE
PAIN MANAGEMENT:
NURSES
3.

Client and Family Teaching providing

information about impending pain and pain
management to the client and family to lessen
anxiety about the unknown and to provide the client
with a means of controlling the pain.

4. Providing Physical Care the patient in pain may

be unable to participate in the usual ADLs or to
perform usual self-care and may need assistance to
carry out these activities. The patient is usually
more comfortable when physical and self-care
needs have been met.

PAIN MANAGEMENT
Pharmacologic

PAIN MANAGEMENT: PHARMACOLOGIC

Managing a patients pain pharmacologically is

accomplished in collaboration with the physician or
other primary care provider, the patient, and often the
family.

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
Premedication Assessment :
1. Ask the patient about allergies to medications and the
nature of any previous allergic responses. True allergic or
anaphylactic responses to opioids are rare but are not
uncommon.
2. The nurse must obtain the patients medication history
(current, usual, or recent use of prescribed or OTC
medications), along with a history of health problem.

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
3. Before administering analgesic agents, the nurse should
assess the patients status, including the intensity of
current pain, changes in pain intensity after the previous
dose of medication and side effects of the medications.

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
Terms Associated With Pain Medications:
1. Addiction the compulsive use of a substance despite
negative consequences, such as health threats or legal
problems.
2. Drug Abuse the use of any chemical substance for other
than a medical purpose.
3. Physical Drug Dependence - a biologic need for a
substance. If the substance is not supplied, physical
withdrawal symptoms occur.

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
4. Drug Tolerance the process by which the body requires
a progressively greater amount of a drug to achieve the
same results.
5. Pseudoaddicton behavior involving drug-seeking, a
result of receiving inadequate pain relief.

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
TYPES OF MEDICATION:
1. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDs)
.act on peripheral nerve endings and minimize pain
by interfering with prostaglandin synthesis. It is the
treatment of choice for mild pain and continue to
be effective when combined with narcotics for
moderate to severe pain.

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
They have anti-inflammatory, analgesic, and
antipyretic effects. It is believed that they inhibit
the enzyme cyclooxegenase, thereby decreasing
synthesis of prostaglandins.These drugs provide
analgesic effects by reducing inflammation and by
perhaps blocking the generation of noxious
impulses. piroxicam (Feldene) j. sulindac (Clinoril)

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
Examples :
a. aspirin (ASA)
b. ketorolac tramethamine (Toradol)
c. naproxen (Naprosyn)
d. ibuprofen (Motrin)
e. naproxen sodium (Anaprox)

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
2. NARCOTICS
- Are derivatives of the opium plant. These drugs
are the pharmacologic treatment of choice for
moderate to sever pain.
- These drugs produce analgesic effect by binding
to opioid receptors both within and outside the
CNS.
- These drugs decrease the awareness of the
sensation of pain by binding to opiate receptors in
the brain and spinal cord. It is also believed that
they diminish the transmission of pain impulses

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
Examples:
a. buprenorphine Hcl (Buprenex)
b. morphine sulfate
c. codeine
d. nalbuphine Hcl (Nubain)
e. hydromorphone Hcl (Dilaudid)
f. oxymorphoneHCl (Numorphan)
g. meperidine HCl (Demerol)
h. pentazocine (Talwin)
i. propoxyphene HCl (Darvon)

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
3. ANTIDEPRESSANTS
- antidepressants within the tricyclic and related
groups act on the production and retention of
serotonin in the CNS, thus inhibiting pain
sensation. They also promote normal sleeping
patterns, further alleviating the suffering of the
client in pain.
- Examples: amitriptyline (Elavil) imipramine
(Tofranil)

PAIN
MANAGEMENT:
PAIN
MANAGEMENT PHARMACOLOGIC
(Pharmacologic)
4. LOCAL ANESTHETICS
- block the initiation and transmission of nerve
impulses in a local area, thus blocking pain as
well.
a. Topical Application EMLA cream (eutectic
mixture or emulsion of local anesthetics) has
been effective for preventing pain associated
with invasive procedures such as lumbar
puncture or the insertion of IV lines. To be
effective, it must be applied 60-90 minutes
before the procedure.

PAIN MANAGEMENT
Non-Pharmacologic

PAIN
MANAGEMENTNON-PHARMACOLOGIC
(Non-Pharmacologic)
PAIN
MANAGEMENT:

Can assist in relieving pain with usually low risk to the

patient. In instances of severe pain that lasts for hours
or days, combining non-pharmacologic interventions
with medications may be the most effective way to
relieve pain.

PAIN
MANAGEMENTNON-PHARMACOLOGIC
(Non-Pharmacologic)
PAIN
MANAGEMENT:
1. Guided Imagery is using ones imagination in a
special way to achieve a specific positive effect. It is
also called creative visualization, and is uses
imaginative power of the mind to create a scene or
sensory experience that relaxes the muscles and
moves the attention of the mind away from the pain
experience.

PAIN
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2. Relaxation Techniques involve the learning of
activities that deeply relax the body and mind.
Relaxation distracts the client, lessens the effects
of stress from pain, increases pain tolerance,
increases the effectiveness of other pain relief
measures and increases perception of pain
control.

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a.

Diaphragmatic breathing can relax

muscles, improve O2 levels, and provide a
feeling of release from tension. The use of
diaphragmatic breathing is more effective when
the client either lies down or sits comfortably,
remains in a quiet environment, and keeps the
eyelid closed. Inhaling and exhaling slowly and
regularly is also helpful.

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b. Progressive Muscle Relaxation (PMR) may be used
alone or in conjunction with deep breathing to help
manage the pain. The client must be taught to tighten
one group of muscle (such as those of the face), hold
the tension for a few seconds, then relax the muscle
group completely. The client should repeat these
actions for all parts of the body. This method is also
effective when the client lies or sits comfortably, is in
quiet environment, and keeps the eyelids closed.

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c. Meditation is a process whereby the client
empties the mind of all sensory data, and
typically, concentrates on a single object, word
or idea. This activity produces a deeply relaxed
state in which O2 consumption decreases,
muscles relax, and endorphins are produced. At
its deepest level, meditation may resemble a
trance.

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3. Hypnosis is a trance state in which the mind
becomes extremely suggestible. To achieve
hypnosis, the client sits or lies down in a dimly
lighted, quiet room. The therapist suggests that
the client relax and fix attention on an object. The
therapist then repeats in a calm, soothing voice
simple phrases, such as instructions to relax and
listen to the therapists voice. The client gradually
becomes more and more relaxed and falls into a
trance in which the client is no longer aware of the
physical environment and hears only the

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4. Transcutaneous Electrical Nerve Stimulation
(TENS) a TENS unit is consists of low-voltage
transmitter connected by wires to electrodes that
are placed directly on the client over painful area.
The client experiences a gentle tapping or
vibrating sensation over the electrodes. The client
can adjust the voltage to achieve maximum pain
relief. It is believe that TENS electrodes stimulate
the large diameter A-beta touch fibers to close the
gate in the substantia gelatinosa. It is also
theorized that TENS stimulates endorphin release

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4. Transcutaneous Electrical Nerve Stimulation
(TENS)

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5. Ice and Heat Therapies- it is believe that ice
and heat stimulate the nonpain receptors in the
same receptor field as the injury. Neither therapy
should be applied to areas with impaired
circulation.

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6. Distraction involves the redirection of the
clients attention away from the pain and onto
something that the client finds more pleasant. It is
thought to reduce the perception of pain by
stimulating the descending control system,
resulting in fewer painful stimuli being transmitted
to the brain.

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7 . Cutaneous Stimulation it is believed that
stimulation of the skin is effective in relieving pain
because it prompts closure of the gate in the
substabtia gelatinosa.
a. Touch the nurse places hands on the clients
body or less than 1 inch above clients body to
realign energy. It may initiate gate closure. It also
relays or communicates caring.

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b. Pressure the nurse places head firmly on or
around the area where the client feels the pain.
It may relieve pain, decrease bleeding, and
prevent swelling, but benefits are temporary;
when pressure is lifted, pain returns.

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c.

Massage the nurse gently or briskly

stimulates clients subcutaneous tissues by
kneading, pulling, or pressing with fingers,
palms or knuckles. Its advantages are, it may
initiate gate closure, with low risk or minimal
side effects, and promotes relaxation and
sedation, but it is time consuming.

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d. Vibration the nurse uses an electrical or
battery operated vibrator to stimulate the
clients subcutaneous tissues. It may also
initiate gate closure with low risk of tissue
damage and less costly than TENS.

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8. Acupuncture is an ancient Chinese system
involving the stimulation of certain specific
points on the body to enhance the flow of vital
energy (chi) along pathways called meridians.

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9. Biofeedback is an electronic method of
measuring physiologic responses, such as brain
waves,
muscle
contraction,
and
skin
temperature,
and
then
feeding
this
information back to the client.