chapter 20 pain management

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Chapter 20

Pain Management


PainPain

• Definition of pain

• The process of pain

– Transduction

– Transmission

– Perception

– Modulation


Phases of PainPhases of Pain


QuestionQuestion

•Is the following statement true or false?

C-fibers carry impulses rapidly at a rate of approximately 5 to 30 meters per second.


AnswerAnswer

False.

C-fibers carry impulses at a slower rate of 0.5 to 2 meters a second. A-delta fibers, which are large myelinated fibers, carry impulses rapidly at a rate of approximately 5 to 30 meters per second.


Pain (cont’d)Pain (cont’d)

• Pain theories

– Endogenous opioids

o Endorphins

o Dynorphins

o Enkephalins


Mechanism of Pain Transmission and Interference

Mechanism of Pain Transmission and Interference


Pain (cont’d)Pain (cont’d)

• Types of pain

– Cutaneous

– Visceral

– Neuropathic

– Acute

– Chronic


QuestionQuestion

•Phantom limb pain belongs to which of the following categories of pain?

a. Cutaneous

b. Visceral

c. Neuropathic

d. Acute


AnswerAnswer

c. Neuropathic

Phantom limb pain is an example of neuropathic pain, which is often experienced days, weeks, or even months after the source of the pain has been treated and resolved.


QuestionQuestion


Somatic pain is discomfort that originates at the skin level.


AnswerAnswer

False.

Somatic pain is discomfort generated from deeper connective tissue. Cutaneous pain is discomfort that originates at the skin level and is a commonly experienced sensation resulting from some form of trauma.


Pain Assessment Standards Pain Assessment Standards

• Pain: the fifth vital sign

• JCAHO standards

• Compliance with established standards of care


JCAHO Components of a Comprehensive Pain Assessment

JCAHO Components of a Comprehensive Pain Assessment


Pain Assessment Data Pain Assessment Data

• Components of brief or basic pain assessment

• Questions to be asked during admission assessment

• Underassessed and undertreated clients


Components of Pain AssessmentComponents of Pain Assessment


Pain Intensity Assessment Tools Pain Intensity Assessment Tools • Four types of pain assessment

tools

– Numeric scale

– Word scale

– Linear scale

– Picture scale

• Different scales for different ages


Pain Intensity Assessment Tools (cont’d)

Pain Intensity Assessment Tools (cont’d)


Pain Management Pain Management

• Treatment biases

• Pain management techniques

• Drug therapy

– Nonopioid drugs

– Opioid drugs


World Health Organization Analgesic Ladder

World Health Organization Analgesic Ladder


Pain Management (cont’d) Pain Management (cont’d)

• Opioid drugs (cont’d)

– Patient-controlled analgesia

– Intraspinal analgesia

• Adjuvant drugs

• Botulinum toxin therapy


Pain Management (cont’d)Pain Management (cont’d)

• Surgical approaches

– Rhizotomy

– Cordotomy


Client and Family Teaching: Pain and Its Management Client and Family Teaching: Pain and Its Management



• Nondrug/nonsurgical interventions

– Education

– Imagery

– Meditation

– Distraction

– Relaxation



• Nondrug/nonsurgical interventions (cont’d)

– Heat and cold

– Transcutaneous electrical nerve stimulation

– Acupuncture and acupressure



• Nondrug/nonsurgical interventions (cont’d)

– Percutaneous electrical nerve stimulation

– Biofeedback

– Hypnosis


Percutaneous Electrical Nerve Stimulation

Percutaneous Electrical Nerve Stimulation


Nursing ImplicationsNursing Implications

• Various nursing diagnoses

• Addiction

• Placebos


General Gerontologic ConsiderationsGeneral Gerontologic Considerations

• Pain in older people

• Assessment of pain in older people

– Fear and anxiety can cause them to endure pain

– Downplaying of pain

– Misleading data


General Gerontologic Considerations (cont’d)


• Assessment of pain in older people (cont’d)

– Older people with cognitive impairment

• Pain control measures for older people

– Adverse effects of certain drugs




• Pain control measures for older people (cont’d)

– Topical application of heat

– Determining appropriate route for individual medication administration

– Increased sensitivity to narcotics among older people


QuestionQuestion


Older adults are less sensitive to pain stimuli.


AnswerAnswer

False.

Age-associated changes in pain perception, sensitivity, and tolerance affect the experience of pain in older adults. Therefore, it is a dangerous assumption to believe that older adults are less sensitive to pain stimuli.

chapter 20 pain management

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