Pain Management Concepts and Challenges

Pain Management Concepts and Challenges

• Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP, 1994).
• Allodynia is pain caused by a stimulus that does not normally cause pain.
• Analgesia is the absence of pain in response to stimulation that would normally cause pain.
• Dysaesthesia is unpleasant abnormal sensations, potentially spontaneous or provoked.
• Hyperaesthesia is increased sensitivity to sensation.
• Hyperpathia is a painful syndrome featuring increased reaction to stimuli, including repetitive stimuli, and a higher pain threshold.
• Pain threshold is the least amount of pain sensation a person can perceive.
• Pain tolerance level is the greatest level of pain a person is willing to endure.
• Total pain includes physical, psychological, cultural, social, and spiritual aspects of pain.

Outline of Pain Management

• Definitions of pain
• Principles of pain
• Physiology of pain
• Classification of pain
• Assessment of pain
• Management of pain
• Treatment Principles
• Non-pharmacological treatment

Physiology of Pain

• Pain pathways involve the peripheral and central nervous systems.
• Pain sensation has an initial sharp phase followed by a longer dull phase, due to different nerve fiber speeds.
• Cellular damage releases chemicals that influence nerve activity and pain intensity.
• Referred pain is when pain from internal organs is perceived in a different location on the body.
• Chronic pain can lead to altered pain perception, increased sensitivity, and unusual sensations like burning or numbness.

Classification of Pain

• Pain can be classified by duration (acute or chronic).
• Pain can also be categorized by underlying mechanism (nociceptive or neuropathic).
• Pain can be classified by situation (breakthrough, incident, or procedural).

Acute Pain

• Originates from a clear, definable injury or illness.
• Has a definite onset and limited, predictable duration.
• Associated with anxiety and sympathetic nervous system overactivity.
• Treatment focuses on the underlying cause, with short-term analgesics.

Chronic Pain

• Results from a chronic pathological process.
• Gradual or ill-defined onset, continuing unabated, and often lasting longer than expected healing time.
• Patient may appear depressed or withdrawn, and pain is often labeled as 'not looking like somebody in pain'.
• No protective benefits; has detrimental effects on the nervous system and psychological well-being.
• Treatment focuses on underlying cause, analgesics, and psychological support.

Nociceptive Pain

• Caused by stimulation of specific sensory receptors in intact tissues, such as skin, muscles, and organs.
• Somatic pain is superficial, sharp, and well-localized (in skin, mucous membranes, tendons/joints).
• Visceral pain is dull, poorly localized, and/or referred to a different body part (often associated with autonomic responses like sweating or nausea).

Neuropathic Pain

• Due to damage or dysfunction of the central or peripheral nervous system.
• Characterized by burning, shooting, aching sensations, and increased/altered sensitivity to stimuli (hyperalgesia or allodynia).
• Requires demonstrable nerve damage or a specific disorder for diagnosis. Not just a description.

Pain Classification: Situation

• Breakthrough pain: transient worsening of pain despite ongoing treatment.
• Incident pain: pain triggered by specific circumstances or activities (e.g. movement).
• Procedural pain: pain related to medical procedures.

Pain Assessment: PQRST

• Precipitating and relieving factors
• Quality of pain (description)
• Radiation of pain
• Site and severity of pain (using a scale)
• Timing and previous treatment

Numeric Pain Rating Scale (NPRS)

• Pain levels are measured on a scale of 0 to 10, with 0 as no pain and 10 as the worst possible.

Wong-Baker FACES Scale

• A visual scale that uses faces to show different levels of pain, useful for children.

FLACC Scale

• This scale assesses pain in individuals who are unable to communicate verbally. It considers face, legs, activity, cry, and consolability.

Pain Management

• The management approach should be tailored to both the type and cause of pain.
• Treatment aims for pain relief, prevention of recurrence, and holistic well-being.
• Pharmacological and non-pharmacological treatments, appropriately applied, are integral to pain management.

Treatment Principles: Taking Pain Seriously

• Oral pain relief is preferred when possible.
• Medications should be dosed based on the duration of the relief, not "as needed".
• Movement up the analgesic ladder should be considered if a single medication isn't working.
• Medication should be adjusted to address pain relief and side effects.

Non-Pharmacological Treatment

• Addresses psychological/cultural/social factors influencing pain.
• Complementary to pharmacological treatment.
• Techniques include reducing symptoms, affecting pain perception, assisting with relaxation, and improving sleep.

Specific Non-Pharmacological Techniques

• Surgery (treating the source of pain)
• Radiotherapy (to address pain due to tumor infiltration)
• Dance therapy
• Music therapy
• Acupuncture
• Physical therapy
• Positioning therapy
• Massage therapy
• Social support
• Spiritual support
• Relaxation techniques
• Hot/cold therapy
• Deep breathing
• Distraction
• Aromatherapy
• Herbs
• Reflexology

Summary Of Quiz Question Answers

• Patient pain assessment by: client's self-report, objective observation, behavioral assessment, numeric pain scale.
• Effective administration of analgesics for chronic pain: around the clock.