Understanding Pain: Types and Management

Comfort and Pain Management

• Pain is a defense mechanism indicating a problem.
• Pain is a subjective experience, present when the individual says it is.
• Nociceptors are peripheral receptors responding to mechanical, thermal, and chemical stimuli.
• Endorphins and enkephalins are endogenous opioid neuromodulators producing analgesic effects.
• Pain sensations are conducted from the injury site to the spinal cord and brain via transmission.
• Acute pain is rapid in onset, protective, and disappears when the situation resolves.
• Referred pain is when a patient with a gallbladder issue feels pain in the right shoulder.
• Neuropathic pain is pain from phantom limbs.
• Chronic pain is hard to localize and describe.
• Terms like dull, sharp, or diffuse describe the quality of pain.

Matching Exercises

• Psychogenic pain has no physical cause but can be intense.

• Allodynia is pain from a normally weak stimulus like a light touch.

• Diabetic neuropathy involves nerve damage causing numbness, prickling, or paresthesias.

• Visceral pain is poorly localized pain originating in body organs.

• Chronic pain lasts 6+ months and interferes with normal functioning.

• Intractable pain is resistant to therapy.

• Cutaneous pain is associated with a burn injury.

• Deep somatic pain is pain associated with a knee injury.

• Visceral pain is pain associated with cancer of the uterus and stomach ulcers.

• Referred pain is associated with neck/jaw pain from a heart attack.

• Distraction requires focusing attention on something other than the pain.

• Biofeedback uses a machine to help control involuntary body mechanisms that may cause pain.

• Acupressure uses fingertips to apply gentle pressure to acupuncture sites.

• TENS involves electrical stimulation to inhibit painful impulses.

• Cutaneous stimulation is the application of cold, ice, or heat.

• Placebo administration is ethically questionable.

Short Answer

• Injured tissue excites nerve endings, releasing histamines, lactic acid, bradykinin, prostaglandins, and substance P.
• Referred pain is transmitted to a cutaneous site because afferent neurons enter the spinal cord at the same level.
• The gate control theory explains pain control via a transmission mechanism in the substantia gelatinosa cells of the spinal cord.
• Culture/ethnicity and family can influence a patient's pain experience, by it being acceptable or unacceptable.
• Fear of the unknown can exaggerate pain.
• No pain experience could lessen pain, while more experience could increase it.
• Addiction may occur with chronic opioid use.
• Pain due to aging is a myth and can be managed.

Pain Assessment Questions

• "How long have you been experiencing this pain?" for duration.
• "On a scale of 1-10, how would you rate your pain?" for quantity and intensity.
• "Can you describe your pain?" to assess quality (dull, sharp, throbbing, intense).
• "Have you noticed physical changes since you've been experiencing it?" for physiologic indicators.
• Placebos should never be used without consent as this can damage the nurse/patient relationship.

Applying Knowledge

• With a patient who rates their pain as 9/10 but is currently talking with family and ate half their lunch an hour ago, the correct decision is to administer Oxycodone/acetaminophen 2 tabs every 4 hours prn moderate pain; Morphine 2 mg IV prn every 4 hours prn severe pain.

Reflective Practice

• Assess client's pain, get more information about their fear/anxiety, educate about neuropathy to manage pain associated with neuropathy.
• By the next visit the patient states 3 interventions she tried and explains the level of effectiveness with each for a successful outcome.
• To achieve the desired outcome with patient centered care, knowledge of pain, diabetes and medications for neuropathy.
• For teamwork and collaboration it may be helpful to consult an endocrinologist or neurologist, educational materials, diabletic footwear, home aide.

Practicing for NCLEX

• Providing a back massage before bed exemplifies the use of cutaneous stimulation for pain relief.
• Assess the constant pain, discomfort and any signs of depression for a recovering patient at their home.
• Giving an anticonvulsant medication is the best example of an adjuvant to treat pain with opioids.
• Patient with dementia condition is inappropriate for PCA.
• It activates the immune system effect correctly identifies the effects of laughter.
• "Your pain is a real experience" would be the best response to say to a patient with amputation.
• No action is needed patient is occasionally drowsy, drifting off to sleep during conversation, but easy to arouse. This is an expected effect.
• Acupuncture means of pain control is based on the gate control theory?
• "How does the pain develop and progress?" is an appropriate interview question to obtain this data.
• Opioid analgesics nurse would expect to administer to a patient with complains of severe pain following a mastectomy.
• Patient experiencing acute pain an effective method to pain control with a PRN drug regimen.
• "Only the patient may press the button for pain medication." to provide the patient and family for administration of an opioid medication via PCA.
• Reposition the patient and gently massage patient's back action the nurse take based on the gate control theory, after moderate to severe incisional pain.
• Have the child use a doll to act out their pain experience is a nurse's best intervention in this situation in the child is in pain but can not verbalize characteristics of the pain.
• Which patients would the nurse document as having acute pain; patients experiencing a heart attack, reporting signs and symptoms of appendicitis and fall victim with a broken ankle.
• Massaging the patient's shoulder, entire back, areas over iliac crests, and sacrum with light vertical stroking motions, assisting the patient to a prone position and draping the patient with the bath blanket, applying warmed lotion to patients back are nursing actions appropriately administering back massages to patients trouble sleeping.
• Patient conditions would the nurse place at risk for neuropathic pain; Postherpetic neuralgia, phantom limb pain, Diabetic neuropathy, complex regional pain syndrome
• Which represent physiologic responses from patient; Increase blood pressure, Muscle tension and rigidity and nausea and vomiting.
• Inform the patient that pushing the button delivers a specified dose of medication, teach that the pump will not deliver medication during the "lock-out" interval, for safety are the correct answers.
• Postcolostomy patient reporting pain 3/10 whose respiratory rate is 8 is the nurse prioritize for assessment because this patient may need medication.