Pain Management PDF

PAIN MANAGEMENT Prepared by Magda yassin Introduction Pain is considered the fifth vital sign (temperature, pulse, respiration, and blood pressure, pain) the nurse must have the knowledge and skills to assess pain, to implement pain relief strategies, and to evaluate the effectiveness of th...

PAIN MANAGEMENT Prepared by Magda yassin Introduction Pain is considered the fifth vital sign (temperature, pulse, respiration, and blood pressure, pain) the nurse must have the knowledge and skills to assess pain, to implement pain relief strategies, and to evaluate the effectiveness of these strategies. Definition of pain an unpleasant sensory and emotional experience, which we primarily associate with tissue damage. Role of pain Simply, pain warns us of potential danger to tissue harm or to the presence of injury. This insult can be within or outside the nervous system, physical or chemical, visible or not. Although the characteristics of pain may differ, the role is still the same; pain is the body's alert system Types of pain 1.Acute pain: typically comes on suddenly and has a limited duration. It's frequently caused by damage to tissue such as bone, muscle, or organs -It alters the vital signs, for instance, raising the patient's heart rate and/or blood pressure. 2.Chronic pain : lasts longer than acute pain and is generally somewhat resistant to medical treatment. It's usually associated with a long-term illness. -The vital signs of a patient dealing with chronic pain are often not affected. That is because the body learns to adapt to deal with that pain Other classification of pain Pain is most often classified by the kind of damage that causes it. 1.Nociceptive pain : pain caused by tissue damage. For examples of nociceptive pain are a cut or a broken bone. 2.Neuropathic pain: pain caused by nerve damage. Classic examples of this pain are diabetic peripheral neuropathy. 3.psychogenic pain: pain that is affected by psychological factors. Psychogenic pain most often has a physical origin either in tissue damage or nerve damage, but the pain caused by that damage is increased or prolonged by such factors as fear, depression, stress, or anxiety. Effect of pain Pain produces a physiological stress response that includes increased heart and breathing rates to facilitate the increasing demands of oxygen and other nutrients to vital organs. Failure to relieve pain produces a prolonged stress state, which can result in harmful multisystem effects Factors affecting pain response 1.Age: Age can greatly influence a patient’s perception of the pain. Infants are sensitive to pain and typically exhibit discomfort through crying or physical movement. Older adults may often ignore their pain. 2.Gender:women tended to report higher levels of pain than men. 3.Previous experience with Pain: Patients previous exposures to pain will often influence their reactions, coping mechanisms and measures they can use to successfully manage pain on their own. 4.Cultural norms and Attitudes: Expression of pain is also governed by cultural values. In some cultures, tolerance to pain is a norm and therefore patient suffering pain in silence. Characteristics for assessing pain: Intensity: Intensity of pain ranges from none, mild discomfort to sever. When assessing a client’s pain nurse should determine a client’s pain onset and pain tolerance level. Location: Location of pain is best determined by having the patient point to the area of the body involved. Quality: Nurse asks patient to describe pain in his own words without offering clues. For example, the patient is asked to describe what the pain feels like. Timing: Sometimes the etiology of pain can be determined when time aspects are known. Therefore, the nurse inquires about the onset, duration, relationship between time and intensity. Pain assessment -Patients should be asked to describe their pain in terms of the following characteristics: Location, radiation, mode of onset, character, temporal pattern, exacerbating and relieving factors, and intensity. -Nurses can help patients more accurately report their pain by using these very specific PQRST assessment questions: 1. P = Provocation/Palliation. What were you doing when the pain started? 2. Q = Quality/Quantity. What does it feel like? 3. R = Region/Radiation. 4. S = Severity Scale. 5. T = Timing. Pain intensity scale  Pain intensity Scale 0 (no pain) to l0 (worst possible pain) scale. -pain in the 1 to 3 range is deemed mild pain. -A rating of 4 to 6 is moderate pain. -Pain reaching 7 to 10 is deemed severe pain and is associated with the worst outcomes. Definition of pain management: It refers to therapies used to manage a patient's pain and can include medication (pharmacological) or other therapies that do not make use of drugs (non- pharmacological). Pharmacological therapies Pharmacological therapies make use of medication to treat the patient’s pain. These include non-opioid analgesics, opioid analgesics, and adjuvant analgesics. 1.Non-opioid analgesics: are used to treat mild to moderate pain and include acetaminophen, NSAIDs (nonsteroidal anti-inflammatory drugs, such as ibuprofen), and aspirin. 2.Opioid analgesics: are used to treat moderate to severe pain (morphine) -Opioids are narcotics and can be highly addictive. Clinicians should prescribe "...the lowest effective dose of immediate-release opioids." 3.Adjuvant analgesics: are drugs with a primary indication other than pain but have analgesic properties and can alleviate pain in some conditions. Adjuvant analgesics include antidepressants, and topical analgesics. Non-pharmacological therapies Are therapies that do not involve medications and may be categorized as complementary and alternative medicine (CAM). These include: 1.Physical therapy: the treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery. 2.Massage: the manipulation of the body's soft tissues 3.Guided imagery: a type of focused relaxation or meditation, often led by a trained practitioner or teacher. 4.Distraction: shifting or moving one's attention away; in distraction therapy, one trains the brain to focus its attention onto something other than the pain (even though the pain is still there). 5.Biofeedback: a mind-body therapy that can improve physical and mental health; during a biofeedback session, a practitioner will use painless sensors to measure certain bodily functions. 6.Acupuncture: A therapy that involves the insertion of very thin needles through the skin at strategic points on the body; deriving from Chinese medicine, acupuncture can be used to alleviate stress a well as pain. ANY QUESTIONS THANK YOU