Pain Part 1- 2018 (2).pptx

Focus on Pain Garry Johnson, DHSc, RN Presented by Karen Cheung, RN 1 Student Learning Outcomes  Explain how the physiology of pain relates to the selection of interventions for pain relief.  Describe guidelines for selecting and individualizing comfort and pain interventions.  Describe non-pharm...

Focus on Pain Garry Johnson, DHSc, RN Presented by Karen Cheung, RN 1 Student Learning Outcomes  Explain how the physiology of pain relates to the selection of interventions for pain relief.  Describe guidelines for selecting and individualizing comfort and pain interventions.  Describe non-pharmacological measure for pain relief and supportive comfort measures.  Describe the implication for opioid analgesics, nonopioids, and NSAIDS use. 2 Student Learning Outcomes  Utilize the nursing process in care of a client experiencing discomfort or pain.  Explain how cultural factors influence the pain experience 3 Nursing Roles     Assess pain and communicate with other health care providers Ensure initiation of adequate pain relief measures Evaluate effectiveness of interventions Advocate for those in pain 4 Magnitude of the Pain Problem  Acute pain is the most common reason for health care visits  25 million Americans have acute pain caused by injury or surgery  50 million Americans suffer from persistent or chronic pain such as arthritis  Over 25 million suffer from migraine headaches 5 Magnitude of the Pain Problem  Despite the prevalence of pain, many studies document inadequate pain management across care settings and patient populations 6 Magnitude of the Pain Problem  Why nurses undertreat pain ◦ Inadequate skills to assess and treat pain ◦ Unwillingness to believe patient reports ◦ Lack of time, expertise, and perceived importance of pain assessments ◦ False concepts of addiction and tolerance 7 Magnitude of the Pain Problem  Consequences of untreated pain ◦Unnecessary suffering ◦Physical and psychosocial dysfunction ◦Impaired recovery from acute illness and surgery ◦Immunosuppression ◦Sleep disturbances 8 Definition of Pain  “Whatever the person experiencing pain says it is” ………..Margo McCaffery  Unpleasant sensory and emotional experience associated with actual or potential tissue damage (Perry,Potter pg. 962) 9 Pain Mechanisms  Nociception (normal): physiologic process that communicates tissue damage to the CNS  Involves four processes  Transduction  Transmission  Perception  Modulation 10 Pain Mechanisms Transduction  Transduction Conversion of stimulus into electrical energy 11 Pain Mechanisms Transmission Sending of impulse across a sensory pain nerve fiber (nociceptor) 12 Pain Mechanisms Perception-The patient’s experience of pain 13 Pain Mechanisms Modulation   Activation of descending pathways that exert inhibitory or facilitatory effects on the transmission of pain Can occur at periphery, spinal cord, brainstem, and cerebral cortex https://www.google.com/search? q=pain+perception+in+brain&biw=1366&bih=653&sourc e=lnms&tbm=isch&sa=X&ved=0ahUKEwi2Kn3w8XJAhUto4MKHfasAG8Q_AUIBigB#tbm=isch&q=d escending+modulation+of+pain&imgrc=Ei4fgD-Q0LHjjM %3A 14 Review Gate Control Theory of Pain Categorizing Pain Timing Acute vs. Chronic  Underlying Pathology Nociceptive vs. Neuropathic  Cancer vs. Non-Cancer  Location Somatic vs. Visceral vs. Referred  Acute vs Chronic Pain Characteristic Cause Acute Pain Generally known Chronic Pain Often unknown Duration of pain Short, well-characterized Persists after healing, ³3 months Treatment approach Resolution of underlying cause, usually self-limited Underlying cause and pain disorder; outcome is often pain control, not cure Acute Pain  Manifestations reflect sympathetic nervous system activation ◦ Increased heart rate ◦ Increased respiratory rate ◦ Increased blood pressure 19 Chronic Pain   Does not go away; characterized by periods of waxing and waning Behavioral manifestations ◦ Decreased physical movement/activity ◦ Fatigue ◦ Withdrawal from others and social interaction 20 Domains of Chronic Pain Quality of Life Physical functioning Ability to perform activities of daily living Work Recreation Psychological Morbidity Depression Anxiety, anger Sleep disturbances Loss of self-esteem Social Consequences  Marital/family relations  Intimacy/sexual activity  Social isolation Socioeconomic Consequences  Healthcare costs  Disability  Lost workdays Nociceptive vs Neuropathic Pain Nociceptive Pain Caused by activity in neural pathways in response to potentially tissue-damaging stimuli Postoperative pain Mixed Type Neuropathic Caused by a combination of both primary injury and secondary effects Pain primary lesion or dysfunction in the nervous system CRPS* Arthritis Mechanical low back pain Initiated or caused by Sickle cell crisis Sports/exercise injuries *Complex regional pain syndrome Postherpetic neuralgia Neuropathic low back pain Trigeminal neuralgia Central poststroke pain Distal polyneuropathy (eg, diabetic, HIV) Possible Descriptions of Neuropathic Pain  Sensations ◦ numbness ◦ tingling ◦ burning ◦ paresthetic ◦ paroxysmal ◦ lancinating ◦ electriclike ◦ raw skin ◦ shooting ◦ deep, dull, bonelike ache  Signs/Symptoms ◦ allodynia: pain from a stimulus that does not normally evoke pain  thermal  mechanical ◦ hyperalgesia: exaggerated response to a normally painful stimulus Cancer Pain Usually related to:  Tumor progression  Invasive procedures  Toxicity of treatment  Infection  Physical limitation https://www.google.com/search? q=cancer+pain&biw=1366&bih=653&source=lnms&tbm=isch&sa=X&sqi=2&ved= 0ahUKEwicmui818XJAhUyrIMKHeLDAE0Q_AUIBygC#imgrc=aK4UDFmC09X39M%3A Somatic Pain (body pain)    Aching or throbbing Localized Arises from bone, joint, muscle, skin, or connective tissue 25 Visceral Pain  Tumor involvement or obstruction  Arises from internal organs such as the intestine and bladder 26 Breakthrough Pain  Transient, moderate to severe  Occurs beyond treated pain  Usually rapid onset and brief duration with variable frequency and intensity  Often why nurse give PRN in addition to regular pain RX’d pain meds 27 Referred Pain 28 Nature of Pain     Involves physical, emotional, and cognitive components Physical and/or mental stimulus Is exhausting and demands energy Interferes with relationships https://www.google.com/search? q=pain+perception+in+brain&biw=1366&bih=653&tbm=isch&imgil=bKdkfLbym_8k1M%253A %253B7uRWOd7m_G6bVM%253Bhttp%25253A%25252F%25252Fbretcontreras.com%25252Fa-revolution-in-theunderstanding-of-pain-and-treatment-of-chronic-pain%25252F&source=iu&pf=m&fir=bKdkfLbym_8k1M %253A%252C7uRWOd7m_G6bVM%252C_&usg=__sLS6TK7bfnJMmurOp-_hEFKzN4U %3D&ved=0ahUKEwi2Kn3w8XJAhUto4MKHfasAG8QyjcIMw&ei=N0VjVv7gH63GjgT22YL4Bg#imgrc=bKdkfL Dimensions of Pain Physiologic  Genetic, anatomic, and physical determinants  Influence how stimuli are recognized and described 30 Dimensions of Pain Affective  Emotional response to pain experience ◦Anger ◦Fear ◦Depression ◦Anxiety 31 Dimensions of Pain Affective  Studies demonstrate a link between depression and pain ◦ Treating one can relieve the symptoms of the other 32 Dimensions of Pain Behavioral  Observable actions used to express the pain ◦ Facial expressions ◦ Socially withdrawn ◦ Less physically active ◦ Guarding ◦ Crying       Observable actions used to control the pain Exercise Taking Medication Sleep Relaxation Alternative and Complimentary Practices 33 Dimensions of PainBehavioral Copyright © 2018, Elsevier Inc. All rights reserved. 34 Dimensions of pain  Older Adults https://www.google.com/search? q=infant+in+pain&biw=1366&bih=653&tbm=isch&imgil=lpXjh6lrdmOrGM%253A %253BBQmIsvfUcloJNM%253Bhttp%25253A%25252F%25252Fpurplecrying.info%25252Fsub-pages %25252Fcrying%25252Fwhy-we-know-your-infant-is-not-inpain.php&source=iu&pf=m&fir=lpXjh6lrdmOrGM%253A%252CBQmIsvfUcloJNM %252C_&usg=__Q3Va_PTe0q5OvYsVR3lf2l_Z_jc %3D&ved=0ahUKEwjricDIwsfJAhVwjIMKHSDLAE0QyjcILQ&ei=OFBkVuuNFvCYjgSgloPoBA#imgrc=UAG f7imnHav64M%3A&usg=__Q3Va_PTe0q5OvYsVR3lf2l_Z_jc%3D Infants https://www.google.com/search? q=culture+and+pain+expression&biw=1366&bih=653&sou rce=lnms&tbm=isch&sa=X&ved=0ahUKEwiom_7MxMfJAhVu joMKHSpLAZkQ_AUIBigB#tbm=isch&q=culture+and+pain+ &imgrc=ZhUK71TbB4A-oM%3A  Culture Dimensions of Pain Dimensions of Pain Cognitive  Beliefs, attitudes, memories, and meaning attributed to pain  Influence response to pain and must be incorporated into the comprehensive treatment plan 37 Description of Pain  Subjective: patients experience and self-report is essential ◦ Can be problematic when dealing with special populations (coma or dementia)  Nonverbal information such as behaviors aids the assessment of pain 38 Pain Assessment  Nurse is responsible to ◦Gather and document data ◦Make collaborative decisions with patient and other health care providers 39 Assessing the Patient With Pain  Onset and duration  Location/distribution  Quality  Intensity Assessment cont’d Aggravating/relieving factors  Associated features or secondary signs/symptoms  Associated factors  ◦ mood/emotional distress ◦ functional activities  Treatment response 41 Pain Assessment: Tools 42 Pain Assessment  Associated symptoms  Can worsen pain  Anxiety  Fatigue  Depression 43 Pain Treatment Principles 1. 2. 3. 4. Follow principles of assessment Every patient deserves adequate pain management Treatment based on patients goals Use drug and nondrug therapies 44 Pain Treatment Principles 5. 6. 7. 8. Use a multidisciplinary approach Evaluate effectiveness Prevent or manage side effects Involve patient and family teaching through assessment and treatment 45