Pain Management Class Session 3 PDF

Pain Management Dr. Salwa Alalawi Objectives Explain the fundamental concepts of pain. Identify practical non- pharmacologic methods that can be used in the clinical setting in patients with pain. Utilize the nursing process as a framework for the care of patients with pain.  Definit...

Pain Management Dr. Salwa Alalawi Objectives Explain the fundamental concepts of pain. Identify practical non- pharmacologic methods that can be used in the clinical setting in patients with pain. Utilize the nursing process as a framework for the care of patients with pain.  Definition of Pain An unpleasant sensory and emotional experience associated with actual or potential tissue damage. impact a person’s: Psychosocial Emotional Physical functioning highly personal and subjective experience Harmful effect of pain Types and categories of Pain Acute: The most recent Pain associated with injury, such as tissue damage result from surgery, burn procedures, it is expected to be for relatively short duration. Chronic: resolve within months or persist throughout person`s life. Cancer or non- cancer pain (peripheral neuropathy from diabetes, back or neck pain after injury, and osteoarthritis pain from joint degeneration). Breakthrough pain: experience of acute exacerbation of pain. Nociceptive (physiologic pain): normal functioning of physiologic systems that leads to perceptions of noxious stimuli as being painful. Neuropathic (pathophysiologic) pain is pathologic and results from abnormal processing of sensory input by the nervous system as a result of damage to the peripheral or central nervous system (CNS) or both. combination of nociceptive and neuropathic pain: Sickle cell disease pain Types and categories of Pain Nociceptive (physiologic pain): Somatic pain: Surgical trauma, wound and burn pan, labor pain osteoporosis pain Visceral pain : GI tract and pancreas (ulcerative colitis, irritable bowel syndrome, crohn`s disease, pancreatitis Neuropathic (pathophysiologic) pain Centrality generated pain Deafferentation pain: phantom pain, post stroke pain following spinal cord injury. Sympathetically maintained pain: complex reginal pain syndrome Peripheral generated pain Diabetic neuropathy, neck, shoulder and back pain Mixed pain: Fibromylagia, headaches, pain associated with HIV. Myofascial pain lyme disease  Transmission: Transduction: Transmit delta activate and C fibers to nociceptors after detect thermal noxious stimuli and mechanical injury, allow relatively quick localization of pain which response to rapid reflex withdrawal from the painful Perception: stimulus. transmission of noxious Stimuli. activate higher Modulation: brain structures Response to for the occurrence noxious stimuli by of awareness, releasing of emotions, and serotonin and drives associated norepinpherine. with pain Anitdepreesent to fight pain. Neuropathic pain Cause release of inflammatory cytokines that alter gene expression and sensitivity in nociceptive fibers.  Neuropathic Pain Peripheral Mechanism – hyperexcitability of nerve endings in periphery leading to neuroplasticity (abnormal reorganization of nervous system due to damage or dysfunction) – accumulation of sodium channels in injured nociceptors which lower depolarization and increase response to stimuli. Central Mechanism – abnormal hyperexcitability of central neurons in the spinal cord central sensitization. Influx of sodium lower threshold of nerve activation increasing response to stimuli. Allodynia pain from normal nonnoxious stimulus. Pain assessment Patient self-reporting of pain Location of pain: state or point to the area(s) of pain on the body Intensity : Numeric rating scale Wong-Baker FACES pain rating scale. Faces pain scale- Revised (FPS-R) Verbal Descriptive Scale (VDs) Visual Analog Scale (VAS) Pain assessment Quality of pain: describe how the pain feels. Descriptors such as “sharp,” “shooting,” or “burning” Onset and duration: when the pain started and whether it is constant or intermittent. Aggrading and reliving factors: what makes the pain worse and what makes it better. Effect of pain on function and quality of life: ability to perform recovery activities should be regularly evaluated in the patient with acute pain. Comfort-function (pain-intenstiy) goal: Other information: The patient’s culture, past pain experiences, and pertinent medical history Pain should be reassessed with each new report of pain at regular basis and before and after the administration of analgesic agents Pain assessment FLACC: Facial expression, Leg movement, Activity, Crying, and Consolability for young children PAINAD (Pain Assessment IN Advanced Dementia): indicated for use in adults with advanced dementia CPOT (Critical Care Pain Observation Tool): indicated for use in patients in critical care units who cannot self-report pain Pain assessment FLACC: Facial expression, Leg movement, Activity, Crying, and Consolability for young children PAINAD (Pain Assessment IN Advanced Dementia): indicated for use in adults with advanced dementia CPOT (Critical Care Pain Observation Tool): indicated for use in patients in critical care units who cannot self-report pain Pain assessment FLACC: Facial expression, Leg movement, Activity, Crying, and Consolability for young children PAINAD (Pain Assessment IN Advanced Dementia): indicated for use in adults with advanced dementia CPOT (Critical Care Pain Observation Tool): indicated for use in patients in critical care units who cannot self-report pain Guidelines for Assessing Pain in Patients With Disabilities. Braille system Sign language Written notes Pictures Computer generated speech Pain Management Pharmacologic Management of Pain: Multimodal Analgesia Routes of Administration Oral route (IV) route transdermal, rectal, or subcutaneous route Intraspinal analgesia“neuraxial” Perineural anesthesia (peripheral nerve block) Dosing Regimen Analgesic agent to be given on a scheduled around-the-clock (ATC) basis, Opioid and Nonopioid Analgesic Agents Patient-controlled analgesia (PCA) Nonpharmacologic Methods of Pain Management Considerations in Selecting and Using Nonpharmacologic Methods chart 12/7  Evaluating Pain Management Strategies Relief of Pain, evidence when the patient Rates pain at a lower intensity after intervention Rates pain at a lower intensity for longer periods. Correct administration of prescribed analgesic medications, evidenced when the patient or family States correct dose of medication Administers correct dose using correct procedure Identifies side effects of medication Describes action taken to prevent or correct side effects.  Evaluating Pain Management Strategies Use of non-pharmacological pain strategies as recommended, evidenced when the patient: Reports practice of non-pharmacological strategies. Describes expected outcomes of nonpharmacological strategies Minimal effects of pain and minimal side effects of interventions, as evidenced by Participation in activities Reports adequate sleep and absence of fatigue and constipation NCP for pain Management Chart 12/8 Thank You