UNIT IV PAIN PDF

F.O.N GENERIC BSN SEMESTER II UNIT IV: CONCEPT OF PAIN (DIFFERENT THERAPIES) OBJECTIVES 1. Define the process of pain (physiological changes) 2. Describe the different theories of pain theory. 3. Differentiate between acute and chronic pain 4. Discuss the non pharmacologic interventions pain manage...

F.O.N GENERIC BSN SEMESTER II UNIT IV: CONCEPT OF PAIN (DIFFERENT THERAPIES) OBJECTIVES 1. Define the process of pain (physiological changes) 2. Describe the different theories of pain theory. 3. Differentiate between acute and chronic pain 4. Discuss the non pharmacologic interventions pain management. 5. Identify pharmacologic interventions for pain management PAIN PAIN Pain is defined as; an unpleasant sensation and emotional experience, usually caused by tissue damage. Or Pain is; an uncomfortable or unpleasant feeling, as a prick, tingle, sting, burn, or ache which may be sharp or dull. It may come and go, or may be constant. PAIN PROCESS A pain message is transmitted to the brain by specialized nerve cells known as nociceptors (pain receptors). When receptors are stimulated by temperature, pressure or chemicals, they release neurotransmitters (chemical ‘messengers’) within the cells which facilitate communication between nerve cells. Pain receptor to the spinal cord, and then to the thalamus (Region of the brain). The thalamus then transmits signal to other areas of the brain to be processed. Brain, coordinates an appropriate response. The brain can send a signal back to the spinal cord and nerves to increaseor decrease the severity of pain. For example, the brain can signal the release of natural painkillers (endorphins). Alternately, the brain can direct the release of neurotransmitters that enhance pain or hormones that stimulate the immune system to respond to an injury.  TYPES OF PAIN i. ACUTE PAIN It is a pain of short duration, usually comes on suddenly caused by something specific. It is sharp in quality, can lasts from minutes to about three months (sometimes up to six months). Acute pain usually doesn’t last longer than six months, it typically subsides after the injury heals or the illness subsides. Causes of acute pain include;  Surgery  Broken bones  Dental work  Burns or cuts ii. CHRONIC PAIN It is a pain that is ongoing and longer in duration usually lasts more than six months. This type of pain can continue even after the injury or illness has healed. Pain signals remain active in the nervous system for weeks, months or years. Some people suffer chronic pain even when there is no past injury or apparent body damage. Chronic pain is linked to conditions that include:  Headache  Arthritis  Cancer  Back pain. ACUTE VS CHRONIC PAIN ACUTE PAIN CHRONIC PAIN Onset Usually comes on suddenly Usually comes on gradually Cause Due to specific cause or tissue damage Usually the result of long term diseased as acute injury, surgery etc conditions as; cancer Duration Short, but can be lasts for six months Lasts longer than six months Severity Correlates with amount of tissue Not correlated with tissue damage damage Characteristics Sharp & Localized Dull, aching, generalized Status Considered as symptom Considered as disease Relief Reduces as the injury healed Usually not reduced even injury has healed  iii. NEUROPATHIC PAIN Pain caused by damage to the nerves or other parts of the nervous system. Often described as shooting, stabbing, or burning pain, or it feels like pins and needles. This pain is sensitive to touch and can make difficulty while facing hot or cold. It may be intermittent and it can be so severe while performing everyday tasks. NOTE: Neuropathic pain is a common type of chronic pain. iv. NOCICEPTIVE PAIN Pain caused by damage to body tissue as an external injury, characterized by sharp, achy, or throbbing conditions. This type of pain is often experienced in the joints, muscles, skin, tendons, and bones. E.g. After hit to elbow, twist to ankle, or fall and scrape the knee, results in nociceptive pain. NOTE: It can be both acute and chronic. v. RADICULAR PAIN Pain that occur when the spinal nerve gets compressed or inflamed radiates from the back and hip into the leg(s) by way of the spine and spinal nerve root. Nature of pain includes; tingling, numbness, and muscle weakness. Example: Sciatic pain=Pain due to the sciatic nerve being affected. This type of pain is often steady, and people can feel it deep in the leg. Walking, sitting, and some other activities can make sciatica worse. It is one of the most common forms of radicular pain. vi. NOCIPLASTIC PAIN Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain. Effect of this pain can be amplified, may be widespread, involve various tissues (body, viscera) and be greater than would be expected given the amount of identifiable tissue or nerve damage. Common characteristics; fatigue, poor sleep, memory, and low mood. It is often associated with conditions as; fibromyalgia, chronic pelvic pain, tension-type headaches or chronic low back pain. This type of pain does not respond to most medicines and usually requires a tailored program of care involves; addressing factors that can contribute to ongoing pain (lifestyle, mood, activity, work, social factors). PAIN THEORIES 1. NEUROMATRIX MODEL BY RONALD MELZACK (MID 1900) Theory proposed that; if an individual suffered an injury, through trauma, infection, or disease, a signal would transmit to the brain which would, in turn, result in the sensation of pain. This philosophy suggests that; it is the central nervous system that is responsible for producing painful sensations rather than the periphery. The model denotes that there are four components within the central nervous system responsible for creating pain. Components within the CNS; 1. Body-self neuromatrix 2. The cyclic processing, and synthesis of signals 3. The sentinel neural hub 4. The activation of the neuromatrix According to Melzack; the neuromatrix consists of multiple areas within the central nervous system that contribute to the signal, which allows for the feeling of pain. These areas include; the spinal cord, brain stem and thalamus, limbic system, insular cortex, somato-sensory cortex, motor cortex, and prefrontal cortex. 2. PATTERN THEORY OF PAIN: Theory proposed by Goldscheider states that; pain is generated by non-specified receptor. Pain sensation depends upon the spatio-temporal pattern of nerve impulses reaching the brain. Pain, warmth, cold--codes of neural activity evoked from the skin by changes in its environment. Nerve impulse entering CNS -Diff. For diff. region and will vary from person to person due to anatomical variation. A stimulus evokes certain pattern that the brain receives and recognizes. PAIN MANAGEMENT A. NON-PHARMACOLOGICAL PAIN MANAGEMENT i. Hypnosis (sleep induction)  With hypnosis, a psychologist or doctor guides patient into an altered state of consciousness which helps to narrow the attention to reduce discomfort. ii. Comfort therapy  Companionship  Exercise  Heat/cold application  Lotions/massage therapy  Meditation  Music, art, or drama therapy  Pastoral counseling  Positioning iii. Physical and occupational therapy o Aqua therapy o Tone and strengthening o Desensitization  iv. Psychosocial therapy/counseling  Individual counseling  Family counseling  Group counseling v. Neurostimulation  Acupuncture  Acupressure B. PHARMACOLOGIC INTERVENTIONS FOR PAIN MANAGEMENT WHO analgesic ladder step 1-3 are considered as an ideal pharmacologic pain management I. STEP 1: NON- OPIOID MEDICATION (MILD TO MODERATE PAIN) NSAIDs Non-steroidal anti-inflammatory drugs as aspirin, ibuprofen, diclofenac weaken and reduce the levels of chemical mediators (prostaglandins) produced during inflammation, relieving symptoms of pain, swelling and redness. II. STEP 2: COMPOUND ANALGESICS: (MILD TO MODERATE PAIN) These are combination of two or more drugs in a single tablet as codeine (a weak opiate) and paracetamol. E.g. Co-codamol and co-dydramol which contain codeine and paracetamol. III. STEP 3 OPIOID MEDICATIONS: (SEVERE PAIN) Medications derived from morphine that actually mimic the body’s own analgesic system and are strongest and most effective painkillers. They have a similar molecular structure as endogenous opioids, they work in the central nervous system by stopping the passage of neurotransmitters across the nerve synapse which blocks or attenuates the experience of pain. E.g.Tramadol, Buprenorphine, and diamorphine (heroin). REFERENCES 1. Grichnik KP, Ferrante FM. The difference between acute and chronic pain. Mt Sinai J Med. 1991 May;58(3):217-20. PMID: 1875958.https://www.physio- pedia.com/Pharmacology_in_Pain_Management 2. https://www.google.com/search?q=acute+vs+chronic+pain&rlz=1C1BNSD_enPK1018PK10 18&source=lnms&tbm=isch&sa=X&ved=2ahUKEwjKqMSaod36AhVGLewKHR8TD34Q_ AUoAXoECAIQAw&biw=1600&bih=789&dpr=1#imgrc=C1X7O0KCHY-uYM 3. https://www.ncbi.nlm.nih.gov/books/NBK545194/ 4. https://stanfordhealthcare.org/medical-conditions/pain/pain/treatments/non-pharmacological- pain-management.html 5. https://www.atrainceu.com/content/4-physiology-pain 6. https://www.google.com/search?q=pain&rlz=1C1GCEK_enPK1006PK1006&oq=pain&aqs= chrome..69i57j69i60j69i61l2.3059j0j4&sourceid=chrome&ie=UTF-8