Pain management, Complementary therapies

what is pain

pain is wtv pt says it is

pain = subjective

• reliable source

individualized

effects quality of life

pain

unpleasant sensory + emotional experience

may be actual or potential tissue damage

physical or psychological

factors affecting pain

cultural and ethnicity

• social norm

• attitude

• religion

• psychology

environment

• light

• noise

• ppl

psychological

• anxiety

• exhaustion

past experience

• memories

• trauma

types of pain

acute

chronic

etiology:

• nociceptive

• neuropathic

acute pain

rapid onset

short term

known cause

goes away after treatment underlying cause

tissue damage or organic disease

chronic pain

last beyond healing

lifelong

remission + exacerbation, severe, consistent

• exacerbation: flare-up

• remission: symptoms disappear but disease still present

emotional effects:

• depression

• frustration

• anger

etiology nociceptive

tissue damage

normal pain response

types:

• somatic → muscle, bone

• visceral → organ

etiology neuropathic

pathophysiologic

nerve damage

CNS or PNS

burning, tingling

pain pathway

transduction → transmission → perception → modulation `

transduction

begin at periphery

nociceptors → primary afferent neurons

noxious stimulus → impulse

injury → chemical response

pain → spinal cord

initiates action potential

chemical response transduction

1. Prostaglandins

2. Bradykinin 

3. Serotonin 

4. Substance P 

5. Histamine

action potential propagation

Process

• Resting = -90 mV 

• Stimulus → Na enter → depolarization -65mV

• Signal travels nerve 

END:

• K leave → repolarization 

• Na/K pump restores balance

• impulse conducted along nerve fiber

transmission

action potential → site damage → spinal cord → ascend higher center

phases

• injury site → spinal cord

• spinal cord → braim stem/thalamus

• thalamus → cortex

transmission phases

injury site → spinal cord

• nociceptor terminates in cord

spinal cord → brain stem/thalamus

• release SP/neurotransmitters impulse to dorsal horn

thalamus → cortex

• thalamus relay station sends impulses to central structure for processing

perception of pain

end neural transmission activity

brain recognizes pain

conscious experience

central structures

perception of pain central structure

reticular system

• autonomic response

• engages attention

somatosensory cortex

• localizes

• characterizes

limbic system

• emotion/behavior response

modulation

body reduces pain signal

change or inhibition of nociceptive impulses

neuron in brain stem → spinal cord → release substance → inhibit transmission of nociceptive impulses

• endogenous opioids

• serotonin (5HT)

• norepinephrine (NE)

response to pain

behavioral responses — Voluntary

affective responses — Psychological

physiological response — Involuntary

behavioral responses

voluntary

visible

• guarding

• grimacing

• restless

• crying

• moaning

• clenching

affective responses

psychological

emotional

• fear

• anxiety

• depression

• anger

• withdrawal

physiological response

involuntary

sympathetic → early

• ↑ HR

• ↑ BP

• ↑ RR

• pallor

• muscle tension

parasympathetic → later

• N/V

• syncope

• ↓ HR

• ↓BP

nursing process

A-ssess

D-iagnosis

P-lanning

I-ntervention

E-valuation

assessment

PQRSTU

factors

• psychological

• emotional

• sociocultural

• physiologic

ask: OLD CARTS

OLD CARTS

O-onset

L-location

D-duration

C-characteristics

A-aggravating and relieving factors

R-related symptoms

T-treatments

S-severity

assessment tool

numeric rating scale

verbal descriptive pain scale

Wong-Baker FACES pain rating scale

pain assessment in advanced dementia scare (PAINAD)

pain assessment in advance dementia scale

breathing

• 0: normal

• 1: labored breathing, short hyperventilation

• 2: noisy labored, long hyperventilation, Cheyne-Stokes

negative vocalization

• 0: none

• 1: moan/groan, low-level speech

• 2: repeated trouble calling out, loud moaning/groaning, cry

facial expression

• 0: smile, inexpressive

• 1: sad, frightened, frown

• 2: facial grimacing

body language

• 0: relax

• 1: tense, distressed pacing, fidgeting

• 2: rigid, fist clenched, knee pulled up, pulling/pushing away

consolability

• 0: no need to console

• 1: distracted, reassured by voice, touch

• 2: unable to console

nursing process special population

children

pt with dementia

critically ill

development delayed

cognitive impairment

language barrier

nursing diagnosis

NANDA-I approved

• problem

• etiology

• medical diagnosis

• evidence

  • acute or chronic: pain r/t __ AEB__

planning

outcome

SMART goal

SMART goal

S-specific

M-measurable

A-achievable

R-relevant

T-time-bound

implementation

goal

• nursing assistance

• reduce pain

• promote self-care

• trusting nurse-pt relationship

• educate pt

intervention

• pharmacological

• non-pharmacological

• complementary/alternative relief

complementary/alternative relief

tighten/smooth wrinkled bed linens

position tubing on side pt laying

change wet dressing/linens

prevent constipation

remove/prevent painful stimuli

pharmacological

analgesics

opioids

• controlled substances

nonopioids

• NSAIDs

• adjuvant

nonpharmacological

ice/heat

elevation/compression

physical therapy/exercise

complementary/alternatives

pharmacological intervention

5 rights

• pt

• drug

• route

• time

• dose

know previous response to analgesics

select proper medication

accurate dose

the pasero opioid-induced sedation scale

S- sleep, easy to arouse

1- awake, alert

2- occasionally drowsy, easy to arouse

3- freq drowsy, drift to sleep during conversation

4- somnolent with minimal or no response to stimuli

complementary/alternatives

mind/body practices

• relax, distract, guided imagery

• yoga, chiroprac

• acupuncture

• aromatherapy

natural products

• herbal

• nutrition supplement

• nutrition therapy

other

• homeopathy

• naturopathy

• chinese medicine

distraction

conscious attention

req pt to focus on something else

effective for mild pain

effective with analgesics → brief or severe pain

humor

positive effect on immune system

for pt who are responsive to its use/wishes

used with analgesics

relieve acute pain in children

music

relax, soothe, distraction, decrease pain

neurotransmitter: epinephrine, norepinephrine

hormone: cortisol

immune/ANS: sympathetic, parasympathetic

psychological response

combination with opioids for moderate postoperative pain

guided imagery

5 senses

• look

• listen

• feel

• touch

• taste

focus

relaxation

goal:

• promote parasympathetic nervous activity to reduce sympathetic activity and restore balance

noise-free env

focus on breathing

evaluation

did intervention work

reduce pain

reassess pain score

adjust plan

opioids

opioids

tolerance

• not working for pt, pt is use to the drug

dependence

• need it, withdrawal

addiction

• physical/psychological need

priorities

Pain is subjective 

Pt is #1 source 

Use PQRSTU 

Chronic pain → multimodal treatment 

Early pain = increase VS 

Late pain = decrease VS

Combone pharm + non-pharm

PAIN mnemonic

P-pt decides pain level/scale

A-assess PQRSTU

I-intervene (multi-method)

N-never ignore subjective report

holistic + integrative care

holistic

• mind + body + spirit

integrative

• traditional medicine + alternative therapies