Pain

Pain

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Subjective

Physiology of Pain

CNS & PNS process stimuli → Mobilizes the nociceptors (noxious stimuli) → Pathways are activated → Patient experiences a response (pain)

Biopsychosocial Model

Psychological, biological, and social factors interact to influence health and illness related to pain.

Acute Pain

Sudden or slow onset with predictable end, Lasts less than six months

Chronic Pain

Constant or recurring without predictable end, Lasts longer than six months

Nociceptive Pain

Pain felt in the tissue, an organ, damaged body part, or referred

• Can be visceral, somatic, or cutaneous

• Visceral = pain within organs

• Somatic = pain throughout skin, bones, joints, muscles

• Cutaneous = another name for somatic

Neuropathic Pain

Nerve pain, Described as intense, shooting, or burning

Cancer Pain

• Only recognized recently as a separate type

• Types include tumor pain, bone pain, and treatment-

associated.

• Should be treated with special considerations

What is PQRST?

• P = Precipitating cause

• Q = Quality

• R = Region

• S = Severity

• T = Timing

Wong-Baker FACES Pain Rating Scale

Face, Legs, Activity, Cry, Consolability Scale (FLACC)

Crying, Requires Oxygen, Increased Vital Signs, Expression, Sleeplessness Scale (CRIES)

Nonpharmacological Pain Interventions

Positioning

• Off bony prominences

• Reposition every 2 hours

Cutaneous Stimulation

• Heat and cold therapy

• Touch, massage, acupressure, transcutaneous electronic stimulation (TENS)

Cognitive Strategies

• Cognitive behavioral therapy to manage negative thoughts around pain

• Distraction, imagery, relaxation, music

Therapeutic Touch

• Improves mood and a better sense of well-being

Transcutaneous Electronic Stimulation (TENS)

Low voltage electrical impulses applied

over painful areas

• Deeper pain relief completed with

extracorporeal shock-wave lithotripsy

(ESWL)

Pharmacological Interventions

Opioids

• Activate opioid receptors in the nervous system

• Monitoring is required

Nonopioids

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

• May enhance bleeding

• Acetaminophen

Adjuvant Analgesics

• Address underlying pain generators

• Used with opioids

• Corticosteroids, antidepressants, medical marijuana

Types of Opioids - Natural

• Come from opium poppy

• Codeine and morphine

Types of Opioids - Semisynthetic

Created from

naturally

occurring

opiates

• Heroin,

hydrocodone,

oxycodone,

hydromorphone

Types of Opioids - Synthetic

Manufactured

• Fentanyl,

tramadol

Patient-Controlled Analgesia (PCA)

Frequently used

postoperatively

• Allows patient control when

they receive small amounts of

pain medication

• Attached to a pump which

goes through IV

• May also be administered

through epidural

SBIRT

• S = Screening

• B = Brief intervention

• I = Intervention

• R = Referral

• T = Treatment