Managing Pain & Related Nursing Care – Quick Review

Pain Fundamentals

• Pain = subjective, unpleasant sensation; often warning sign but can occur without tissue damage
• Cardinal sign; should never be ignored—teach patient prompt reporting

Pain Physiology & Theories

• Perceived in brain; influenced by anxiety, depression, fatigue, chronic disease
• Gate‐Control Theory: CNS “gates” modulate or block impulses
• Endorphins: body’s morphine-like peptides; bind opioid receptors to inhibit pain

Pain Classification

• Acute: intense, short (<6 months); SNS response (↑ epinephrine)
• Chronic: continuous / intermittent >6 months; not protective
• Continuous vs. intermittent examples (sciatica, abdominal cramps)
• Nociceptive (aching/throbbing), Visceral (poorly localized; referred), Neuropathic (sharp/burning), Cancer (complex; multimodal therapy)

Pain Assessment

• Pain = fifth vital sign (Joint Commission)
• Benefits of adequate control: faster recovery, shorter LOS, fewer readmits, ↑QOL
• Consequences of unrelieved pain: ↑O2 demand, resp dysfunction, ↓GI motility, confusion, immune suppression
• HILDA: How feels, Intensity, Location, Duration, Aggravating/Alleviating
• Include impact on sleep/ADLs, PMH, VS, use of non-invasive measures

Non-Pharmacologic Interventions

• Massage, TENS, Hot/Cold, Guided imagery, Biofeedback, Acupuncture (invasive)

Pharmacologic Management

• Non-opioids (mild-moderate): Acetaminophen max 4000\,mg/24\,h; NSAIDs (Aspirin, Ibuprofen, Naproxen, Ketorolac, COX-2 like Celecoxib)
  • Give with food/milk + full glass H2O; watch GI bleed, renal/liver toxicity
• Opioids (moderate-severe): Morphine (renal caution), Hydromorphone, Fentanyl, Demerol (seizure risk); routes PO, IV (post-op best), IM (traumatic), patches
  • Side-effects mnemonic “DESIGNER”: Dry mouth, Euphoria, Sedation, Itch, GI constipation, Nausea, Eyes (miosis), Respiratory depression
• Adjuvants: Antidepressants (↑ serotonin), Anticonvulsants (e.g., Carbamazepine) for neuropathic pain
• PCA: patient only; lockout prevents overdose; pre-op teaching essential
• Epidural: Morphine/Fentanyl/Hydromorphone; monitor site, infection, resp, urinary retention
• Elastomeric pumps: supplemental 2–5 days; ensure catheter patency

Special Considerations

• Older adults: ↑GI bleed (NSAIDs), renal/liver toxicity, polypharmacy
• Tolerance/physical dependence common after 1–4 wks; ≠ addiction

Nursing Interventions

• Respond immediately; believe patient; educate, reduce anxiety
• Comfort measures: adjust linens/tubes, warm blankets, alignment, prevent urinary retention/constipation
• Prevent rather than chase severe pain; schedule PRN round-the-clock for moderate-severe

Sleep & Rest

• Sleep essential for healing; bed rest ≠ sleep
• Deprivation: ↓ reflexes/memory, mood swings, irritability
• Affecting factors: hospital routines, illness, anxiety/depression, substances, environment, exercise
• Promote sleep: assess patterns, plan with patient, reduce stimuli, give hypnotic/analgesic, ensure safety

Quick Calculation Example

• Vicodin =5\,mg hydrocodone +300\,mg acetaminophen
  • If 2 tabs q4h \Rightarrow 12 tabs/24 h ⇒ 12\times300=3600\,mg acetaminophen (<4000\,mg max)