Chronic Pain Final(1) - Tagged

Week 2: Persistent/Chronic Pain in Nursing

  • Slides adapted from: Fulford, M. & Miller Sautz, D. in Lewis’s medical-surgical nursing in Canada.

What is Persistent/Chronic Pain?

  • Defined as pain that persists for longer than 3 months (IASP, 2020).

  • May have an identifiable cause or no visible injury associated.

  • Can be challenging to diagnose clinically.

  • Often under-diagnosed and undertreated.

  • Patients may stop seeking care due to depression and loss of hope.

Characteristics of Acute Pain

  • Temporary in nature.

  • Serves as a warning signal indicating something is wrong.

  • Generally resolves with healing.

Differences between Chronic and Acute Pain

  • Chronic pain persists beyond normal healing periods.

  • Often more complex and multifactorial.

Pain Sensitivity Concepts

  • Allodynia: Pain due to a stimulus that normally doesn't cause pain.

  • Pain Centralization: Phenomenon where pain signals are heightened.

Clinical Observations in Chronic Pain

  • Traditional vital sign changes commonly associated with acute pain are often absent in chronic pain.

  • Behavioral changes may include:

    • Decreased activity

    • Social withdrawal

    • Mood changes

    • Fatigue

Assessing Chronic Pain as an RN

  • Gather information systematically:

    • Review presenting information and past medical history.

    • Identify important data crucial for current assessment.

    • Scan for urgent issues or symptoms.

    • Collect subjective and objective data comprehensively.

Functional Impact of Chronic Pain

  • Emphasis on assessing the functional impact of chronic pain rather than just pain levels.

    • Zero pain may not be achievable; focus on the ability to cope.

    • Goal: pain management that allows for full participation in daily life.

Pain Processing Mechanics

  • Pain processing can be broken down into:

    • Transduction: Cell damage from noxious stimuli and release of sensitizing chemicals (prostaglandins, bradykinin, etc.).

    • Perception: Conscious experience of pain.

    • Transmission: Action potential continues from injury site to brain for processing

    • Modulation: Brain releases inhibitory signals to affect pain transmission.

Types of Pain

  • Nociceptive Pain: Caused by tissue injury, localized, resolves with healing.

  • Neuropathic Pain: Arises from lesions or diseases of the nervous system; described as burning or shooting pain associated with numbness.

  • Cancer Pain: Results from tumor pressure or disease processes, often treated with opioids or surgical resection.

Neuropathic Pain Assessment (DN4 Score)

  • Characteristics assessed include burning sensations, tingling, and hypoesthesia.

  • A score of 4/10 indicates neuropathic pain.

Pain Management Strategies

  • Treatment focuses on:

    • Removing painful stimuli

    • Opioids + non-opioid medications based on pain severity.

    • Adjuvant therapies for pain management.

Pain Experience Complexity

  • The pain experience is multifaceted; not simply a stimulus-response model.

Brain's Role in Pain Perception

  • Different brain regions involved include:

    • Somatosensory Cortex: Locates pain

    • Limbic System: Processes emotional response

    • Thalamus: Relays sensory information

Dimensions of Pain Experience

  • Sensory-Discriminative: Recognition and identification of pain.

  • Motivational-Affective: Emotional responses, which can lead to negative emotions and affect quality of life.

  • Behavioral: Observable actions in response to pain, affecting daily functioning.

  • Cognitive Evaluative: How beliefs and coping strategies impact one's experience of pain.

Definitions of Pain

  • General Definitions:

    • Pain as a complex experience with various dimensions (Lewis, 2020).

    • Unpleasant experience linked with tissue damage (IASP, 2020).

    • Subjective perception of the experiencing individual (McCaffrey, 1968).

Transition from Acute to Chronic Pain

  • Influencing factors include:

    • Unrelieved acute pain

    • Long-term inflammatory conditions

    • Psychological responses to pain

    • Socio-cultural adversity.

Understanding Pain Centralization

  • Factors leading to centralization:

    • Prolonged undertreated pain.

    • Changes in nervous system that lower pain thresholds.

  • Chronic pain can override normal pain processing, resulting in increased sensitivity.

Biopsychosocial Model of Pain

  • Chronic pain results from intricate interactions among:

    • Biological (genetics, sleep, hormones).

    • Psychological (depression, anxiety).

    • Social (support, cultural factors).

Current Trends in Chronic Pain in Canada

  • Approximately 7.63 million Canadians live with chronic pain.

  • Major factors influencing treatment include:

    • Opioid prescribing challenges.

    • Social inequities such as poverty and marginalized communities.

Pain Assessment Techniques

  • Questions focused on psychosocial aspects of pain.

  • Engage in role-play to enhance assessment skills.

Trauma-Informed Care Principles

  • Address trauma's impact on pain perception and treatment.

  • Develop safe environments for pain management.

Addressing Pain Stigma

  • Recognition of different perceptions in pain experience between professionals and patients.

  • Need for validated patient experiences and overcoming unconscious biases.

Best Practices in Pain Management

  • Patient-centered care and adaptive frameworks tailored to needs.

  • Emphasizing interprofessional collaborations and clear referral pathways.

Reflection on Pain Knowledge

  • How concepts of pain evolve through learning; role of nurses as advocates in pain care.

Symptoms of Persistent Pain

  • Multi-focal pain often not correlated with identifiable injuries.

  • Associated central nervous system symptoms such as fatigue and mood issues.

Comprehensive Pain Assessment

  • Incorporate various assessment tools for a thorough evaluation:

    • Pain narratives, symptom-specific questionnaires, and behavioral observations.

Pain Scales and Questionnaires

  • Simple Descriptive Pain Intensity Scale, Numeric Pain Intensity Scale, and Faces Pain Scale - Revised.

Pharmacologic Strategies for Pain Management

  • Centrally acting drugs, tricyclic antidepressants, and gabapentinoids.

  • Optimal use of opioids guided by clinical guidelines.

Patient Education and Resources

  • Available resources for pain management strategies and self-care.

Evaluation of Pain Management

  • Continuous assessment of:

    • Pain control and beliefs

    • Emotional wellbeing

    • Functional impact

    • Existing barriers to care.

References and Resources

  • Relevant literature on chronic pain management and assessment strategies.