Comfort/Pain

Comfort/Pain

  • The relationship between comfort and pain involves the idea that bringing one can alleviate the other.

Pain and its Perception

  • Referenced video: https://www.youtube.com/watch?v=eakyDiXX6Uc

Defining Pain

  • Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.

  • Verbatim Definition: "Pain is what the person says it is" (McCaffery, 1985).

  • Margo McCaffery partnered with Chris Pasero to define pain.

What Is Pain?

  • Pain is considered an unpleasant sensory/emotional experience with several key attributes:
      - Can have destructive effects.
      - Can serve as a warning of potential injury.
      - It is a multidimensional experience.

What Happens with Pain

  • Origin of Pain:
      - Refers to the site where pain is felt, which may not always correlate with the location of the underlying issue.

  • Effects of Pain:
      - Interferes with daily life activities.
      - Can be protective in nature, acting as a warning sign.
      - Comes in many types.

Types of Pain

  • Cutaneous/Superficial Pain:
      - Location: Skin or subcutaneous tissue.
      - Examples: Burns, abrasions.   

  • Visceral Pain:
      - Location: Deep pain, abdominal cavity, cranium, thorax.
      - Not localized; described as tight, pressure, or crampy.
      - Examples: Menstrual pain, labor pains, gastrointestinal issues, organ cancers.   

  • Somatic Pain:
      - Location: Ligaments, tendons, nerves, blood vessels, and bones.
      - Localized; described as achy or tender.
      - Examples: Fractures, sprains, arthritis.   

  • Radiating Pain:
      - Begins in one location but radiates to other locations.
      - Example: A sore throat may extend to the ears and cause a headache.   

  • Referred Pain:
      - Occurs in an area distant from the original site of pain.
      - Example: Myocardial infarction (MI) can be felt in the left arm, jaw, shoulder blades, or as an earache.   

  • Phantom Pain:
      - Originates from a body part that is no longer there.
      - Example: Pain experienced in an amputated limb.   

  • Psychogenic Pain:
      - Arises from the mind, often due to anxiety or depression.
      - Example: Pain perceived without a physiological cause found in the body.   

  • Idiopathic Pain:
      - Pain is real to the patient but lacks a physiological or psychological basis.   

Chris Pasero Pain Scale

  • The Pasero Opioid-induced Sedation Scale (POSS) is a validated tool for assessing sedation when administering opioid medications for pain management.

  • Endorsed by The Joint Commission and the American Society for Pain Management Nursing to prevent adverse opioid-related respiratory events.

Chris Pasero Pain Scale: POSS Scale

  • POSS Scale Breakdown:
      - S = Sleep, easy to arouse:
        - Acceptable; no action needed; possible increase in opioid dose if required.   - 1 = Awake and alert:
        - Acceptable; no action needed; possible increase in opioid dose if required.   - 2 = Slightly drowsy, easily aroused:
        - Acceptable; no action needed; possible increase in opioid dose if required.   - 3 = Frequently drowsy, arousable, drifts off during conversation:
        - Unacceptable; monitor respiratory status and sedation closely; consider reducing opioid dose or alternate pain relief strategies.    4- = Somnolent with minimal or no response to stimulation:
        - Unacceptable; stop opioid; monitor closely; possible naloxone administration required.

Cause of Pain

  • Nociceptive Pain:
      - Most common type; results from the body's response to potentially damaging stimuli, such as:
        - Trauma, surgery, or inflammation.

Nociceptive Pain Types:

  • Visceral Pain:
      - Originates from internal organs.

  • Somatic Pain:
      - Originates from skin, muscles, bones (e.g., fractures), and connective tissue.

Neuropathic Pain

  • A complex and chronic pain arising from nerve injury, leading to repeated pain signals even in the absence of painful stimuli.

Physiological Pain

  • Pain felt in the body which manifests through physiological symptoms.

Duration of Pain

  • Acute Pain:
      - Short duration with rapid onset, may last up to 3 months.
      - Associated with actual or potential tissue damage; exhibits pain behaviors due to novelty of pain.   

  • Chronic Pain:
      - Lasts for 3 months or longer; associated with chronic illnesses like diabetes or cancer.
      - Exhibits periods of remission or exacerbation; has emotional and psychological impacts such as withdrawal, depression, anger, and fatigue.   

  • Intractable Pain:
      - Chronic pain that is very resistant to relief.

Pain Descriptions

  • Pain Quality:
      - Sharp, dull, aching, throbbing, stabbing, burning, ripping, or tingling.

  • Pain Time Period:
      - Episodic, intermittent, or constant.   

  • Pain Intensity:
      - Measured as mild, distracting, moderate, severe, or intolerable.

Factors That Influence Pain

  • Emotions

  • Previous experiences with pain

  • Developmental stage of the individual

  • Sociocultural factors

  • Communication skills

  • Cognitive impairments

  • Intensity of the pain itself.

Medications for Pain

  • Acetaminophen:
      - Used for moderate pain.
      - Side Effects: Vomiting, diarrhea.

  • NSAIDs (Ibuprofen & Naproxen):
      - Side Effects: Coffee ground emesis, ringing in the ears, abdominal pain, weakness.   

  • Opioids:
      - Side Effects: Change in level of consciousness (LOC), respiratory depression, confusion, constipation, urinary retention.   

  • Antidepressants:
      - Side Effects: Weight gain, dizziness.   

  • Sedatives or Hypnotics:
      - Side Effects: Disrupted natural sleep (e.g., REM), drowsiness.

Patient Controlled Analgesia

  • Utilizes a PCA pump located at the bedside, allowing patients to control their medication.

  • Timed intervals allow for safety; nursing staff programs per provider's orders and monitors effectiveness.

Body Reaction to Pain

  • Endocrine Reaction:
      - Can cause bone, joint, & muscle pain through hormone release (e.g., adrenaline, cortisol).

  • Cardiovascular Impact:
      - Can result in heart disease and hypertension.

  • Musculoskeletal Effect:
      - Can lead to muscle and bone pain.

  • Respiratory Involvement:
      - Affects inspiration and expiration.

  • Genitourinary Responses:
      - May manifest as dull, burning, UTI-like sensations, or overactive bladder.

  • Gastrointestinal Reactions:
      - Descriptions: Aching, burning, cramping, stabbing, twisting, or dull sensations.

Assessing Pain

  • Obtain a comprehensive pain history, including onset, location, and aggravating or alleviating factors (subjective data).

  • Evaluate nonverbal signs such as:
      - Elevated pulse/blood pressure.
      - Crying, moaning, or grimacing.

Pain Assessment Tools

  • Visual Analogue Scale (VAS)

  • Numeric Rating Scale (NRS)

  • Simple Descriptor Scale

  • Wong-Baker Faces Pain Rating Scale

  • FLACC Scale: Used for assessing young children (ages 2 months to 7 years).

Rating the Intensity of Pain

  • When patients rate their pain with a number, they are reflecting its intensity.

Nonverbal Signs of Pain

  • Includes facial expression, posture, body positioning, vital sign changes, and behavioral manifestations.

  • Assessment for depression is also significant in understanding pain manifestations.

Pain Management Strategies

  • Techniques include:
      - Cutaneous stimulation (e.g., skin contact).
      - Transcutaneous electrical nerve stimulation (TENS).
      - Percutaneous electrical nerve stimulation (PENS).
      - Spinal cord stimulation (SCS).
      - Acupuncture, acupressure, and massage therapies.
      - Application of heat and cold for relief.
      - Contralateral stimulation methodologies.

TENS and PENS Units

  • Low voltage units that assist in managing pain, especially effective for lower back pain.

Acupuncture

  • A non-pharmacologic pain relief measure involving needle insertion at specific points (e.g., Sishen-zhen, various other designated points).

Chemical Pain Relief Measures

  • Various medical interventions include:
      - Nerve blocks, epidural injections, local anesthesia, and topical anesthesia.

  • Monitoring for end-of-dose medication failure; seek additional prescriptions for breakthrough pain if pain worsens.

Pain Management (Continued)

  • Oral Sucrose:
      - Used for infants up to 12 months as a sweet formula to assist with pain management.

  • Immobilization Techniques:
      - Include the use of casts or splints.

  • Cognitive-Behavioral Interventions:
      - Focus on addressing negative thoughts, enhancing guided imagery, and promoting positive thinking.

Medication Types for Pain Management

  • Nonopiod Analgesics:
      - NSAIDs, acetaminophen.

  • Adjuvant Analgesics:
      - Medications designed for other purposes that also alleviate pain (e.g., antidepressants, corticosteroids, muscle relaxants, anticonvulsants).   

  • Opioid Analgesics:
      - Can be administered via IV, transdermal patches, or epidural routes.
      - Include client-controlled IV analgesia pumps or oral dispensers.

Alleviating Factors for Pain

  • Factors that may improve pain include rest, activity, movement, use of ice and heat, and specific protective measures like UV protective glasses.

Opioid and Non-opioid Symptom Monitoring

  • Non-opioid Concerns:
      - Risk of bleeding, liver damage, dizziness, abdominal pain, and weakness.

  • Opioid Concerns:
      - Changes in LOC, smooth muscle relaxation, and effects on motor skills.

Pain and Sleep Interference

  • Pharmacological Measures for Sleep Disturbance Related to Pain:
      - Ambien, Lunesta, and melatonin.

  • Non-Pharmacological Measures:
      - Bedtime rituals (e.g., warm drinks, warm baths) are effective strategies.

Sleep Apnea

  • For patients using CPAP (Continuous Positive Airway Pressure), a healthcare provider's order is necessary in both acute care and home settings.

  • Ensure CPAP is utilized during sleep and monitor vital signs for effectiveness.