Unit A

Pain

$       What is Pain?

-Protective:

                                    -alerts about danger, helps avoid more injury

                        -Physiological

                                    -subjective signs & symptoms, objective symptoms

                        -McCaffery “Pain is what the person says it is, existing when he/she says it does.”

$          Pathophysiology of Pain

-Nociceptive Pain

                                    -stimulus-response process

-pain stimulus sends impulse across peripheral nerve fiber, stimulus is either inhibited in the spinal cord or transmitted through the thalamus

                                    -stimulus carried along peripheral nerves of CNS

                                    -somatic - bone, joint, muscle, skin

                                    -visceral - GI, pancreas

                        -Cerebral Cortex

                                    -interprets quality of pain: past experience, knowledge, culture

                        -Neurotransmitter release

-bradykinins, potassium, serotonin, histamine, substance P (inflammatory response, spread pain message)

      -A-Delta Peripheral Nerve Fibers

                                    -sharp, fast, localize source, detect intensity (protective reflex)

                              -C Fibers

                                    -small, slow, widespread pain, burning sensation, persistant

$          Protective Reflex Response

-A-Delta Fibers synapse w/motor neurons

                        -Motor Impulses

-reflex arc, efferent (motor) fibers, peripheral muscle (contraction or withdrawal from source)

$          Gate Control Theory

-A-Beta Fibers

                                    -dominate input, releases neurotransmitter inhibitors, closes gate

                                    -stimuli (massage, pressure)

$          Pain Perception Modifiers

-Neuromodulators - close gate, inhibit substance P

-Endogenous Opiates - body’s natural pain relievers, endorphins, distraction, counseling, exercise

$          Types of Pain

-Acute Pain - less than 6 months, mild to severe, sympathetic nervous system response (increased pulse, resps, BP, diaphoresis, dilated pupils), related to tissue injury, resolves w/healing, pt appears restless/anxious, pt reports pain, pt exhibits behavior indicative of pain: crying, rubbing/holding area

-Chronic - longer than 6 months, varying intensity, parasympathetic nervous system response (vital signs normal), dry, warm skin, pupils normal or dilated, pain continues beyond healing, pt appears depressed & withdrawn, often does not mention pain unless asked, pain behavior often absent

                        -Cancer Pain - acute or chronic, under management

$          Perception

-Age

                                    Infancy

                                    Older Adults

                        -Gender (cultural influence)

                        -Meaning (threat, loss, achievement)

                        -Anxiety

                        -Past experience

                        -Fatigue

                        -Coping style

                        -Support system

$          Assessment

-Verbal cues, non-verbal cues

                        -onset/duration

                        -location: localized, generalized

                        -intensity: 0-10 scale

                        -relief measures

                        -effect on pt: VS, respiratory effect, inhibition of activity, interference w/ADL’s

$          Treatments

-NOT JUST MEDICATIONS!!!

                        -relaxation techniques

                        -diversionary activities

$          Nursing Diagnoses

-Pain, acute/chronic; Ineffective breathing pattern; Anxiety; Activity Intolerance; Fear; Ineffective individual coping