The Challenge of Pain Control

The Challenge of Pain Control Marilyn Gripping Sept. 18, 2010

Disclaimer • The views and opinions I present today are entirely my own. They do not necessarily reflect the views of the Calgary Health Region, or either of Norquest or Bow Valley Colleges. • My views and opinions should not be construed as an official explanation or interpretation.

Disclosure I have no relationship that could be perceived as placing me in a real or apparent conflict of interest in the context of this presentation.

What is Pain? • “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” (Jovey, page 9)

“Whatever the person experiencing it says it is and exists whenever he says it does.” (Linton, 202)

Factors Influencing Pain Experience • Pain Threshold • Pain Tolerance • Age • Physical Activity • Nervous System Integrity

Surgery/Anesthesia • Culture • Religious Beliefs • Past Experiences/Anxiety • Situational Factors

Perception of Pain • Afferent pathways • Nociceptors • CNS • Pain receptors • Spinal cord • Brain • Efferent pathways • Descending pathway

Endorphins and Enkephalins • Body’s natural opioid-like substances • Block transmission of pain to spinal cord • Individuals produce different amounts

Decrease Endorphins • Prolonged stress • Pain • Use of opioids • Alcohol

Increase Endorphins • Brief stress • Pain • Laughter, • Exercise • Acupuncture • Transcutaneous Electrical Nerve Stimulation (TENS) • Massive Trauma • Sexual Activity

Gate-Control Theory • Pain reflects both physical and psychosocial factors

Gate-Control Theory

Gate-Control Theory – con’t

Types of Pain • Acute • Subacute • Chronic • Baseline Pain • Breakthrough Pain

Categories of Pain • Nociceptive • Somatic • Visceral • Neuropathic • CNCP (Chronic Non-Cancer Pain)

Pain Severity • Pain Scale • Pain is rated on a scale of 0-10 where “0” is no pain and “10” is the worst pain imaginable or the worst pain the person has ever had.

Statistics • 1/3 of all people suffering with chronic pain are treated successfully with NSAIDs • Chronic pain in elderly is very common and is often undertreated • Risk of addiction is usually less than the need to control chronic pain

The Treatment Continuum • Most efficient use of locally available medical resources • More available, less expensive, less invasive, fewer side effects • Less available, more expensive, more invasive, more side effects

Examples: • Physical • Psychological • Pharmacological • Invasive Therapies

Prescribing of pain meds • Dose to effect • Exceptions: • NSAIDS • Antidepressants • Anticonvulsants

Analgesic Ladder

Adjuvants • Drugs primarily developed to treat other conditions

Bibliography • Dhalla, Irfan A, et al. (2009). Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ-JAMC, 181 (12), 891-896. • Fischer, Benedikt, Rehm, Jurgen (2009). Deaths related to the use of prescription opioids. CMAJ-JAMC, 181 (12), 881-882. • Jovey, Roman D. (Ed). (2008). Managing Pain – The Canadian Healthcare Professional’s Reference. (2008 Edition).City: Purdue Pharma. • Kozier, B., Erb. G., Berman, A., Snyder, S., Bouchal, D.S.R., Hirst, S., et al. (2010). Fundamentals of Canadian Nursing: Concepts, process and practice (2nd Canadian ed.) Toronto: Pearson Education Canada. • Linton, A. (2007). Introduction to medical-surgical nursing (4th ed.). Philadelphia, PA: Saunders.

The Challenge of Pain Control