Chapter 20 Pain Management

1. Chapter 20 Pain Management

2. Pain • Definition of pain • The process of pain • Transduction • Transmission • Perception • Modulation

3. Phases of Pain

4. Question • Is the following statement true or false? C-fibers carry impulses rapidly at a rate of approximately 5 to 30 meters per second.

5. Answer False. C-fibers carry impulses at a slower rate of 0.5 to 2 meters a second. A-delta fibers, which are large myelinated fibers, carry impulses rapidly at a rate of approximately 5 to 30 meters per second.

6. Pain (cont’d) • Pain theories • Endogenous opioids • Endorphins • Dynorphins • Enkephalins

7. Mechanism of Pain Transmission and Interference

8. Pain (cont’d) • Types of pain • Cutaneous • Visceral • Neuropathic • Acute • Chronic

9. Question • Phantom limb pain belongs to which of the following categories of pain? a. Cutaneous b. Visceral c. Neuropathic d. Acute

10. Answer c. Neuropathic Phantom limb pain is an example of neuropathic pain, which is often experienced days, weeks, or even months after the source of the pain has been treated and resolved.

11. Question • Is the following statement true or false? Somatic pain is discomfort that originates at the skin level.

12. Answer False. Somatic pain is discomfort generated from deeper connective tissue. Cutaneous pain is discomfort that originates at the skin level and is a commonly experienced sensation resulting from some form of trauma.

13. Pain Assessment Standards • Pain: the fifth vital sign • JCAHO standards • Compliance with established standards of care

14. JCAHO Components of a Comprehensive Pain Assessment

15. Pain Assessment Data • Components of brief or basic pain assessment • Questions to be asked during admission assessment • Underassessed and undertreated clients

16. Components of Pain Assessment

17. Pain Intensity Assessment Tools • Four types of pain assessment tools • Numeric scale • Word scale • Linear scale • Picture scale • Different scales for different ages

18. Pain Intensity Assessment Tools (cont’d)

19. Pain Management • Treatment biases • Pain management techniques • Drug therapy • Nonopioiddrugs • Opioiddrugs

20. World Health Organization Analgesic Ladder

21. Pain Management (cont’d) • Opioiddrugs (cont’d) • Patient-controlledanalgesia • Intraspinal analgesia • Adjuvantdrugs • Botulinum toxin therapy

22. Pain Management (cont’d) • Surgicalapproaches • Rhizotomy • Cordotomy

23. Client and Family Teaching: Pain and Its Management

24. Pain Management (cont’d) • Nondrug/nonsurgicalinterventions • Education • Imagery • Meditation • Distraction • Relaxation

25. Pain Management (cont’d) • Nondrug/nonsurgicalinterventions (cont’d) • Heat and cold • Transcutaneous electrical nerve stimulation • Acupuncture and acupressure

26. Pain Management (cont’d) • Nondrug/nonsurgicalinterventions (cont’d) • Percutaneous electrical nerve stimulation • Biofeedback • Hypnosis

27. Percutaneous Electrical Nerve Stimulation

28. Nursing Implications • Various nursing diagnoses • Addiction • Placebos

29. General Gerontologic Considerations • Pain in older people • Assessment of pain in older people • Fear and anxiety can cause them to endure pain • Downplaying of pain • Misleading data

30. General Gerontologic Considerations (cont’d) • Assessment of pain in older people (cont’d) • Older people with cognitive impairment • Pain control measures for older people • Adverse effects of certain drugs

31. General Gerontologic Considerations (cont’d) • Pain control measures for older people (cont’d) • Topical application of heat • Determining appropriate route for individual medication administration • Increased sensitivity to narcotics among older people

32. Question • Is the following statement true or false? Older adults are less sensitive to pain stimuli.

33. Answer False. Age-associated changes in pain perception, sensitivity, and tolerance affect the experience of pain in older adults. Therefore, it is a dangerous assumption to believe that older adults are less sensitive to pain stimuli.