Pain managment

Berman& Snyder 2014:1227

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 Pain: Objectives
• Differentiate between acute and chronic
pain. Tabulate your answer
• Identify various types of pain
• Describe the factors influencing pain
perception and response
• Describe subjective and objective date to
be collected when assessing pain
• Describe individualizing care for clients
with pain
• Describe types of distraction activities
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 Definition of pain
• An unpleasant sensory and emotional
experience associated with actual or
potential tissue damage or described in
terms of such damage

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 Acute pain
• Relatively short duration e.g. pain of fracture or
abdominal surgery
• Increased pulse rate
• Increased respiratory rate
• Elevated blood pressure
• Dilated pupils
• Related to tissue injury, resolves with healing
• May be restless and anxious
• Reports pain
• Crying, rubbing area, holding area

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 Chronic pain
• Develop slowly, last longer
• Vital signs normal
• Dry warm skin
• Pupils normal or dilated
• Continues beyond healing
• Usually depressed and withdrawn
• Often does not mention pain unless asked
• Pain behavior often absent
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 Types of Pain
Pain is classified according to location, duration
and intensity
1. Location
- Radiating pain is perceived at the
source of the pain and extends to nearby
tissue e.g. cardiac pain - chest pain -left
shoulder -down left arm
- Referred pain - pain felt in part of the
body that is considerably removed from
tissue causing pain e.g. gallbladder- right
shoulder 6
 Types of pain (continue)
1.Location (continue)
- Visceral pain – pain arising from organs
or hollow viscera
- being perceived in an area remote from
the organ causing the pain e.g. liver- right
back and front side of neck
2. Duration
- acute pain: last only expected recovery period
- chronic pain: prolonged – 3 months or longer
3. Intensity
- mild, moderate, severe pain
- rating 1 - 10 (0 = no pain) (10 = worst pain)

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 Types of pain (continue)
• Etiology
- Cutaneous pain – in skin or
subcutaneous tissue e.g. paper cut
- Deep somatic pain – from ligaments,
tendon, bones, blood vessels and nerves
e.g. ankle sprain
- Neuropathic pain – damage or
malfunctioning nerves e.g. phantom
pain – is painful sensation perceived in
body part that is missing (amputation)

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Identify the types of pain below

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Factor affecting pain experience
• Ethnic and cultural values
• Developmental stage
• Environment and support persons
• Previous pain experience
• Meaning of current pain
• Anxiety and stress

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 Subjective data: The OLDCARTSS system
• O - Onset
• L - Location
• D - Duration
• C - Characteristics
• A - Associated symptoms
• R - Relieving / aggravating factors
• T - Treatment
• S - Sequence
• S - Summarize
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 Objective data
• Facial expression – clenched teeth
• Vocalizations – moaning, groaning or crying
• Immobilization of part of body
• Purposeless body movements – tossing and
turning in bed
• Rhythmic body movement
• Changes in speech
• Associated symptoms
• Behavioral changes – confusion, restlessness

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 General strategies for pain
• Acknowledge the client’s pain
• Assisting support person
• Reducing misconceptions about pain
• Reducing fear and anxiety
• Preventing pain

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Individualizing care for clients with pain
• Establish a trusting relationship
• Consider the client's ability and willingness to
participate actively in pain relief measures
• Use a variety of pain relief measures
• Provide measures to relieve pain before it
becomes severe
• Use pain-relieving measures that the client
believes are effective
• Base the choice of the pain relief measure on
the clients report of the severity of the pain

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 Individualizing care for clients with pain
(continue)
• If a pain relief measure is ineffective,
encourage the client to try it once or twice
more before abandoning it
• Maintain an unbiased attitude (open mind)
about what may relieve the pain
• Keep trying
• Prevent harm to the client
• Educate the client and support persons
about pain

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 Types of Distraction
• Visual distraction
• Auditory distraction
• Tactile distraction
- slow rhythmic breathing
- massage
- holding or stroking a pet or toy
• Intellectual distraction

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