PAIN

MANAGEMENT
CHAPTER 46
JIWANI MAE B.LAROZARN,MAN
I FEEL ANGRY
WHEN...?
WHAT IS
PAIN??
PAIN IS "AN UNPLEASANT
SENSORY AND EMOTIONAL
EXPERIENCE ASSOCIATED
WITH ACTUAL OR
POTENTIAL TISSUE
DAMAGE, OR DESCRIBED IN
TERMS OF SUCH DAMAGE"
(AMERICAN PAIN SOCIETY [APS], 2003;
GORDON, 2002).
TYPES OF PAIN MAY
BE DESCRIBED IN
TERMS OF
1. LOCATION,
2. DURATION,
3. INTENSITY, AND
4. ETIOLOGY
 LOCATION
CLASSIFICATIONS OF
PAIN BASED ON
WHERE IT IS IN THE
BODY
(E.G., HEADACHE,
BACKACHE, CHEST
PAIN)
 LOCATION
ALSO PAIN MAY BE REFERRED
(APPEAR TO ARISE IN
DIFFERENT AREAS) TO OTHER
PARTS OF THE BODY.
FOR EXAMPLE, CARDIAC PAIN
MAY BE FELT IN THE
SHOULDER OR LEFT ARM, WITH
OR WITHOUT CHEST PAIN.
 LOCATION
VISCERAL PAIN (PAIN ARISING
FROM ORGANS OR HOLLOW
VISCERA) OFTEN PRESENTS
THIS WAY, BEING PERCEIVED
IN AN AREA REMOTE FROM THE
ORGAN CAUSING THE PAIN
(FIGURE 46-1 •).
 DURATION
WHEN PAIN LASTS ONLY
THROUGH THE EXPECTED
RECOVERY PERIOD, IT IS
DESCRIBED AS ACUTE PAIN,
WHETHER IT HAS A SUDDEN OR
SLOW ONSET AND REGARDLESS
OF THE INTENSITY.
 DURATION
CHRONIC PAIN, ON THE OTHER
HAND, IS PROLONGED, USUALLY
RECURRING OR PERSISTING
OVER 6 MONTHS OR LONGER,
AND INTERFERES WITH
FUNCTIONING.
INTENSITY
 ETIOLOGY
DESIGNATING TYPES OF PAIN
BY ETIOLOGY CAN BE DONE
UNDER THE BROAD CATEGORIES
OF
1. PHYSIOLOGICAL PAIN AND
2. NEUROPATHIC PAIN
 ETIOLOGY
PHYSIOLOGICAL PAIN IS
EXPERIENCED WHEN AN
INTACT, PROPERLY
FUNCTIONING NERVOUS
SYSTEM SENDS SIGNALS THAT
TISSUES ARE DAMAGED,
REQUIRING ATTENTION AND
PROPER CARE.
 ETIOLOGY
EXAMPLE
THE PAIN EXPERIENCED
FOLLOWING A CUT OR BROKEN
BONE ALERTS THE PERSON TO
AVOID FURTHER DAMAGE UNTIL
IT IS PROPERLY HEALED.
 ETIOLOGY
SUBCATEGORIES OF
PHYSIOLOGICAL PAIN INCLUDE
SOMATIC OR VISCERAL.
SOMATIC PAIN ORIGINATES IN
THE SKIN, MUSCLES, BONE, OR
CONNECTIVE TISSUE.
THE SHARP SENSATION OF A
PAPER CUT OR ACHING OF A
SPRAINED ANKLE ARE COMMON
EXAMPLES OF SOMATIC PAIN.
 ETIOLOGY
NEUROPATHIC PAIN IS
EXPERIENCED BY PEOPLE WHO
HAVE DAMAGED OR
MALFUNCTIONING NERVES. THE
NERVES MAY BE ABNORMAL
DUE TO ILLNESS (E.G.,
POSTHERPETIC NEURALGIA,
DIABETIC PERIPHERAL
NEUROPATHY), INJURY (E.G.,
PHANTON LIMB PAIN, SPINAL
CORD INJURY PAIN), OR
UNDETERMINED REASONS.
 FACTORS AFFECTING THE PAIN
EXPERIENCE NUMEROUS FACTORS CAN
AFFECT A PERSON'S PERCEPTION OF AND
REACTION TO PAIN. THESE INCLUDE THE
PERSON'S

1. ETHNIC AND CULTURAL VALUES,

2. DEVELOPMENTAL STAGE,
3. ENVIRONMENT AND
4. SUPPORT PEOPLE,
5. PREVIOUS PAIN EXPERIENCES, AND
6. THE MEANING OF THE CURRENT
PAIN.
 ETHNIC AND CULTURAL
VALUES
IN SOME MIDDLE EASTERN AND AFRICAN
CULTURES, SELF-INFLICTION OF PAIN IS
A SIGN OF MOURNING OR GRIEF. IN
OTHER GROUPS, PAIN MAY BE
ANTICIPATED AS PART OF THE
RITUALISTIC PRACTICES, AND THEREFORE
TOLERANCE OF PAIN SIGNIFIES
STRENGTH AND ENDURANCE.
 DEVELOPMENTAL STAGE

THE AGE AND DEVELOPMENTAL STAGE OF

A CLIENT IS AN IMPORTANT VARIABLE
THAT WILL INFLUENCE BOTH THE
REACTION TO AND THE EXPRESSION OF
PAIN. AGE VARIATIONS AND RELATED
NURSING INTERVENTIONS ARE PRESENTED
IN TABLE 46-3
 PAIN HISTORY

INITIAL PAIN ASSESSMENT FOR SOMEONE IN

SEVERE ACUTE PAIN MAY CONSIST OF ONLY
A FEW QUESTIONS BEFORE INTERVENTION
OCCURS. IN ADDITION, THE NURSE MAY
FOCUS ON THE FOLLOWING:
1. PREVIOUS PAIN TREATMENT AND
EFFECTIVENESS
2. WHEN AND WHAT ANALGESICS WERE
LAST TAKEN OT
3. HER MEDICATIONS BEING TAKEN
4. ALLERGIES TO MEDICATIONS
 KEY STRATEGIES IN PAIN
MANAGEMENT KEY STRATEGIES TO
REDUCE PAIN INCLUDE
1. ACKNOWLEDGING AND ACCEPTING
THE CLIENT'S PAIN,
2. ASSISTING SUPPORT PERSONS,
3. REDUCING MISCONCEPTIONS
ABOUT PAIN,
4. REDUCING FEAR AND ANXIETY,
AND PREVENTING PAIN.
 ACKNOWLEDGING AND ACCEPTING CLIENT'S
PAIN
CONSIDER THESE FOUR WAYS OF COMMUNICATING THIS
BELIEF:

1. ACKNOWLEDGE THE POSSIBILITY OF THE

PAIN
2. LISTEN ATTENTIVELY TO WHAT THE CLIENT
SAYS ABOUT THE PAIN
3. CONVEY THAT YOU NEED TO ASK ABOUT
THE PAIN
4. ATTEND TO THE CLIENT'S NEEDS PROMPTLY
 ASSISTING SUPPORT PERSONS.
SUPPORT PERSONS OFTEN NEED ASSISTANCE TO
RESPOND IN A HELPFUL MANNER TO THE
PERSON EXPERICENCING PAIN. NURSES CAN
HELP BY GIVING THEM ACCURATE
INFORMATION ABOUT THE PAIN AND
PROVIDING OPPORTUNITIES FOR THEM TO
DISCUSS THEIR EMOTIONAL REACTIONS, WHICH
MAY INCLUDE ANGER , FEAR, FRUSTRATION,
AND FEELINGS OF INADEQUACY .
REDUCING MISCONCEPTIONS ABOUT
PAIN.
REDUCING A CLIENT'S MISCONCEPTIONS ABOUT
THE PAIN AND ITS TREATMENT WILL REMOVE
ONE OF THE BARRIERS TO OPTIMAL PAIN
RELIEF. THE NURSE SHOULD EXPLAIN TO THE
CLIENT THAT PAIN IS A HIGHLY INDIVIDUAL
EXPERIENCE AND THAT IT IS ONLY THE CLIENT
WHO REALLY EXPERIENCES THE PAIN ,
ALTHOUGH OTHERS CAN UNDERSTAN AND
EMPATHIZE .
 REDUCING FEAR AND ANXIETY.

IT IS IMPORTANT TO HELP RELIEVE STRONG

EMOTIONS CAPABLE OF AMPLIFYING PAIN
(E.G., ANXIETY, ANGER, AND FEAR). WHEN
CLIENTS HAVE NO OPPORTUNITY TO TALK
ABOUT THEIR PAIN AND ASSOCIATED FEARS,
THEIR PERCEPTIONS AND REACTIONS TO THE
PAIN CAN BE INTENSIFIED.
 PREVENTING PAIN.
A PREVENTIVE APPROACH TO PAIN
MANAGEMENT INVOLVES THE PROVISION OF
MEASURES TO TREAT THE PAIN BEFORE IT
OCCURS OR BEFORE IT BECOMES SEVERE.

PREVEMPTIVE ANALGESIA IS THE

ADMINISTRATION OF ANALGESICS PRIOR TO AN
INVASIVE OR OPERATIVE PROCEDURE IN ORDER
TO TREAT PAIN BEFORE IT OCCURS.
WE FEEL WHAT WE FEEL
We all feel the full range of emotions in different situations.
Wherever we are on the happy or sad, engaged or bored,
proud or embarrassed.It's okay to feel what we feel and
express it in a safe and healthy way.
THANK YOU FOR
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