PAIN

MR SANDWE T.K
GENERAL OBJECTIVE

At the end of the lecture/discussion students should be

able to acquire Knowledge and understanding of pain.

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SPECIFIC OBJECTIVES
At the end of the lecture/discussion students should be able to;
• Define pain.
• Explain the simple physiology of pain.
• State the causes of pain.
• State the types of pain.
• Explain the management of pain.

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INTRODUCTION

• Pain occurs in all clinical settings, among different groups of

patients thus, the nurse has a central role in pain assessment
and management. To perform this role, the nurse should have a
thorough understanding of the physiological and psychosocial
dimensions of pain.

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Definition of pain

Pain is a sensation where a person experiences

discomfort, distress or suffering due to overstimulation
of sensory nerves.

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 Or

• “Unpleasant sensory and emotional experience

associated with actual or potential tissue damage, or
described in terms of such damage

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Physiology of pain

• Pain begins with stimulation of specialized sensory nerve

endings located on the body surface or in deeper structures.
Some areas of the body are richly supplied with more pain
receptors example; the skin , arterial walls, periosteum and joint
surfaces.

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• The receptors produce impulses that are carried to the spinal
cord and the thalamus. At this point the person becomes aware
of the pain. The interpretation of the site of stimulus, quality and
intensity of pain is made at the cortical level in the cerebral
cortex.

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• In addition to interpretation impulses are initiated which activate
the physical response to pain.

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Physiology of Pain
• In response to tissue injury, chemical mediators can
sensitize and activate Nociceptors.
• Injured cells release chemicals such as K + that depolarize nerve
terminals, making nociceptors more responsive.
• Injured cells also release bradykinin and Substance P, which
can further sensitize nociceptive terminals.

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Physiology of pain…….
• Histamine is released from mast cells, serotonin
(5-HT) from platelets, and prostaglandins from
cell membranes, all contributing to the
inflammatory process and they activate or
sensitize the nociceptors.

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Physiology of pain

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TYPES OF PAIN
❖Mild pain
❖Moderate pain
❖Severe pain
❖Phantom pain
❖Neurogenic pain
❖Referred pain
❖Acute pain
❖Chronic pain
❖Intractable pain
❖Nociceptive
❖Neuropathic

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Types of pain

Acute pain

• Pain of short duration, usually less than 6 months

• It usually protective and has an identifiable cause

• It has limited tissue damage

• Physical manifestations include-increased heart rate,

respiratory rate, blood pressure, and anxiety .

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Chronic Pain
• May start as acute pain but last longer beyond the normal time of recovery
usually more than 6 months
• Cause may not be known
• Physical manifestations include flat affect, reduced physical
movement/activity, fatigue and withdraw from others and social
interactions.

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 Idiopathic Pain

Chronic pain in the absence of an identifiable physical or

emotional cause.

Referred Pain

• Form of visceral pain which is felt in an area distant from the

from the site of stimulus
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 Psychogenic Pain

• Pain not caused by nociception but by psychological factors.

• Patient will usually report pain that does not match the
underlying disorder

• Its diagnosed after ruling out all the other causes of pain.

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• Nociceptive :Pain caused by inflammed or
damaged tissue.
• Neuropathic :caused by damage to or
malfunction of the Nervous system

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BENEFITS OF PAIN
SENSATION
• 1. Pain gives warning signal about the existence of
a problem or threat. It also creates awareness of
injury.
• 2. Pain prevents further damage by causing reflex
withdrawal of the body from the source of injury
• 3. Pain forces the person to rest or to minimize
the activities thus enabling rapid healing of
injured part
• 4. Pain urges the person to take required
treatment to prevent major damage.

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MANAGEMENT OF PAIN

• Pain is subjective, no two persons experience pain in the same

way and no two painful events create identical responses or
feelings in a person.

• In order to be able to manage pain there is need to conduct a

pain assessment. Accurate pain assessment is an essential
element in effective pain management

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• Pain assessment mainly involves direct interview and
observation of the patient.

• The use of pain scales and physical examination completes the

assessment.

• Before assessment remember that the pt may use other words

other than pain to denote pain e.g. aching.

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 During assessment, consider the following characteristics of
pain.
Pattern of pain.
• Ask the patient about the onset of pain-for acute pain the
patient may know exactly while for chronic pain the patient may
not precisely identify the time of onset.
• Knowledge of onset can guide in identifying possible cause and
treatment strategies.
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 Location of Pain

• The area or location of pain assists in identifying the possible

cause and treatment too. Some individuals may specify the
precise location while others may simply say it’s hurting all over
.

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 Quality of pain

• Quality refers to the nature of pain e.g. neuropathic pain may be

described as burning, shooting or stabbing while nociceptive
pain may be described as sharp. Throbbing and cramping.

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 Associated symptoms
• Associated symptoms such as anxiety, fatigue or depression
may exacerbate or may be exacerbated by pain. Ask for
activities that improve or worsen the pain e.g. in
musculoskeletal pain movement and ambulation may worsen
pain while resting and immobilization of the affected part may
decrease the pain.

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 Intensity of Pain
• Assessing the severity and intensity of pain helps in identifying
the treatment strategies.
• Pain scales can be used to help the patient communicate the
intensity of pain.
Such scales include:
• Numerical pain intensity scales. On a scale of 0-10, patient
rates his pain. 0 stands for no pain, 5 moderate pain and 10
Worst possible pain.

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• Descriptive pain intensity Scale-describes pain in terms
of no pain, mild pain, moderate pain, severe pain, Very
severe pain and worst possible pain.

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NURSING CARE OF A PATIENT IN PAIN.

• A widely used method of providing effective care is the nursing

care plan. With the use of a care plan the nurse is able to
diagnose the problem, plan for expected outcomes, implement
interventions, state reasons for the interventions, and evaluate
the outcome.

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Nursing Diagnosis.

• Acute pain – Related to tissue injury from an incision site.

• Activity intolerance—Related to unrelieved pain.
• Ineffective coping—Related to lack of knowledge of possible
methods of coping.

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Outcomes.

• Outcomes and goals should be determined. A realistic outcome

should be established to control or maintain the client at
desired levels of pain and functioning.
Desired outcomes are that:
• Report acceptable pain levels.
• Perform daily activities without limitation related to pain.
• Increased patient comfort

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NURSING MEASURES TO RELIEVE
PAIN.
• Rest and relaxation
• To promote rest and relaxation ensure that there is no noise in
the environment.
• Plan your work in a way that procedures are carried out at
almost the same time.
• Alley anxiety
• Explain procedures to the patient. Encourage the patient to
verbalize their pain and fears. Reassure the patient that
everything possible is being done to minimize or provide relief
.

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• Position
• Change of position may provide relief ( this depends on the
cause of pain) for the patient by reducing the pressure on the
site.
• Diversional Therapy
• Can be done by providing books, news paper to read, music or
television. This will help in keeping the patients mind off the
pain.
•

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 Local application
• A Warm or Cold compress can be applied. But care must be
taken as to not add further injury.
Analgesia
• Give the prescribed analgesics and document on the patient
treatment chart.

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SUMMARY

In today’s lecture we have discussed pain. The definition, and

causes of pain. We have also been able to look at the simple
physiology of pain, types of pain and the management of a
patient in pain.

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CONCLUSION

We have come to the end of our lecture. Thank you for your
attention and participation.

SANDWE T.K
REFERENCES
• Anne W and Allison G (2010),Ross and Wilsom, Anatomy
and Physiology in health and Illness,11th edition,
Edinburgh, London.
• Black,Hawks, (2005) Medical Surgical Nursing, Clinical
Management for positive outcomes, 18th Edition,Saunders,
Elsevier inc. pages 276-301.
• Elaine N. Marieb (1989), Human anatomy Physiology,3rd
edition, redwood city, California.
•
• 4. Potter and Perry (2009),Fundamentals of Nursing 6th
edition, st Louis University School of Nursing,st Louis, Missouri.
•

SANDWE T.K