Introduction to Pain

Presented by
L/Dr.Khanda M Ahmed
 What is pain ?
Pain is defined by the International Association for the Study of Pain
(IASP) as “ An unpleasant sensory and emotional experience
associated with actual or potential tissue damage or described in
terms of such damage”
Pain is furthermore referred to as a subjective experience and
sensation that can be diagnosed independently of its cause and
hence the numerous propositions for replacing the word ‘pain’ with
‘people in pain’.
 Types of pain
1-Acute pain:-is a relatively brief sensation, usually less than three months
duration.
2-Chronic pain:-lasts more than six months , exists beyond the time for normal
organic healing. The pain begins to impair other functions, Patients may begin to
experience helplessness and hopelessness, this leads to the classic signs of
depression (lethargy, sleep disturbance, weight loss) and may quit work.
Chronic pain can be subjected to two major classes: nociceptive and neuropathic.
Nociceptive pain is regularly experienced and includes events like burns and injuries.
Neuropathic pain is as the result of nerve pathways problems resulting from medical
conditions like HIV, diabetes and shingles. It can also result from spinal/limb injuries
neuropathic pain as associated with feelings of tingling, numbness or electric shocks.
 Assessment of pain
According to the American Pain Society, pain is often considered to be a
fifth vital sign; therefore, it requires continuous monitoring and
improvement to ensure that patients receive the best possible care and
treatment to identify and monitor pain as appropriate
Accuracy in pain assessment is necessary and requires nurses’
involvement in this process to gain an understanding of a patient’s pain
experience by pain management.
To understand the nature of pain, pain is assessed based on some
dimensions, i.e. intensity, duration, localization and pathophysiology.
 Assessment tools of pain
The assessment tools are:-
A-Uni-dimensional tools such as:-
1-Verbal Rating Scale (VRS): (None, Mild, Moderate, Severe)
2-Visual Analogue Scale(VAS)

0cm (no pain) 10cm(worst pain)

3-Numerical Rating Scale(NRS)

0 1 2 3 4 5 6 7 8 9 10
3-

4-
B-Multi-dimensional tools:

Multi-dimensional tools: Are used to assess both quantity and

quality of pain and are more often used in chronic pain
situations; such as:
1-McGill Pain Questionnaire.
2-Brief Pain Intensity.
3-Short-Form 36(SF-36).
4-Pain Diaries.
 It is also important to remember that pain in different sites
should be assessed independently since the selection of
measurement tools for an individual patient will depend on :
1-Level of pain during assessment.
2-The complexity of pain.
3- patient’s general condition.
4- Patient’s Level of concentration.
5-Patient’s Cognitive ability.
6-Patient’s command of the language
The assessment of pain in children and the elderly is a difficult but
necessary of the care of these special patients populations.
In both of these populations, problems in the patient’s ability to
comprehend and verbalize their pain symptomatology make many of
traditional pain assessment tools used in adults less useful.
If the client can’t respond verbally then non-verbal cues must be
assessed for example: facial expressions, behavior, unusual
movements, vocal sound (moaning),or muscle contraction especially
around the eyes.
 Pain Pathways

The pathway to pain is a complicated, fascinator expression of how

our amazing bodies work, first there is a source of pain ,a direct
causative factor, stimulation of pain receptor may be mechanical,
chemical, thermal electric or ischemic.
The sensation travels along the sensory pathways and ascends the
spinal cord and the thalamus. The autonomic nervous system is
activated and sensation travel to the sensory area of the cerebral
cortex. Pain reception occurs in the thalamus, where awareness and
integration take place and pain interpretation occurs in the cerebral
cortex.
 Techniques for pain control
In the late 1980s the World Health Organization( WHO ) published guidelines for the
control of pain in cancer patients .These guidelines correlates the intensity of pain to
pharmacologic intervention.
1-Pharmacological methods
A-Patient controlled analgesia (PCA) (eg.morphine)

B-Epidural pain control (eg.fentanyl)

C-Direct IV pain control (eg.paracetamol)

2-Non-pharmacological methods
A-physical methods :such as
1-Transcutanous Electrical Nerve Stimulation(TENS).
2-Vibration or massage.
3-Acupuncutre.
4-Cold and heat therapy.
B-Cognitive-Behavioral methods
1-Imagery.
2-Deep breathing.
3-Hypnosis.