PAIN MECHANISM &

ASSESSMENT

John Weru
02/07/2020
 Outline
• Definition & Epidemiology
• Classification
• Pathophysiology
• Assessment
 Pain is...
• “An unpleasant sensory and emotional
experience associated with actual or
potential tissue damage”

IASP, 1979
• “What the person says it is…”
McCaffery & Pasero, 1999
 Pain
• On top of its disease-specific and physical
components, pain is made up of distinct
psychological, social, and spiritual domains
Green et al (2002)
 Epidemiology

• 50 million people are partially or totally

disabled due to pain
• 70 to 90% of patients with advanced cancer
have significant pain that requiring Opioids
• Severe pain interferes with patients' quality
of life.

https://www.slideshare.net/DrKarlJawhariR
eviews/understanding-and-managing-chron
ic-pain
 Epidemiology
• 80% of elderly patients have chronic pain
• 66% have pain in the last month of life
• 50 % of hospitalized patients with pain are
under-medicated.
• 50% of patients who are taking pain
medication do not experience adequate
relief
• Study on Ca cervix patients with LBP-40-
effects on QOL of patient & family
 Total Pain!!!
Physical

Social / Cultural Spiritual

Psychological
 Categories of Pain
– Somatogenic
– Psychogenic

Classification of Pain
– Acute or Chronic
– Nociceptive or Neuropathic
 Why Treat Pain?
• Basic human right!
• ↓ pain and suffering
• ↓ complications – next slide
• ↓ likelihood of chronic pain development
• ↑ patient satisfaction
• ↑ speed of recovery → ↓ length of stay → ↓
cost
• ↑ productivity and quality of life
https://www.slideshare.net/AnestesiUnhas/what-do-people-know
-about-pain-isapm-2015-dr-mary-s-54418872
 Nociception
Transduction perception

modulation

Transmission
 KEY POINTS
• “Emphasis is placed on the utilization of a multimodal analgesic
approach to maximize analgesia while minimizing side-effects.”
– Transduction
– Transmission
– Modulation
– Perception
• There is as of yet no single silver bullet!!
Pain Assessment - History
• OPQRSTU
• Is the pain limiting activity?
• What does the patient feel about
the pain?
• What are the expectations of
treatment?
• What are the patient’s fears?
• What are the patient’s previous
experience of pain and illness?
NB/Electromagnetic studies to
assess cause of pain
 Least pain

Worst pain
imaginable
BEHAVIORAL PAIN SCALE
Examination
 Conclusion
• Total pain approach key to effective and
efficient pain management
• Pain is more subjective than objective
• Quality assessment of essence
• Make pain visible
“We all must die, But that I can save
him days of torture, that is what I feel
is my great and ever new privilege.
Pain is a more terrible lord of mankind
that even death itself”
Albert Schweitzer