SEMINAR

TOPIC: PAIN & SENSORY

DEPRIVATION

P re s e n t e d By : Ne h a T h a k u r
M . S c ( N s g. ) 1 s t yr.
PAIN
DEFINITION

Pain is universally unpleasant emotional and sensory

experience often associated with damage to the body.
It is the feeling common to such experiences as
stubbing a toe, burning a finger, putting iodine on a
cut and is caused by activation of specialized pain-
signaling nerve fibers or by damage or disease
affecting the somatosensory nervous system.
NATURE OF PAIN

Pain is much more than a physical sensation caused

by a specific stimulus.

 The pain experience is complex, involving physical,

emotional and cognitive components.

Pain is subjective and highly individualized.

The stimulus for pain can be physical and/or mental

in nature.
CONT….

Pain is exhausting and demands person’s energy.

Pain cannot be objectively measured, such as blood

test. Only the client knows whether the pain is present
and what the experience is like.

It is not the responsibility of clients to prove that they

are in pain, it is the nurse’s responsibility to accept
patient’s report of pain.
 PHYSIOLOGY OF PAIN

There are four processes of normal pain:

Transduction
Transmission
Perception
Modulation
 TRANSDUCTION

Pain is usually caused by thermal, chemical or

mechanical stimuli. The energy of these stimuli is
converted into electrical energy. This energy
conversion is known as transduction.
 TRANSMISSION

Transmission is the process of transferring pain

information from the peripheral to the central
nervous system.
 PERCEPTION

Perception of pain is the awareness—typically an

uncomfortable awareness—associated with a specific
area of the body.
It depends on the transmission of pain signals
through the thalamus to the cortex and limbic
system.
 MODULATION

It is the inhibition of pain impulse.

A-delta fibers send sensory impulses to the spinal
cord, where they synapse with spinal motor neurons.
The motor impulses travel along the efferent nerve
fiber back to a peripheral muscle near to the site of
stimulation.
 Contraction of the muscle leads to protective
withdrawal from source of pain.
 GATE CONTROL THEORY

To explain why thoughts and emotions

influence pain perception, Ronald Melzack
and Patrick Wall proposed that a gating
mechanism exists within the dorsal horn
of the spinal cord. 
CONT…..

When no input comes in, the inhibitory neuron

prevents the projection neuron from sending signals to
the brain (gate is closed).
 Normal somatosensory input happens when there is
more large-fiber stimulation (or only large-fiber
stimulation). Both the inhibitory neuron and the
projection neuron are stimulated, but the inhibitory
neuron prevents the projection neuron from sending
signals to the brain (gate is closed).
CONT…

Nociception (pain reception) happens when there is

more small-fiber stimulation or only small-fiber
stimulation. This inactivates the inhibitory neuron,
and the projection neuron sends signals to the brain
informing it of pain (gate is open).
TYPES OF PAIN

On the basis of duration pain is of two types:

Acute pain

Chronic pain
CONT….

Acute pain
Acute pain is pain of sudden onset, lasting for hours to
days and disappears once the underlying cause is treated.
Acute pain has a clear cause. It could result from any
illness, trauma, surgery or any painful medical
procedures.
Chronic pain
Chronic pain is the pain that starts as an acute pain and
continues beyond the normal time expected for resolution
of the problem or persists or recurs for various other
reasons. It is not therapeutically beneficial to the patient.
Classification based on location:

This is based on the site at which the pain is located.

Examples:
Headache
Back pain
Joint pain
Stomach pain
Cardiac pain
Referred pain: pain due to problems in other areas
manifest in different body part.
• For example, cardiac pain may be felt in the shoulder or
left arm, with or without chest pain.
Classification based on intensity:

1. Mild pain
2. Moderate pain
3. Severe pain
Mild pain: Pain scale reading from 1 to 3 is
considered as mild pain.
Moderate pain: Pain scale reading from 4 to 6 is
considered as moderate pain
Severe pain: Pain scale reading from 7 to 10 is
considered as severe pain.
Classification based on etiology:

1.Nociceptive pain
2.Somatic pain
3.Visceral pain
4.Neuropathic pain
5.Peripheral neuropathic pain
6.Central neuropathic pain
 
 1. NOCICEPTIVE PAIN

• Nociceptive pain is experienced when an intact,

properly functioning nervous system sends signals
that tissues are damaged, requiring attention and
proper care.
• For example, the pain experienced following a cut or
broken bone alerts the person to avoid further
damage until it is properly healed.
• Once stabilized or healed, the pain goes away.
2. Somatic pain

This is the pain that is originating from 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.
3.Visceral pain:

Visceral pain is pain that results from the activation

of nociceptors of the thoracic, pelvic, or abdominal
viscera (organs).
Characterized by cramping, throbbing, pressing, or
aching qualities. Examples: labor pain, angina
pectoris, or irritable bowel.
4.Neuropathic pain:

• Neuropathic pain is associated with damaged or

malfunctioning nerves due to illness, injury, or
undetermined reasons.
Examples:
Diabetic peripheral neuropathy
Phantom limb pain
Spinal cord injury pain
 ASESSMENT OF PAIN

 Assessment of pain helps to understand types,

pattern and interventions of pain. Assessment of
onset and duration, location and intensity of pain is
of great importance. Intensity can be assessed by
following scales:
Wong baker FACES pain rating scale.
Numerical pain rating scale.
FLACC scale
Wong Baker FACES pain rating scale

 This is used to assess pain in children ages 3 and

older. The scale consist of 6 cartoon faces ranging
from a smiling face(no hurt) to increasingly less
happy face to a final sad tearful face(hurts worst).

 Numerical pain rating scale
In this the client rates the
pain on a scale of 0-10. A
rate of 0 to 3 indicates mild
pain, 4-6 moderate pain,
and 7-10 severe pain. The
scale work best when
assessing pain intensity
before and after therapeutic
interventions.
FLACC SCALE

The FLACC is a behavior pain assessment scale for

use in non-verbal patients unable to provide reports
of pain. This scale usually includes assessing facial
expressions, movements, activity, cry and consol
ability.
Non pharmacological pain management

Acupuncture
Acupressure
Aroma therapy
Distraction
Heat and cold
Imagery
Massage
Reflexology
Transcutaneous or percutaneous electric stimulation
Therapeutic touch
 Pharmacological management
Acute pain is treated with medications like
analgesics(opioid or nonopioid), non-steroidal anti-
inflammatory drugs and anesthetics.
Management of chronic pain, however, is much more
difficult and may require the coordinated efforts of a
pain management team, which typically includes
medical practitioners, clinical psychologists,
physiotherapists, occupational therapists, and nurse
practitioners.
 INTRODUCTION

 People are unique because they are able to sense a

variety of meaningful stimuli allow a person to learn
about the environment and are necessary for healthy
functioning and normal development.
 Definition: Sensory deprivation is the lack of
sensory stimulus perception (sight, hearing, etc.) by
experimentally taking away one or more of the
senses. Sensory deprivation
 NORMAL PERCEPTION:

Stimulation comes from in and outside the body

particularly through the senses of sight (visual),
hearing (auditory), touch (tactile), smell (olfactory),
taste (gustatory) and kinesthetic (position and
movement).
 SENSORY EXPERIENCE:

• Sensory Reception: it is the process of receiving

data about the external environment through the
senses
• Sensory Perception: it is the conscious process of
selecting, organizing and interpreting data from the
senses into meaningful information.
 FACTORS FOR PERCEPTION:

• Stimulus: Capable of initiating a response

• Receptor or sense organ: receive stimulus and
convert it into a nerve impulse
• Nerve Impulse: it can be conducted along a
nervous pathway from the receptor or sense organ
to the brain.
• A particular area in the brain must receive and
translate the impulse into the sensation.
 TYPES OF SENSORY
DEPRIVATION
Visual deprivation:
 Binocular &
 Monocular deprivation.
Auditory deprivation
Tactile deprivation
Olfactory deprivation.
Gustatory deprivation
 VISUAL DEPRIVATION

The very fast change in the ocular dominance of the

cells during monocular deprivation
It occur due to the change of the efficacy of synapses
from the closed eye.
Also depends on the speed at which the deprivation
effects.
After 5 weeks of age, a constant deprivation occurs.
 AUDITORY DEPRIVATION

Refers to the lack of adequate hearing stimulation.

with auditory deprivation, brain gradually losses
some of its information processing ability.
Ability of the auditory system to process speech
declines due to a lack of stimulation.
 TACTILE DEPRIVATION

Deprivation in coma/immobilization
A long term care poorly responsive patient will be
confined to bed being turned every 3-4hrs,
occasionally being ambulated.
Physician visits the patient only if the nurses reports a
problem, patient may run a fever of 102-103degrees
for 3-4 days.
Patient is often unattended for a long periods of times.
Occasionally lying on the soiled or wet sheets until the
next routine nursing visits.
 GUSTATORY

Prolonged incubations
Prolonged coma state
Prolonged ryles tube feeding
Post oral reconstructive surgery
Oral carcinoma.
Poor quality of meal served for long time.
 EFFECTS OF SENSORY DEPRIVATION

• Perceptual Responses: inaccurate perception of sight,

sounds, tastes, smell & body position, coordination &
equilibrium.
• Cognitive Responses: patient’s inability to control the
direction of the thought content. Attention span & ability
to concentrate decreased. Patient may demonstrate
difficulty with memory, problem solving & task
performance.
• Emotional response: include apathy anxiety ,fear,
anger, panic or depression, rapid mood change occur.
 
 SENSORY DEPRIVATION IN HOSPITAL SETTINGS

In the hospital such occurrences fall into two general

categories:–
Altered sensory reception
Deprived environment
 Altered sensory reception

Occurs in such conditions as spinal cord injury, brain

damage, and changes in receptor organs, sleep
deprivation, and chronic illness. The person does not
receive adequate sensory input because of an
interference with the nervous systems ability to
receive and process stimuli.
 Deprived environments

It can have negative effects on a person’s sensor

stasis. A person who is immobilized or isolated for
any reason is deprived of the usual amount of
stimulation and may show manifestations of sensory
deprivation.
RISK FACTORS IN THE HEALTH CARE ENVIRONMENT

• Private room
• Eyes bandaged
• Bed rest
• Sensory aid not available (hearing aid, glasses)
•Isolation precautions
• Few visitors
Management of sensory deprivation

 visual stimulation:
Pictures, flowers, greeting cards, etc in the room:

 Wearing sunglasses before going outside.

 Use pocket magnifiers.

 Provide telescopic lens, eyeglasses which are

smaller, easier to focus and have greater range.
Cont….

Auditory stimulation:
 Call the person by his or her name.
 Reorient the patient.
 Speak slowly, clearly, maintain eye-to-eye contact.
 Procedure explanation.
 Use sensory aids.
 Allow the client to express himself/ herself.
Cont…..

 Gustatory and olfactory stimulation:

 Attention to the oral hygiene and properly fitting
dentures.
 Serve fresh food.
 Smell food before eating.
 Removal of unpleasant odor from the environment.
 Client’s room should be clean, empty bedpans or
urinals, removed soiled lenins.
Cont…

 Tactile stimulation:
 Provide touch therapy.
 Hair brushing, combing, a back rub etc.
 Minimize irritating stimuli.
CONCLUSSION

Alteration in sensory perception is a great challenge

to care in ICU setting and other areas. The nurse
should take remedial measures in order to prevent
psychological and other complication in the patient
admitted in ICU and other areas.
REFERENCES…

Ruth F Craven,J Hirnle “Fundamentals of Nursing

”lippincott, 3rd edition pp-1173-1187.
Taylor, Lillis, LeMone “Fundamentals of Nursing –
art and Science of Nursing care”,lippincott 4th edition
Kaplan, shaddok “Concise Text Book of Psychiatry”
pp-409-425