THE FIFTH VITAL

SIGN
March 2011
 djc
 PAIN
unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described
in terms of such damage. (American
Pain Society)
TYPES OF PAIN
1.LOCATION:
REFERRED- appear to arise in different
areas. Eg. Cardiac pain (felt in shoulder or
left arm, with or without chest pain)

VISCERAL- pain arising from organs or

hollow viscera.
2. DURATION
ACUTE- sudden, or slow onset, less
than 6 months

CHRONIC- prolonged, usually

recurring or persisting over 6 months
or longer, and intereferes with
functioning.
Comparison of Acute and Chronic
Pain
ACUTE CHRONIC
•Mild to severe •Mild to severe
•Increased pulse rate
•Increased respiratory rate
•Elevated blood pressure
•Diaphoresis •Dry, warm skin
•Dilated pupils •Pupils normal or dilated
•Appears restless and anxious •Appears depressed and withdrawn
•Reports pain •Doesn’t mention pain unless asked
•Exhibits behavior: crying, rubbing •Pain behavior often absent
area, holding area
3. INTENSITY
MILD PAIN- 1-3 range on pain scale

MODERATE PAIN- 4-6 range on pain

scale

SEVERE PAIN- 7-10 range on pain scale

PHYSIOLOGY OF PAIN

1. NOCICEPTION

Mechanical, thermal,
chemical stimuli

Detection of primary
sensory neurons
Nociceptor activation

Signals transduced
and transmitted to
the spine and brain

Signals modified
before ultimately
understood and felt
2. GATE CONTROL THEORY
 PAIN ASSESSMENT
C HARACTER
ONSET
L OCATION
D URATION
E XACERBATION
R ELIEF
R ADIATION
ONSET
L OCATION
DURATION
CHARACTERISTICS
AGGRAVATING FACTORS
RADIATION
T REATMENT
PPRECIPITATING FACTORS
QUALITY OF PAIN
RADIATION, RELIEVING FACTORS
SEVERITY/ SIGN AND SYMPTOMS
TIME/ ONSET
 PAIN ASSESSMENT TOOL FOR
CHILDREN

PINAKA PINAKA
WALANG SAKIT KATAMTAMANG SAKIT MATINDING MALUBHA
KONTING SAKIT SAKIT NG
MATINDING SAKIT SAKIT
 PAIN INTERVENTIONS
NON-PHARMACOLOGIC
 Relaxation techniques
 Hot or cold packs
 Massage
 Hypnosis
 Music therapy
 Acupuncture
 Imagery (using your imagination to create mental
pictures or situations to relieve pain)
PHARMACOLOGIC INTERVENTIONS
WHO THREE STEP APPROACH

OPIOID (moderate to severe)

+/- NON-OPIOID
+/- ADJUVANT

OPIOID (mild to moderate)

+/- NON-OPIOID
+/- ADJUVANT

NON-OPIOID
+/- ADJUVANT
 NON-OPIOID/ MIXED OR STRONG COANALGESICS
NSAIDS WEAK OPIOIDS OPIOIDS
•Acetaminophen •Butorphanol •Fentanyl •Anticonvulsants
•ASA •Hydrocodone citrate •Hydroxyzine
•Diclofenac •Codeine •Topical local
sodium •Tramadol •Meperidine anesthetic
•Ibuprofen HCl
•Indomethacin •Morphine
•Naproxen Sulfate
•Meloxicam •Methdaone

Reference: Fundamentals of Nursing 8th edition by Kozier and Erb

END