Pain

HEALTH ASSESSMENT
PAIN
College of Science In

BSN - 1C
Nursing

Bautista, Ronna Celine V.

Bebis, Michelle Anne P..
Pain

What is
Pain?
"an unpleasant sensory and emotional experience, which we primarily
associate with tissue damage or describe in terms of such damage" - The
International Association for the Study of Pain (IASP, 2017,p.1)

Pain is a combination of physiologic phenomena

but with psychosocial aspects that influence it's
perception.
Pain

Physiologic Response
To Pain
• Anxiety, fear, hopelessness, sleeplessness, thoughts of suicide
• Focus on pain, reports of pain , cries and moans, frowns and facial grimaces
• Decrease in cognitive function, mental confusion, and altered temperament, high somatization, and dilated pupils
• Increased heart rate; peripheral, systemic, and coronary vascular resistance; Increased blood pressure
• Increased respiratory rate and sputum retention, resulting in infection and atelectasis
• Decreased gastric and intestinal motility
• Decreased urinary output, resulting in urinary retention, fluid overload, depression of all immune responses
• Increased antidiuretic hormone, epinephrine, norepinephrine, aldosterone, glucagons; decreased insulin, testosterone
• Hyperglycemia , glucose intolerance, insulin resistance, protein catabolism
• Muscle spasm, resulting in impaired muscle function and immobility, perspiration
CLASSIFICATION OF PAIN

TYPE OF PAIN DEFINITION

Emotional pain or mental pain; refers to pain originating from the person's
psychological dimension and has been found to underlue suicidal behavoir
Psychological Pain
(Verrocchio et al., 2016). This mental pain is seperate from criteria for depression,
butdepression can cause pain as well.

The process of somanization, when psychological pain becomes physical (Burton,

2018) somatization involves transferring or converting unconfortable feeelings into
Psychosomatic or Psychogenic pain
physical symptoms, which may be more tolerable.
Examples include limb paralysis, sensoryloss, seizures (often called pseudoseizures)

Pain caused by nerve receptors detecting harmful stimuli. The receptors react to
mechanical, chemical or thermal stimuli that may cause damage to skin , muscles,
Nociceptive pain
bones, orconnective tissue (Smith, 2018). Nociceptive pain is the most common type of
 Result for damgae or dsynfunction of any level of the nervous system (peripheral nerves,
spinal cord, or brain) (Cleveland clinic, 2015). Nerve function may change at the site of the
Neurophatic pain
damge, affecting one or more nerves or the central nervouse system , about 30% of
neuropathies are caused by diabetes.

Has two aspect; inflammatory and immunes responses accompanying and causing both
nociceptive and meurologic pain; and inflammatory pain syndromes , such as backpain,
Inflammatory pain shoulder pain, anhritis, rheumatoid arthritis , fibromyalgia, and migraine (H-Wave.com,
2019). In many types of pain inflammatory pain is involved and may enhance the
sensation of pain.

Occurs when stimuli in the tissue (skin, muscles, joints, skeleto, connective tissue) are
activated stimulisuch as force, temperature, vibrationand swelling activate the nerve
Somatic Pain
receptors and produce a sensation of cramping gnwaing, aching, or sharp pain ( duggal,
2017)

Occurs when the nerves in the internal organsin the chest, abdomen, intestines or pelvis
Visceral Pain are stimulated viceral pain feels vague, not localized , witha sensation of a deep squeeze,
pressure or arching (Duggal, 2017).
PSYCHOLOGICAL PAIN
Example;
• Deep sorrow,
• sadness, or depression.
• Grief. Intense distress.
• Loneliness and isolation.
PSYCHOSOMATIC OR PSYCHOGENIC PAIN
Examples include
• limb paralysis,
• sensoryloss,
• seizures (often called pseudoseizures)
NOCICEPTIVE PAIN

Examples
• stubbing your toe,
• having a sports injury,
• a dental procedure.
INFLAMMATORY PAIN
Example includes
• swelling
• redness
• heat
 SOMATIC PAIN
Examples of somatic pain include:
• bone fractures.
• strained muscles.
• connective tissue diseases, such as osteoporosis.
• cancer that affects the skin or bones.
• skin cuts, scrapes, and burns.
• joint pain, including arthritis pain.
VISCERAL PAIN
EXAMPLES
• bladder pain,
• endometriosis,
• irritable bowel syndrome,
• and prostate pain
 A sensation of pain in body region distant form the actual source of painful
Referred Pain
stimulated.

Phantom Pain Pain in a part of the body that has been removed, suchas a leg.

In more than one type of pain. Cancer may have little to no pain. When pain occurs, the first
pain often related to tumor pressure on nerves, bones, orother body organs (cancer
research Uk2018). Cancer treatments ( chemotheraphy and radiation) also cause their own
Cancer Pain pain responses. Cancer pain may be acute or chronic. Tpes of pain in cancer include nerve
pain, bonepain, tissue pain, and the pain may be referred or phantom ( pain in a part of the
body that has been removed). Inflammatory pain is often a significant part of cancer pain,
both noceceptive and neurophatic.
OTHER CLASSIFICATION CATEGORIES FOR
CATEGORY PAIN TYPES

Acute (occurs suddenly and does not last longer than 6 konths ) versus chronic
DURATION
( persistent, ongoing, lasts longer than 6months)

Central (develops from the spinal cord or brain injury, stroke, or multiple sclerosis)
LOCATION versus peripheral (originates from the pheripheral part of the nervous system,
i:e.trigeminal neuralgia, polyneuropathiesor radiicupopathies).
Pain Scale

Numeric Rating Scale

0-10 Numeric Pain Intensity Scale

Visual Analog Scale (VAS)

Pain Scale

Verbal Descriptor Scale

Pain Scale

Wong-Baker FACES Pain Rating Scale

Pain Scale

Self-Assessment: Memorial Pain Assessment Card

Pain Scale

McCaffrey Initial Pain Assessment Tool

Pain

To be a culturally competent nurse caring for clients in

pain:
• Be aware of your own cultural and family values
• Be aware of your personal biases and assumptions about people with different values than
yours.
• Be aware and accept cultural differences between yourself and individual clients.
• Be capable of understanding the dynamics of the difference.
• Be able to adapt to diversity. (Weissman et al., 2004)
 PSYCHOSOCIAL FACTORS AFFECTING PAIN
PERCEPTION AND ASSESSMENT
• several factors, including developmental level or Age and Culture affect pain
and assessment.
• Although psychological factors and culture were thought to account for gender
differences in pain perception; more recent research has demonstrated
psychologic bases for differences. (Bulls et al.,2015 Medical news today,2015).
woman seem to be more sensitive to pain and have less efficient endogenous
pain inhibitory capacity compared with men.
 DEVELOPMENTAL LEVEL; OLDER ADULTS

An estimated 60 to 75% of adults over 65years of age report suffering from some
persistent pain, and as many as 30% report from chronic pain (Molton
&Terril,2014).Not knowing whether the older people are feeling pain can lead to
gross (older population or others ) are feeling pain can lead to gross
undertreatment of pain in these groups.
COLLECTING SUBJECTIVE DATA ; THE NURSING HEALTH
HISTORY
The exact words used to describe the experienced pain are used to help in the diagnosis and
management.
A through pain assessment includes includes;
• location
• intensity
• quality
• pattern
• precipitating factors
• pain relief
• effect of pain in daily activities
• what coping strategies
 COLLECTING OBJECTIVE DATA ; PHYSICAL
EXAMINATION
Objective data for pain are collected by observing the client’s movement and
responses to touch or descriptions of the pain experienced.

During the examination of the client, remember these key points:

• Choose a reliable assessment tool
• Explain to the client the purpose of rating the intensity of pain
• Ensure the client’s privacy and confidentiality
• Respect the client’s behavoir toward pain and the terms used to express it
• Understand that different cultures may express pain differently and maintain
different pain thresholds and expectations
 Bautista & Bebis

THANK YOU!
BSN - 1C
Bachelor of Science In
Nursing

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