Transcript Pain Management - Ravenwood-PA

Pain Management
• Patrice Levy, RN
• Therapeutics NURS 7724
• November 25, 2002
Objectives
• Define pain
• Define addiction, physical dependence,
tolerance, and adjuvant analgesic
• Identify the types/classification of pain
• Explain the pain mechanisms
• Identify the barriers to pain management
and harmful effects of unrelieved pain
Definition of Pain
• Pain is an unpleasant sensory and emotional
experience associated with acute or
potential tissue damage, or described in
terms of such damage.
– IASP, APS - 1992, Mersky, Bogduk - 1994
Definition of Pain
• Pain is whatever the experiencing
person says it is, existing
whenever he says it does
• McCaffery - 1968
Definitions
• Addiction: Psychologic dependence. A pattern of
compulsive drug use characterized by continued
craving for an opioid for effects other than pain
relief.
• Tolerance: A decrease in one or more effects of the
opioid
• Physical Dependence: is the occurrence of
withdrawal symptoms when the drug is stopped.
Definitions
• Adjuvant analgesic: A drug that has a
primary indication other than pain.
Types of Pain
• Acute Pain- brief pain that subsides as
healing takes place
• Cancer Pain
• Chronic Nonmalignant Pain
Classification of Pain
Nociceptive- term used to describe how pain
becomes conscious
• Neuropathic- abnormal processing of
sensory input by the peripheral or CNS
Nociception Pain Pathway
Transduction- Conversion of one energy
from another, begins in the periphery when
a noxious stimulus causes tissue damage.
• Transmission- movement of impulses from
the site of transduction to the brain.
• Perception- conscious experience of pain.
• Modulation- inhibition of nociceptive
impulses.
Nociception - The Process
Nociceptive Pain
• Somatic Pain- arises from bones, joints,
muscle, or connective tissue. Usually
described as aching or throbbing in quality.
Pain is well localized.
• Visceral Pain- arises from the visceral
organs, GI tract/pancreas.
Neuropathic Pain
• Centrally Generated- results from injury to
• the CNS or peripheral nervous system
• Peripherally Generated- generalized or
• specific pain along a damaged nerve.
Barriers to Pain Management
• Health Care Professionals
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Inadequate knowledge
Lack of education
Poor assessment
Regulatory Constraints
Barriers of Pain Management
• Patients and the Public
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Reluctance to report pain
Reluctance to take analgesics
Concerns about addiction
Concerns about tolerance
Desire to be a “good patient”
Barriers to Pain Management
• Health Care System
• Pain assessment and treatment a low priority in daily
practice
• Restrictive regulation of controlled substances
Harmful Effects of Unrelieved
Pain
• Endocrine System
overactivity
• Cardiovascular
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Hypercoagulation
Increase Heart Rate
Increase Blood Pressure
Increase Cardiac Workload
Increase Oxygen Demand
• Respiratory
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Muscle Spasm
Decrease Tidal Volume
Decrease Vital Capacity
Decrease Alveolar
Ventilation
• Genitourinary
– Urinary Retention
– Hypokalemia
Harmful Effects of Unrelieved
Pain
• Gastrointestinal
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Increase intestinal Secretion
Increase smooth muscle tone
Decrease Gastric Emptying
Decrease Intestinal Motility
• Musculoskelatal
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Muscle Spasm
Impaired Function
Fatigue
Imobility
• Cognitive Function
– Mental Decline
• Immune Function
– Decrease Immune Function
– Decrease NK Cell Activity
• Developmental Effect
– Experience associated with
pain remembered and this can
have an effect on future
behavior
Harmful Effects of Unrelieved
Pain
• Future Pain
– Poorly controlled acute
pain can predispose
patients to debilitating
pain syndromes.
– Phantom Pain
– Herpetic Pain
• Quality of Life
– Impact of unrelieved
pain on quality of life
is significant , ranging
from decreased
physical activity to
hopelessness and
suicidal ideations
Conclusion
•
The power point presentation on pain
management discussed the basic mechanisms
underlying the causes and effects of pain.
References
Fanciullo, G, (2000). Acute Pain Management , Symposium Spotlight: The 16th Annual Meeting of the American
Academy of Pain Medicine, New Orleans, La., Feb. 24-27.
Joint Commission on Accreditation of Healthcare Organization, (2000). Pain assessment
and management an
organizational approach. Oakbrook, Il.: Joint Commission on Accreditation of Healthcare Organization.
McCaffery, M. & Ferrell, B. (1999). Pain Clinical Manual (2nd ed.). St. Louis: Mosby.
Phillips, D. (2000). JCAHO pain management standards are unveiled, JAMA, 284 (4).
Rubinger, H, & Gardner, Richard, (2002). Pain and Suffering, Continuing Care, 21, (4), 22.
Smith,Rita, Curi, M., Silverman, A, (2002). Pain Management: The global connection, Nursing Management, 33 (6), 27.
Stratton, L. (1999). Evaluating the effectiveness of a hospital pain management program, Journal of Nursing Care
Quality, 13 (4), 8-18.
U.S. Department of Health and Human Services, Agency for Health Care Policy and Research: Acute Pain Management