Transcript Types of Pain

Chapter 20
Comfort
Pain—A Complex Phenomenon
• Pain relies on the patient’s perception and report.
• Four out of ten people experience pain on a daily basis.
• The elderly are more likely to experience pain than
younger adults and will suffer moderate to severe pain
twice as long as younger persons.
• Pain can be both under and over reported by the elderly.
Types of Pain
• Nociceptive pain
– Arises from mechanical, thermal, or chemical noxious
stimuli to the A delta and C afferent nociceptors.
• Found in fasciae, muscles, joints, and other deep
structures.
• Activation causes a transduction of painful stimuli
along the primary afferent fiber of the dorsal horn
of the spinal column.
Types of Pain (cont.)
• Neuropathic pain
– Associated with diabetic neuropathies, postherpetic
neuralgias, and other insults to the nervous system.
• Sharp, stabbing, tingling, or burning pain with a
very sudden onset of high intensity.
• Lasts a few seconds or lingers for a longer period.
Types of Nociceptive Pain
• Somatic Pain
– Characteristic of pain in the bone and soft tissue
masses.
– Well localized and described as throbbing or aching.
• Visceral Pain
– Associated with disorders that can cause generalized
or referred pain.
– Described as deep and aching.
Complications of Unrelieved Pain in the
Elderly
• Limited mobility
– Pressure ulcers, pneumonia, and constipation
• Poor appetite
– Malnutrition and dehydration
• Depression, hopelessness, spiritual distress
Effective Pain Management
• Qualitative and quantitative assessment of symptoms.
– Inquiries into the presence of pain
– Description of pain through questioning
• Physical examination to offer additional insights into
patients’ pain
– Ongoing assessment
Pain Management Variables
• Role of aging on pain
• Assessing patients with cognitive deficits
• Cultural factors
Pain Assessment Instruments
• Numeric rating scale: Asks the patient to rate pain on
a scale from 1 to 10.
• Visual Analogue Scale: Uses a horizontal line with “no
pain” on the left end and “pain as bad as it can possibly
be” on the right end.
• McGill Pain Questionnaire: Contains 78 words
categorized into 20 groups, a drawing of the body, and a
Present Pain Intensity (PPI) scale.
Underlying Factors in Pain Management
• Poor positioning or posture
• Inactivity
• Emotional issues
• Adverse drug reactions
Examples of Alternative Therapies for
Pain Management
• Acupressure
• Heat and cold therapies
• Acupuncture
• Herbal medicine
• Aromatherapy
• Homeopathic remedies
• Biofeedback
• Hypnosis
• Chiropractic
• Naturopathy
• Electrical stimulation
• Osteopathy
• Exercises
• Prayer
• Guided imagery
• Progressive relaxation
Diet Influences on Pain
• Persons with inflammatory conditions should eliminate
arachidonic acid from diet.
• Omega-3 fatty acids can reduce inflammation.
• Antioxidants offer protection from inflammation.
Opioids of Choice for Pain Management
• Moderate to Severe Pain
– Codeine
– Oxycodone
– Hydrocodone
• Severe Pain
– Morphine
– Fentanyl
Areas of Concern with Drug Use
• Propoxyphene and pentazocine are not advised for use
with the elderly.
• Ongoing evaluation of responsiveness to drugs and
possible adverse effects is important.
– Adverse reactions can develop from drugs used for a
long time that have not presented problems before.
Comfort Measures
• Giving the patient undivided attention regardless of the
length of the interaction.
• Listening attentively.
• Explaining.
• Touching.
• Perceiving.
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).