Transcript Pain Management

Pain Management
What is pain?
One of the most common reasons
people seek healthcare
One of the most widely undertreated health problems
Pathophysiology
 A sensation caused by some type of
noxious stimulation
 A pattern of responses that function to
protect the individual from harm
 Whatever the experiencing person says
it is whenever he says it does
Components of Pain
Physical
Caused by some kind of noxious
stimulant
Emotional
Results of combination of thoughts,
feelings, and beliefs
Behavioral
Pattern of responses that function to
protect the individual from further
harm
Causes of Pain
Cutaneous
Direct stimulation to skin (cut)
Somatic
From musculo-skeletal system
(sprained muscle)
Visceral
Arising from hollow organs
(appendicitis)
Neuropathic
Damage to nervous system
Referred
Pain arising from someplace
else in body
Descriptions of pain
• Chronic: occurring over a
long period of time
• Acute: sudden, brief onset
Visual Analog Scale
This is a line 10 cm. long (about 4 inches) that
is divided into ten divisions. Patients are
asked to show the amount of pain on a 1-10
scale.
Researchers say that patients cannot function
with a scale with more than ten points.
PQRST
This mnemonic is devised to show
the steps in pain assessment:
Provoking factors
Quality
Region/Radiation
Severity/Symptoms
Timing
• Provoking factors include what caused
the pain and what might be making it
worse
• Quality questions refer to how the pain
feels…let the patient tell but offer
suggestions if necessary, like sharp,
dull, throbbing, burning, etc.
• Region….have patient point to area that
hurts
• Severity can be measured with the pain
rating scales
• Symptoms may accompany the
pain….nausea, vomiting, etc
• Timing refers to when the pain started,
how long it lasts
Be aware
• Just because a patient cannot respond
to pain doesn’t mean there is no pain
• Activities of daily living (ADLs) may
be effected
• Neurological status will alter the
response to pain
Pain Management
Management must be timely,
individualized,
and bring the pain to an
acceptable level of tolerance
Pharmacologic interventions
Must be individualized
• Three main categories:
– Non-opioids
– Opioids
– Adjuvants
 Non-opioids:
 Acetominophen (Tylenol)
 Aspirin
 NSAIDs (Advil)
 Opioids
 Weak
 Codeine
 Oxycodone
 Vicodin
 Strong
 Hydromorhone
 Morphine
 Merperidine
 Adjuvants
 Primary function is not pain relief but provide relief
 May modify mood so patient feels better
Precautions to giving pain
medications
• Medication choice may depend on
practitioner’s preference, however:
– Should not give two analgesics
from same class at same time
– Must be aware of effects of
medications
– Must watch for allergic reactions
Routes of medication
administration
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Oral
Injection
Intravenous (includes PCA)
Epidural
Rectal
Topical
WHO Pain Ladder
SEVERE PAIN:
Keep giving mild pain
medication and add a
strong opioid such as
morphine or Fentanyl
MODERATE PAIN:
Keep giving mild pain
medication and add a
mild
Opioid such as codeine
MILD PAIN:
Aspirin, ibuprophen
Acetominophen,
naprosyn
Concepts of WHO Pain Ladder
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By the mouth
By the clock
By the ladder
For the individual
With attention to detail
Placebos
Controversial use of an
inactive substance to satisfy
the demand for medication
Non-pharmacologic interventions
Pain control without using medications
• Alter the environment
• Relaxation and guided imagery
– Meditation
• Cutaneous stimulation
– Massage, acupressure, acupuncture,
TENS
• Biofeedback
• Therapeutic touch
• Education
JCAHO Standards for Pain
Management
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Address care at the end of life
Assess and manage pain appropriately
Assess pain in all patients
Support safe medication ordering and
administration
• Monitor patient during postprocedure period
• Rehabilitate for optimal level of
function
• Educate about pain an managing pain
• Plan for discharge continued care if
needed
• Collect data to monitor performance
Nurses spend more time with
patients than any other
provider. They must stay
informed in order to give the
best care to their patients.
• References:
– Falk. Kim Marie. Pain Management. National
Center of Continuing Education. Catalog 98
TX.
– http://www.fxbcenter.org/caring/painladder.htm
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– http://www.harcourthealth.com/Mosby/Wong/f
yi_03.html