PAIN

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PAIN:

PAIN

DEFINITION :

DEFINITION ‘Pain is defined as an unpleasant subjective sensory and emotional experiences associated with actual or potential tissue damage or described in terms of such damage’ (IASP)

DEFINITION:

DEFINITION ‘Pain is defined as a state in which an individual experience and reports the presence of service discomfort or an uncomfortable situation ‘ (CARPENITO 2003)

TYPES OF PAIN :

TYPES OF PAIN According to duration Acute pain Chronic pain Cancerous pain Non cancerous pain Chronic intermittent pain

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According to where it experienced Radiating pain Referred pain

REFERRED PAIN REGIONS:

REFERRED PAIN REGIONS

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According to origin Cutaneous Deep somatic visceral

TYPES continue..:

TYPES continue.. Nociceptive pain Somatic pain Visceral pain

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Neuropathic pain Centrally generated pain deafferentation pain Sympathetically maintained pain Peripherally generated pain Poly neuropathies Mono neuropathies

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Intractable pain Phantom pain

PAIN SYNDROME:

PAIN SYNDROME Complex regional pain syndrome Post mastectomy pain syndrome Post traumatic head ache Fibro myalgia Hemiplegia associated shoulder pain Pain associated with sickle cell disease

PAIN SYNDROME CONTINUE…:

PAIN SYNDROME CONTINUE… AIDS related pain Burn pain Guillain Barre syndrome and pain

DESCRIPTIVE TERMS OF PAIN:

DESCRIPTIVE TERMS OF PAIN Sharp Piercing Shooting Crushing Tender

DESCRIPTIVE TERMS CONTINUE…:

DESCRIPTIVE TERMS CONTINUE… Hurting Aching Dull Sore Cramping prickling

HARMFUL EFFECTS OF PAIN:

HARMFUL EFFECTS OF PAIN Effects of acute pain Effects of chronic pain

FACTORS INFLUENCING PAIN RESPONSE:

FACTORS INFLUENCING PAIN RESPONSE Psychological factors Age Fatigue Genes Neurological function

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SOCIAL FACTORS Attention Previous experience Family and social support

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SPIRITUAL FACTORS PSYCHOLOGICAL FACTORS Anxiety and depression Coping styles CULTURAL FACTORS

COMMON MYTHS ABOUT PAIN :

COMMON MYTHS ABOUT PAIN The nurse is the best judge of a client’s pain If pain is ignored , it will go away. Clients should not take any measures to relieve their pain until it is unbearable. Clients taking pain medications will become addicted to the drug.

COMMON MYTHS continue…:

COMMON MYTHS continue… Most complaints of pain are purely psychological, only real pain manifests in obvious physical signs such as moaning or grimacing Clients with severe tissue damage experience significant pain, those with less damage feels less pain

Nursing process:

Nursing process

ASSESSMENT:

ASSESSMENT Assess regarding The characteristics of pain Coping resources Affective response Behavioural and psychological response

CHARECTERISTICS OF PAIN :

CHARECTERISTICS OF PAIN Intensity Pain threshold Pain tolerance Timing

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Location Quality Personal meaning Aggravating and alleviating factors Pain behaviours

OLDCART MNEMONICS:

OLDCART MNEMONICS O - Onset L - Location D - Duration C - Characteristics A - Aggravating factors R - Radiation T - Treatment

PQRS MNEMONICS:

PQRS MNEMONICS P - Provoked Q - Quality R - Radiation S - Severity T - Timing

ASSESSMENT TOOLS:

ASSESSMENT TOOLS VISUAL ANALOGUE SCALE Simple descriptive pain scale 0 – 1o numeric pain intensity scale Visual analogue scale

SIMPLE DESCRIPTIVE PAIN INTENSITY SCALE:

SIMPLE DESCRIPTIVE PAIN INTENSITY SCALE

0- 1O NUMERIC PAIN INTENSITY SCALE :

0- 1O NUMERIC PAIN INTENSITY SCALE

VISUAL ANALOGUE SCALE:

VISUAL ANALOGUE SCALE

FACES PAIN SCALE:

FACES PAIN SCALE

PAIN DIARY:

PAIN DIARY Date and time Intensity Situation How did you feel? What were you thinking? What did you do to ease the pain? How effective was the pain control strategy?

PAIN MEASURMENT IN CHILDREN:

PAIN MEASURMENT IN CHILDREN NEONATES AND INFANTS Physiological changes Behavioural response

PRE SCHOOLERS:

PRE SCHOOLERS OUCHER SCALE HAPPY – SAD FACE SCALE COLOR ANALOGUE SCALE POKER CHIP TOOL LADDER SCALE LINEAR ANALOGUE SCALE

THE OUCHER SCALE:

THE OUCHER SCALE

HAPPY – SAD FACE SCALE:

HAPPY – SAD FACE SCALE

COLOR ANALOGUE SCALE:

COLOR ANALOGUE SCALE

COLOR ANALOGUE SCALE Continue…:

COLOR ANALOGUE SCALE Continue… BLUE – NO PAIN GREEN – MILD PAIN ORANGE – MODERATE RED - SEVERE

LADDER SCALE:

LADDER SCALE

LINEAR ANALOGUE SCALE:

LINEAR ANALOGUE SCALE NO SEVERE PAIN PAIN

SCHOOL AGED CHILDREN:

SCHOOL AGED CHILDREN 6 point Numerical verbal pain score O – 100 numerical scale Visual analog scale Modified Mc GILL Pain questionnaire

NURSING DIAGNOSIS:

NURSING DIAGNOSIS acute pain chronic pain Anxiety Ineffective coping Fatigue

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Fear Hopelessness Impaired physical mobility Disturbed sleeping pattern

IMPLEMENTATION:

IMPLEMENTATION NURSES ROLE Administer pain relieving intervention Assess the effectiveness Monitoring for adverse effects Serving as an advocate

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Identify goals for pain management Establish the nurse patient relationship and teaching Providing physical care Managing anxiety related to pain

PHARMACOLOGIC INTERVENTIONS:

PHARMACOLOGIC INTERVENTIONS PRE MEDICATION ASSESSMENT Allergies to medication Nature of any previous allergy response Medication history of the patient Health problems of the patient Pain status Side effects of the particular medication

APPROACHES FOR USING ANALGESICS:

APPROACHES FOR USING ANALGESICS BALANCED ANAESTHESIA PRO- PRE NATA PREVENTIVE APPROACH INDIVIDUALISED DOSAGE PATIENT CONTROLLED ANALGESIA ANAESTHETIC AGENTS ANALGESICS

ANALGESICS:

ANALGESICS OPIOID ANALGESICS NON OPIOID ANALGESICS ADJUVANTS

OPIOID ANALGESICS:

OPIOID ANALGESICS Common opioids are Morphine Fentanyl Phenazocin Tramadol Pethidine

SIDE EFFECTS OF OPIOIDS:

SIDE EFFECTS OF OPIOIDS Respiratory depression and sedation Nausea and vomiting Constipation Inadequate pain relief Tolerance and addiction

NON OPIOID ANALGESICS:

NON OPIOID ANALGESICS Aspirin Salicylate salts Acetaminophen NSAIDs

NSAID’S:

NSAID’S COX I inhibitors COX II inhibitors Eg: valdecoxib

ADJUVANTS:

ADJUVANTS TRICYCLIC ANTI DEPRESSANT AGENTS Eg: Amitryptilline ANTI CONVULSANTS Eg: Tegretol

NON PHARMACOLOGIC MEASURES:

NON PHARMACOLOGIC MEASURES PHYSICAL MODALITIES PSYCHOLOGICAL MODALITIES

PHYSICAL MODALITES:

PHYSICAL MODALITES Thermo therapy Cryo therapy Cutaneous stimulation and massage Accupuncture Accupressure TENS Therapeutic exercise

ACCUPUNCTURE:

ACCUPUNCTURE

TENS:

TENS

THERAPEUTIC EXERCISE:

THERAPEUTIC EXERCISE

PSYCHO SOCIAL MODALITIES:

PSYCHO SOCIAL MODALITIES Relaxation therapy Meditation and imaging Distraction and reframing Bio feedback Patient education Psycho therapy Counselling and emotional support Hypnosis

NEUROLOGIC APPROACH:

NEUROLOGIC APPROACH STIMULATION PROCEDURE

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INTERRUPTION OF PAIN PATHWAYS

FIRST ORDER NEURNE LEVEL :

FIRST ORDER NEURNE LEVEL NEURECTOMY RHIZOTOMY

SECOND ORDER NEURONE LEVEL:

SECOND ORDER NEURONE LEVEL CORDOTOMY DORSAL ROOT ENTRY ZONE

THIRD ORDER NEURONE LEVEL :

THIRD ORDER NEURONE LEVEL CINGULOTOMY THALAMOTOMY

CANCER PAIN MANAGEMENT:

CANCER PAIN MANAGEMENT WHO analgesics ladder Pain treatment continuum

WHO ANALGESICS LADDER:

WHO ANALGESICS LADDER

PAIN TREATMENT CONTINUUM:

PAIN TREATMENT CONTINUUM Pain control Neuro ablation Spinal analgesia Interventions Strong opioids Weak opioids Adjuvant medication NSAID’s Over the counter medication Pain

BIBILIOGRAPHY:

BIBILIOGRAPHY Smeltzer ,S,C, Bare, B, BRUNNER AND SUDDARTH’S TEXT BOOK OF MEDICAL AND SURGICAL NURSING , 10 th edition, (2004), Lippincott Williams & Wilkins. Ballantyne, J, C, THE MASSACHUSETTS GENERAL HOSPITAL HANDBOOK OF PAIN MANAGEMENT, 3 rd edition, (2006), Philadelphia, Lippincott Williams & Wilkins. Kozier, B, etal, FUNDAMENTALS OF NURSING, 7 th edition, (2006), Pearson education.  Taylor, C, etal, FUNDAMENTALS OF NURSING, 6 th edition, (2008), Philadelphia, Lippincott Williams & Wilkins. 

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Potter, P, A, Perry, A, G, FUNDAMENTALS OF NURSING, 6 th edition, Mosby Publications. Black, J, M, Hawker, J, H, MEDICAL SURGICAL NURSING, 7 th edition, Elsevier Publishers, Missouri. Dureja, G, P, HANDBOOK OF PAIN MANAGEMENT, 1 st edition, (2004), Elsevier Publishers.  Stannard, C, PAIN, 2 nd edition, (2004), Elsevier Publishers.

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THANK YOU…