Pain Management-Overview
Dr. Samah El awady
Associate professor of pediatric Nursing
Outlines
• Definition
• Epidemiology
• The character of pain
• Pain related-terminology
• Physiologic Effects of Pain
• Causes of Acute Pain
• Special painful conditions
What is the Pain?
Definition
“Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage.”
(International Association for the Study of Pain, 2019)
“An unpleasant sensation induced by noxious stimuli and
generally received by specialized nerve endings.”
(Cancer Institute , 2018)
Epidemiology
Epidemiology
Pain is an enormous global health problem. Globally, it has been
estimated that 1 in 5 adults suffer from pain and that another 1 in
10 adults are diagnosed with chronic pain each year . (BMC
Public Health. 2018)
On to today’s note. Globally, it is estimated that about one in five,
or about 1.5 billion people, suffer from chronic pain (CP), with
prevalence increasing with age
70 to 90% of patients with advanced disease from cancer have
significant pain that requires the use of opioid drugs.
Epidemiology
80% of elderly patients have chronic pain
66% have pain in the last month of life
Up to 50% of patients who are taking pain medication do
not experience adequate relief
Physiologic Effects of Pain
• Immune System
• Developmental ability
• Quality of Life
• Endocrine & Metabolic
• Musculoskeletal
• Cardiovascular
• GI/GU
Pain related-terminology
Radiating pain: perceived at the source of the pain and
extends to the nearby tissues
Referred pain: felt in a part of the body that is considerably
removed from the tissues causing the pain
Intractable pain: highly resistant to relief
Phantom pain: sensations are described as perceptions that an
individual experiences relating to a limb or an organ that is not
physically part of the body. Limb loss is a result of either removal by
amputation or congenital limb deficiency.
Hyperalgesia: excessive sensitivity to pain
Pain threshold: is the amount of pain stimulation a person requires
in order to feel pain
Pain reaction: includes the autonomic nervous system and
behavioral responses to pain
Pain tolerance: maximum amount and duration of pain that an
individual is willing to endure
Nociceptors: ("pain receptor") is a sensory neuron that
responds to damaging or potentially damaging stimuli by sending
“possible threat” signals to the spinal cord and the brain.
Factors affecting pain perception
AGE
Factors affecting pain perception
CULTURE
MEANING OF
PAIN
PAIN
Pain Control EXPERIENCE
ATTENTION
Sex
Anxiety
Pain classification
Clinical types
Acute pain Chronic pain
Results from noxious stimuli that Results from: nociceptors, visceral,
activates nociceptors neuron or somatic
It accompanies surgery, traumatic
It accompanies chronic disease,
injury, tissue damage, and untreated condition.
inflammatory processes.
Self-limited, resolves over days to
Unresolved as long as underlying
weeks, but can persist for 3 months cause is present.
Treatment is short term and
curative Treatment goal oriented,
multidisciplinary approaches.
Causes of Acute Pain
Post-operative
Obstetric-Labor
Burns
Trauma
Infective / Inflammatory conditions
Ischaemic pain
Choice of Drugs in Treatment of Acute / Chronic
Pain
1) Severity of pain
2) Routes of administration
3) Patient information
4) Patient’s preference
Causes of Post-Operative Pain
Incisional skin and subcutaneous tissue
Deep cutting, coagulation, trauma
Positional nerve compression, traction & bed sore.
IV site needle trauma, extravasation, venous irritation
Tubes drains, nasogastric tube
Respiratory from coughing, deep breathing
Surgical complication of surgery
Others cast, dressing too tight, urinary retention
Causes of Chronic Pain
Cancer pain
Cancer related
From cancer therapy
Non-cancer
Idiopathic
Nociceptive
Neuropathic
Pain Assessment
Good assessment = Successful management
Pain Assessment
• Subjective:
• Pain Scores:
• Unidimentional Acute pain
• Visual analogue scale (VAS), Numerical Rating Scale (NRS)
• Facial expression.
• Multidimentional Chronic pain
• McGill & Pain Inventory.
• Objective:
– Behavioral: refusal to move, cough & deep breath
– Physiological: PR, RR, BP, sweatiness & dilated pupils
Pain Scores
Visual Analogue Scale (VAS)
0 10
Numeric Rating Scale (NRS)
Verbal scale
No Severe
Mild Moderate
Pain Pain
Wong-Baker “Faces Scale”
Questions to Ask about Pain
P A I N
Pattern: onset, course & duration
Area: location
Intensity
Nature: burning, colic, …
Questions to Ask about Pain
Q R S T
Quality - characters of pain
Referred / Radiating
Severity
Timing
Questions to Ask about Pain
LO CAT E S
L – Location.
O – Other Symptoms.
C – Character: deep, burning, throbbing…
A – Aggravating and Alleviating factors.
T – Timing.
E – Effect: your daily routine?
S – Severity.
Non-Drug Strategies
Alternative medicine:
Acupuncture
Cupping
Physical Therapy
ice, heat, massage
Exercise
Psychological therapy
Cognitive-behavioral therapy
Relaxation techniques
Hypnosis
Drug Strategies
1. Salicylates (e.g. aspirin)
• Aspirin has:
• Antipyretic and analgesic,
• Anti-inflammatory actions (> 3 gm/d),
• Anticoagulant.
• Unfortunately, these additional actions
• GIT problems: gastritis, bleeding ulcer.
2. Opioid Therapy
Side Effects
• Common
• Constipation
• Mental clouding
• Less common
– Sweating
– Amenorrhea
• Sexual dysfunction
• Urinary retention
– Headache
Tolerance
Tolerance is a state of adaptation; in which exposure to a
drug results in a diminution of the drug's effects over time.
- 1st in duration of action;
- 2nd in overall effectiveness.
Do Not Use Placebos!
Unethical
They don’t work
Not helpful in diagnosis
Effect is short lived
Destroys trust
