Unit

9:Comfort,Rest,Sleep &
pain
Presented by
Shenbagapraba N
Associate Professor
Department of Community Health and
Chettinad College of Nursing
 Comfort,Rest,Sleep & pain
• Comfort
• Factors influencing comfort
• Types of beds including latest beds,purposes and bedmaking
• Therapeutic positions,Comfort devices
• Sleep and rest
• Physiogy of sleep,Factors affecting sleep
• Promoting rest and sleep ,Sleep disorders
• Pain(Discomfort)
• Physiology,Common causes of pain
• Types,Assessment -Pain scales and narcotic scales
• Pharmacological and non pharmacological pain relieving meadures-use of
narcotics,TEN services,PCA
• Invasive techniques of pain management
• Any other newer measures
• CAM(Complementary & Alternative healing Modalities)
Objectives
• Definition of pain
• Physiology of pain
• Common causes of pain
• Types of pain
Definition
• International Association for the Study of Pain (IASP)
defines pain as a "sensory and emotional experience
associated with tissue damage or described in terms of such
damage

• McCaffery defined pain as "whatever the experiencing

person says it is and whenever he says it does (1979)."

• The American Pain Society goes further by stating that it is

"not the responsibility of clients to prove they are in pain; it
is the nurse's responsibility to accept the clients report of
pain (2005)
process of nociceptive (normal)
pain
Four process of nociceptive (normal) pain:
• Transduction(the action or process of converting
something and especially energy or a message )
• Transmission(sending something out or passing
something on from one person)
• Perception(the ability to notice or understand
something)
• Modulation(the exertion of a modifying or
controlling)
PHYSIOLOGY OF PAIN
THEORIES OF PAIN
Specificity Theory :
Von Frey (1895)
the body has a separate sensory system for
perceiving pain—just as it does for hearing and
vision.this system contains its own special receptors
for detecting pain stimuli, its own peripheral nerves
and pathway to the brain, and its own area of the
brain for processing pain signals
THEORIES OF PAIN Pattern
theory
Goldschneider (1920) proposed that there is no
separate system for perceiving pain, and the
receptors for pain are shared with other senses, such
as of touch.
• According to this view, people feel pain when
certain patterns of neural activity occur, such as
when appropriate types of activity reach excessively
high levels in the brain
THEORIES OF PAIN Gate
Control Theory
• Ronald Melzack and Patrick Wall proposed the Gate
Control Theory in 1965. • account for both "top-
down" brain influences on pain perception as well
as the effects of other tactile stimuli in appearing to
reduce pain • there is a "gate" or control system in
the dorsal horn of the spinal cord through which all
information regarding pain must pass before
reaching the brain. • they can inhibit the
communication of stimulation, while in other cases
they can allow stimulation to be communicated
into the central nervous system
Nature of pain

• Pain is subjective and highly individualized.

• Its stimulus is physical and/or mental in nature.
• Only the patient knows whether pain is present
and how the experience feels.
• May not be directly proportional to amount of
tissue injury
Signs and symptoms of pain
• Increased respiratory rate
• Increased heart rate
• Peripheral vasoconstriction
• Pallor
• Elevated B.P.
• Increased Blood Glucose Levels
• Diaphoresis
• Dilated pupils
• Moaning
• Guarding the area(involantory reaction)
• Restlessness
• Irritability
ETIOLOGY AND
PRECIPITATING FACTORS
• Surgical or accidental trauma.
• Inflammation.
• Musculoskeletal disorders such as muscle spasm.
• Neuropathies secondary to such conditions as diabetes
mellitus acquired
• Immunodeficiency syndrome or multiple sclerosis.
• Visceral disorders such as myocardial infarction.
• Vascular disorders such as sickle cell anemia.
• Invasive diagnostic procedure.
• Excessive pressure, such as with immobility.
• Cancer
Acute pain
• When pain lasts only through the expected
recovery period, it is described as acute pain.
• Acute pain is protective, has an identifiable cause,
is of short duration, and has limited tissue damage
and emotional response.
• It eventually resolves, with or without treatment,
after an injured area heals.
• Complete pain relief is not always achievable, but
reducing pain to a tolerable level is realistic.
• Unrelieved acute pain can progress to chronic pain.
 Chronic pain
• Chronic pain is the pain that lasts longer than 6 months
and is constant or recurring with a mild-to-severe intensity.
• It does not always have an identifiable cause and leads to
great personal suffering.
Examples: arthritic pain, head ache, peripheral neuropathy.
• The possible unknown cause of chronic pain, combined
with the unrelenting nature and uncertainty of its duration,
frustrates a patient, frequently leading to psychological
depression and even suicide.
• Associated symptoms of chronic pain include fatigue,
insomnia, anorexia, weight loss, hopelessness, and anger.
Cont..
CHRONIC PAIN MAY BE :
• Chronic non cancer pain
• Chronic cancer pain
• Chronic episodic pain.
Chronic non cancer pain:
The chronic pain that resulted due to non cancer
disease conditions is termed as chronic non cancer
pain.
Chronic cancer pain:
Cancer pain is the pain that is caused by tumor
progression and related pathological processes, invasive
procedures, toxicities of treatment, infection, and
physical limitations.
• Approximately 70% to 90% of patients with advanced
cancer experience pain.
Chronic episodic pain:
Pain that occurs sporadically over an extended period of
time is episodic pain. Pain episodes last for hours, days,
or weeks.
Examples are migraine headaches.
Classification based on location:
This is based on the site at which the pain is located
Egs:
Headache
Back pain
Joint pain
Stomach pain
Cardiac pain
• Referred pain: pain due to problems in other areas manifest
in different body part.
• For example, cardiac pain may be felt in the shoulder or left
arm, with or without chest pain
Based on intensity
Mild pain:
Pain scale reading from 1 to 3 is considered as mild
pain
Moderate pain:
Pain scale reading from 4 to 6 is considered as
moderate pain
severe pain:
Pain scale reading from 7 to 10 is considered as
severe pain Based on intensity
Classification of pain based on
etiology
Nociceptive pain:
• Nociceptive pain is experienced when an intact,
properly functioning nervous system sends signals
that tissues are damaged, requiring attention and
proper care.
• For example, the pain experienced following a cut
or broken bone alerts the person to avoid further
damage until it is properly healed.
• Once stabilized or healed, the pain goes away
Classification of pain based on etiology
Nociceptive Pain
Somatic pain:
This is the pain that is originating from the skin, muscles,
bone, or connective tissue. The sharp sensation of a paper cut
or aching of a sprained ankle are common examples of somatic
pain
Visceral pain:
Visceral pain is pain that results from the activation of
nociceptors of the thoracic, pelvic, or abdominal viscera
(organs).
• Characterized by cramping, throbbing, pressing, or aching
qualities.
• Examples: labor pain, angina pectoris, or irritable bowel
Neuropathic pain
Neuropathic pain is associated with damaged or malfunctioning nerves due
to illness , injury, or undetermined reasons.
Examples:
• Diabetic peripheral neuropathy
• Phantom limb pain
• Spinal cord injury pain
It is usually chronic.
• it is described as burning, “electric-shock,” and/or tingling, dull, and aching.
• Neuropathic pain tends to be difficult to treat.
• Neuropathic pain is of two types based on which parts of the nervous
system is damaged.
1. Peripheral Neuropathic Pain
2. Central Neuropathic Pain
Neuropathic pain (cont.
1.Peripheral neuropathic pain:
• Due to damage to peripheral nervous system
• Eg: phantom limb pain

2.Central neuropathic pain:

• Results from malfunctioning nerves in the central
nervous system (CNS).
• Eg: spinal cord injury pain,
• Post-stroke pain.
Factors Influencing Pain
1. Developmental factors
2. Physiological factors- fatigue, genes, neurological
functioning
3. Social factors- attention, previous experience,
family and social support, spiritual factors.
4. Psychological factors- anxiety, coping style.
5. Cultural factors
1.Developmental factors
Age:
• Age influences pain, particularly in infants and older
adults. Young children have trouble understanding pain
and the procedures that cause it.
• If they have not developed full vocabularies, they have
difficulty verbally describing and expressing pain to
parents or caregivers.
• With the developmental factors in mind assessment
should be done for pain in children.
• older adults have a greater likelihood of developing
pathological conditions, which are accompanied by pain
2.Physiological Factors
a)Fatigue.
• Fatigue heightens the perception of pain and
decreases coping abilities.
• If it occurs along with sleeplessness, the perception
of pain is even greater.
• Pain is often experienced less after a restful sleep
than at the end of a long day.
Cont..
b)Genes.
Research on healthy human subjects suggests that
genetic information passed on by parents possibly
increases or decreases the person’s sensitivity to pain
and determines pain threshold or pain tolerance
c) Neurological Function.
Any factor that interrupts or influences normal
pain reception or perception (e.g., spinal cord injury)
affects the patient’s awareness of and response to
pain.
3.Social Factors
1.Attention.
The degree to which a patient focuses attention on pain
influences pain perception. Increased attention is
associated with increased pain, whereas distraction is
associated with a diminished pain response
2.Previous Experience.
If a person repeatedly experiences the same type of pain
that was relieved successfully in the past, the patient
finds it easier to interpret the pain sensation. • If a
person is having worst previous experience he may
experience much pain.
Cont..
3. Family and Social Support:
The presence of family or friends can often make the pain
experience less stressful. • The presence of parents is
especially important for children experiencing pain
4. Spiritual Factors:
• Spiritual questions include “Why has this happened to
me?” “Why am I suffering?” Spiritual pain goes beyond
what we can see. “Why has God done this to me?” “Is
this suffering teaching me something?”
• If the person is experiencing like this feelings it makes
much painful
4.Psychological Factors
1. Anxiety:
• Anxiety often increases the perception of pain, and
pain causes feelings of anxiety.
• Critically ill or injured patients who perceive a lack
of control over their environment and care have high
anxiety levels. This anxiety leads to severe pain
2.Coping Style: Persons with better coping levels
perceives less a pain than the person with lower
coping levels
5.Cultural Factors.
• Cultural beliefs and values affect how individuals
cope with pain.
• Individuals learn what is expected and accepted by
their culture, including how to react to pain.
• Culture affects pain expression. Some cultures
believe that it is natural to be demonstrative about
pain. Others tend to be more introverted
questions
• Short answers (5x2=10)
• Define pain
• List out the types of pain
• List out the four factors influencing pain
• Mention the process of pain
• Enlist the four signs and symptoms