2. INTRODUCTION
Pain is a subjective response to both psychological & physical
stressors.
All people usually experience pain at some point during their
lives.
Although pain usually is experienced as uncomfortable &
unwelcome, it also serves a protective role, warning of potential
health- threatening conditions.
For this reason , pain is increasingly referred to as the fifth vital
sign, with recommendation to assess pain with each vital sign
assessment.
3. DEFINITION
The International Association for the Study of Pain
defines pain as "an unpleasant sensory and
emotional experience associated with actual or
potential tissue damage, or described in terms of
such damage".
4. ANATOMY &
NEUROPHYSIOLOGY
The peripheral nervous system is composed of two
types of neurons-
1. Sensory &
2. Motor.
Pain is perceived through the sensory neurons &
responded to through the motor neurons.
5. Connections or synapses occur within the spinal
cord & again within the CNS, where cognitive
analysis of the painful stimulus leads to a response.
A highly intense pain may prompt an immediate
reflex response that precedes awareness of the pain.
6. NEUROPHYSIOLOGY
TRANSDUCTION- Pain stimuli is converted to
electrical energy. This electrical energy is called
transduction, these sends passes an impulses across a
peripheral nerve fiber (nociceptor).
TRANSMISSION-A delta fibers (myelinated) sends
sharp, localized distinct sensation. C fibers
(unmyelinated) rely impulses that are poorly localized,
burning , persistent pain.
7. PERCEPTION- Person is aware of pain, somato
sensory core indentifies the location &intensity of
pain. Patient unfolds a complex reaction,
physiological & behavioral responses is perceived.
MODULATION- inhibitory neurotransmitters
like endogenous opiods work to hinder the
pain transmission. This inhibition of pain
impulse is known as Modulation.
8. ETIOLOGY
Microorganism bacteria, viruses etc.
Inflammation,
Impaired blood flow
Invasive tumor
Radiation/Heat
Obstruction
Spasm/Compression
Decreased movement
Stretching, straining
Fractures
Swelling
Deposits of foreign tissues
Chemicals
Electricity
Conflict , difficulty in life
9. TYPES OF PAIN
The crudest example of this system simply
distinguishes "somatogenic" pain (arising from a
perturbation of the body)
somatogenic pain is divided into "nociceptive"
(caused by activation of nociceptors) and
"neuropathic" (caused by damage to or
malfunction of the nervous system).
10. Nociceptive pain is divided into "superficial" and
"deep" - and deep pain is further divided into "deep
somatic" and "visceral".
11. OTHER TYPES OF PAIN
ACUTE PAIN- it has a sudden onset, is usually
temporary, & localized. Pain that lasts for less than 6
months & has an identified cause is classified as acute
pain.
CHRONIC PAIN- is prolonged pain, lasts for more than
6months, is not associated with an identifiable cause.
BREAKTHROUGH PAIN- is pain that exceeds
baseline treated or untreated pain. It is often described as
a sudden flare that exceeds the analgesic effect of long
acting pain medication.
12. CENTRAL PAIN- central pain is related to a lesion in
the brain that may spontaneously produce high
frequency bursts of impulses that are perceived as pain.
PHANTOM PAIN- is a syndrome that occurs following
amputation of a body part. The client experience pain of
the missing body part even though the client is
completely mentally aware that is gone.
PSYCHOGENIC PAIN- is expected in the absence of
any diagnosed physiologic cause or event. Typically
psychogenic pain involves a long history of severe pain.
13. FACTORS AFFECTING
RESPONSES TO PAIN
AGE- Age may change perception & expression of pain.
There are some variations in pain threshold associated with
the chronological age, but no clear trends have been
established.
PHYSIOLOGICAL - Pain perception or interpretation, is an
important component of the pain experience, because we
perceive & interpret pain based on our own individual
experience, pain is different for each person.
SOCIOCULTURAL- Cultural standards teach an individual
hoe much pain to tolerate, what types of pain to report, to
whom to report the pain, & what kind of treatment to seek.
14. PSYCHOLOGICAL PAIN- Emotional status influences
the pain perception. The sensation of pain may be
blocked by intense concentration or may be increased
by anxiety or fear.
PAST EXPERIENCE WITH PAIN- Previous
experiences with pain are likely to influence the
person’s response to a current pain episode. the adult
usually will have a healthy attitude to pain.
KNOWLEDGE- A lack of understanding of the source,
outcome, & meaning of the pain can contribute
negatively to the pain experience.
16. MEASUREMENT OF PAIN
There are many types of scale to
measure the pain:
McGill Pain Questionnaire
Jimenez technique- PQRST technique
Visual analog scale
0-10 Numeric pain rating scale
Simple descriptive pain intensity scale
17. McGill Pain Questionnaire
It is also known as McGill Pain index, it is a scale of rating
pain.
It is a self report questionnaire that allows individuals to give
their doctor a good description of the quality and intensity of
pain that they are experiencing.
User first select a single word from each group that reflects
their pain. Users then review the list and select the three
words from groups 1 - 10.
Two words from group 11 – 15.
A single word from group 16 and then
One word from the group 17-20.
After completing the questionnaire, users will have selected
seven words that best describe their pain.
