All about pain management. By shah faisal

1. COGNITIVE PERCEPTUAL
PATTERN (Concept of Pain)
Presented by : Ameer Ali

2. Objectives
At the end of this class, students will be able to:
•Define cognitive perceptual pattern (terms related to pain)
•Define mechanism of cognitive perceptual pattern
•Discuss classification of pain by location.
•Enumerate physiological psychosocial factors that affect pain
perception
•Discuss the stages in which the body respond to pain.
•Discuss factors influencing pain.
•Identify guidelines to assess patient’s pain.
•Discuss non-invasive & non- pharmacological techniques to relieve
pain
•Plan and apply nursing process on a client experiencing pain.

3. Definition of Pain
•Pain is an, unpleasant sensory and
emotional experience associated with actual
or potential tissue damage
•According pain is a personal and
subjective experience that can only be felt
by the sufferer.

4. Terminologies Related to Pain
Pain threshold:
Pain Threshold is the level at which a person first
begins to experience pain from a stimulus, either
artificial or biological.
Pain Tolerance:
A person's Pain Tolerance level, is the overall level of
pain a person can tolerate before breaking down
either physically or mentally

5. 1. Sensory:
The portion of the peripheral nervous system that carries
information from the organs and tissues of the body to the
central nervous system.
OR
The "feeling" portion of a nerve; as opposed to motor
chiro-doc.com/glossary.htm

6. 2. Perception
Perceptionis thepointat whichapersonfeels pain.
(FON:AConceptualFrameworkPg.916,2004)
OR
An awareness and understanding of an impression that has
beenpresentedto the senses.Thementalprocessbywhich
weperceive.
Bailliere’sNursesdictionary20th ed

7. "pain transmission" involves several bodily structures:
• Nerve endings. Located throughout the body, externally in the
skin and internally in the body's organs. They pick up the
painful stimuli and convey them to the brain.
• Nerve fibers. These connect the nerve endings, the spinal
cord and the brain. Their job is to carry nerve impulses over
long distances.
• The brain. Interprets the stimuli and reacts to them.
Mechanism of Cognitive Perceptual Pattern

8. Types of Pain by Duration
•Acute pain - this can be intense and short-
lived, in which case we call it acute pain. Acute
pain may be an indication of an injury. When the
injury heals the pain usually goes away.
•Chronic pain - this sensation lasts much
longer than acute pain. Chronic pain can be mild
or intense (severe).

9. Acute Chronic
Onset Abrupt Gradual
Duration 1 second to 6 months Longer than 6 months
Intensity Mild, moderate, severe Mild, moderate, severe
Etiology Biologically
identifiable
May not be easily identified
Physical
response
Increased BP, HR, RR,
dilated pupils, pallor,
nausea and vomiting,
increase muscle tension
and dry mouth
No autonomic nervous system
symptoms

10. Typesof Pain
Pain
Intensity Location Origins
•Acute
•Chronic
•Radiating
•Referred
•Intractable
•Phantom
•Cutaneous
•Deep Somatic
•Visceral

11. Cont.
Referred:
Commoninvisceral painbecausemanyorgansthemselves
havenopainreceptors ;entrance of sensory neuronsfrom
affected organinto samespinal cordsegments asneurons
fromareas wherepainisfelt.
Characteristics: Painis felt in part of bodyseparate from
source of painandmayassumeanycharacteristics. e.g
MI,which maycauserefer painto jaw,left armandleft
shoulder, kidneystones, whichmayrefer paintogroin.

12. Cont.
D. Radiating
Sensation of pain extending from initial site of injury to
another body part
Characteristics: Pain feel as though it travels down or
along body part. It may be intermittent or constant.
E.g.. Low back pain from rupture in trans vertebra disk;

13. Nocioceptive Pain:
• the viscera or the soma.
• Nocioceptive, somatic pain usually occurs due to
real or impending damage to bone, muscle, skin or
connective tissue. Somatic pain is most commonly
described as localized, aching or throbbing.
• Nocioceptive visceral pain usually occurs due to real
or impending damage to the thoracic, abdominal or
pelvic organs (i.e. heart, liver, and bowel). Visceral
pain is often described as deep, cramping, referred,
aching or gnawing (Griffie, McKinnon, Berry, &
Heidrich, 2002).

14. Neuropathic Pain
• Alternatively, neuropathic pain occurs from
damage to peripheral or central nervous
tissues or from distorted processing of pain.
Examples of neuropathic pain include
peripheral neuropathies, neuralgias, phantom
limb pain and spinal cord injuries. It is often
described as burning, piercing, lacerating and
pricking. (Griffie, McKinnon, Berry, & Heidrich,
2002).

15. Age
Gender
Culture
(Meaningof
pain)
Anxiety
Copingstyle
Family andsocial
support

16. NURSING PROCESS
Scenario
• 60 year old patient is having pain on 5 day after the
surgical procedure of open laparotomy. She was shooting
aloud as the pain was untolerable. Upon assessment her
pain scale was 8/10. her vital sign were RR= 25, P=110, BP
= 155/90. her facial expression reveals too much pain.
After administration of pain medication the nurse advise
family member to provide the back massage and some
other intervention to minimize the pain sensation.

17. ResponsestoPain
• PHYSIOLOGICALRESPONSES/ OBJECTIVEDA
T
A
 IncreaseinBP
 Increaseheart rate
 Increaserespiratory rate

18. BEHA
VIORALRESPONSES/ OBJECTIVEDA
T
A
V
erbal response
V
ocalization: moaning, groaning, grunting, sighing,
grasping, crying, screaming
Verbalization: praying, counting, swearingorcursing,
repeating nonsensical phrases
NonV
erbal response
Facial expression
Bodyaction
Behaviors

19. PAINRESPONSES
Sympathetic Responses Parasympathetic Responses
Increases pulse rate Decreased pulse rate
Increased systolic blood pressure Decreased systolic blood pressure;
syncope
Increased respiratory rate Variable breathing pattern
Diaphoresis Nausea/ Vomiting
Increased muscle tension Warm, dry skin
Pallor Prostration
Pupil dilation Pupil constriction
Rapid speech/ elevated pitch Slow, monotonous speech
Increased alertness Less alertness

20. SubjectiveData
Normalpatternidentification
1. Where isthepainlocated?
2. Whatis themagnitudeorintensity (level) of thepain?
3. What level of painwouldtheclient bewillingtotolerate?
4. Howdoesthepainfeel totheclient;
5. Howdoeshedescribe( itsquality)?
6. Howdoesthepainchangeswithrest activity
, or time?
Pain Assessment

21. Cont.
ObjectiveData
• Physical assessment
 V/s
 Associatedcharacteristics
Nausea, vomiting,fatigue, anorexia
 Physical expressionof pain
• Diagnostictest andprocedures

22. Nursing diagnosis
• Alteration in comfort i-e acute / chronic pain
related to the surgical procedure as evidences by
……

23. Planning
• Patient pain will be reduce by 2 degree by the end
of shift
• Patient vital sign will be normal after receiving
the back message.

25. Pain Relive Techniques
• Physical painrelief techniques
 Positioningandhygiene
 CutaneousStimulation
 Pressure
 Massage
 Vibration
 Hot&Coldfomentation
 Contralateral stimulation
 TranscutaneousElectrical NerveStimulation

26. Pain Relive Techniques
Contralateral stimulation:
Cross-lateral movements that enhance right and left-brain
integration thus improving mood, learning, problem solving, and
performance in persons of all ages.
These Contralateral movements have been shown to help
individuals with attention deficit disorder (ADD), attention
deficit/hyperactivity disorder (ADHD), learning disorders, and mood
disorders

27. Cognitive Painrelief techniques
1. AnticipatoryGuidance
2. Distraction
3. Guidedimagery
4. Hypnosis

30. Behavioral painrelief techniques
1. Relaxation
2. Meditation
3. Biofeedback
Theclientlearnvoluntarycontroloverautonomicfunctionsuch
asHeartrate, handtemperatureandmuscletension.
Electrodesareplacesontheclientsbody, andauditory and
visual feedback(I.e., light, sounds, digital orgraphicreading)
providestheclientswithinformationabout musclesrelaxation.
H.R.B.P
.&temperature.Afterbaseline datais obtain the
client learns relaxationanddeepbreathingexercise

31. Pharmacological management
• NonopioidAnalgesics
Aspirin , NonsteroidalAniti inflammatory Drugs(ANSIDs)
&Acetaminophen
•OpioidsAnalgesic
Morphine, pathedine
• Epidural analgesia

32. EVALUATION
• Pain is reduce and now the pain scale is 4
• Patient facial expression are relax and patient feel
comfortable
• Patient vital sign are within normal range and
(Write it down)

33. Nursing process and Pain
Subjective data includes
COLDERR
• Character
• Onset
• Location
• Duration
• Exacerbation
• Radiation
• Relief
• Associated

34. Common Myths about Pain.
• Pain is always result of one’s evil doing.
• The caregiver is the best judge of pain.
•A person with pain will always have
obvious signs such as moaning, abnormal
vital signs, or not eating.
• Pain is a normal part of aging.
• Anxiety always makes pain worse.