Hepatic

1. CONCEPT OF PAIN
(DIFFERENT THERAPIES)
Ms. Sumaira Asim
Generic BSN

2. OBJECTIVES
• At the end of the session learners will be able to:
I. Define the process of pain (physiological changes)
II. Describe the different theories of pain theory.
III.differentiate between acute and chronic pain
IV.Discuss the non pharmacologic interventions pain
management.
V. identify pharmacologic interventions for pain
management

3. PAIN
 “Pain is an unpleasant and highly personal experience
that may be imperceptible to others, while consuming
all parts of an individual’s life”
 “an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or
described in terms of such damage”
 Pain management is the alleviation of pain or a
reduction in pain to a level of comfort that is
acceptable to the client.

4. PROCESS OF PAIN

5. DIFFERENT THEORIES OF PAIN
The foundation for pain management is built on multiple theories and
models. For example, theories in the 17th and 18th century suggested
the existence of specific pain pathways.
 In the 19th century, theories specifically outlined the anatomy and
physiology of pain, including receptors sensitive to pain.
 In 1965, Melzack and Wall developed the Gate Control Theory, which
expanded the physiologic models of pain and led to the development of
the psychosocial and behavioral theories that are part of current pain
management strategies. Nursing models for the delivery of pain
management continue to evolve (American Nurses Association [ANA]

6. GATE CONTROL THEORY

8. DIFFERENTIATE BETWEEN ACUTE AND
CHRONIC PAIN

9. NON PHARMACOLOGIC
INTERVENTIONS PAIN MANAGEMENT

10. CONTI……

12. PHARMACOLOGIC INTERVENTIONS
FOR PAIN MANAGEMENT
1. NONOPIOID ANALGESICS FOR MILD PAIN
2. OPIOID ANALGESICS FOR MODERATE PAIN
3. OPIOID ANALGESICS FOR SEVERE PAIN
4. ADJUVANTS

13. NON-OPIOIDS
Nonopioids include acetaminophen, aspirin and nonsteroidal anti-
inflammatory drugs (NSAIDs) such as ibuprofen. All are useful for
the management of acute and chronic pain. Acetaminophen (Tylenol)
does not affect platelet function and rarely causes GI distress. It does,
however, have serious side effects such as hepatotoxicity and possible
renal toxicity, especially with high doses or with long-term use.
Because acetaminophen is so well tolerated, it is often an ingredient in
OTC remedies (e.g., pain, fever, allergy, cough and cold preparations),
so clients must be instructed to read the ingredient list of all OTC
medicines they take.

14. CONTI……
Aspirin is the oldest nonopioid analgesic and is available
OTC. Because it can prolong bleeding time, clients should
stop taking it 1 week prior to any surgical procedure.
Aspirin should never be given to children under 12 years of
age due to the possibility of Reye’s syndrome
NSAIDs have anti-inflammatory, analgesic, and antipyretic
effects.

15. OPIOIDS
An opioid analgesic is a natural or synthetic morphinelike
substance responsible for reducing moderate to severe pain. In
addition to knowing the pharmacodynamics (how the medication
affects the body) of the various opioid analgesics, it is important
for the nurse to be aware of the potential side effects.
Opioid Analgesics for Moderate Pain These include drugs such as
codeine, hydrocodone, and tramadol. Most of these drugs are
combinations of a nonopioid with an opioid. These medicines are
generally 2 to 4 times more potent than nonopioids alone, and share
some of the risks of both drug classes

16. OPIOID SIDE EFFECTS
When administering any analgesic, the nurse must review adverse
effects. Adverse effects of the opioids typically include sedation,
respiratory depression, nausea, vomiting, constipation, urinary
retention, blurred vision, and sexual dysfunction.
The most concerning adverse effect of opioids is respiratory depression.

17. RANGE ORDERS
• Range orders are medication orders in which the selected dose varies over a
prescribed range according to the client’s situation and status. For example, a prn
range order for morphine 2 to 6 mg IV every 2 h for pain or for oxycodone 5 to 10
mg PO every 4 h prn for pain provides flexibility in dosing to meet individual client
analgesic needs.
• In addition, the Guidelines for Safe Electronic Communication of Medication
Information (Institute for Safe Medication Practices, 2019) states the following:
Do not allow single orders for medications with range doses, various frequencies, or
more than one route of administration. If orders for the same drug are prescribed at
different doses, frequencies, or routes, require separate orders for each that specify
objective measures to guide determination of which dose to administer at which
frequency and by which route. Examples of pain assessment measures that may be
used to guide determination of the dose, route, or frequency of medication include
severity, chronicity, quality of pain, and prior response to analgesics).

18. EQUIANALGESIC DOSING
The term equianalgesic refers to the relative potency of
various opioid analgesics compared to a standard dose of
parenteral morphine.
This tool helps professionals individualize the analgesic
regimen by guiding the adjustment of medication, dose,
time interval, and route of administration.
An equianalgesic table can be used to help provide doses of
approximately equal ability to relieve pain.

19. ADJUVANTS
 An adjuvant is a medication that is not classified as a pain medication.
However, adjuvants have properties that may reduce pain alone or in
combination with other analgesics, relieve other discomforts, potentiate the
effect of pain medications, or reduce the pain medication’s side effects.
 Examples of adjuvants that relieve pain are antidepressants (increase pain
relief, improve mood, and improve sleep), anticonvulsants (stabilize nerve
membranes, reducing excitability and spontaneous firing), and local anesthetics
(block the transmission of pain signals).

20. WORLD HEALTH ORGANIZATION
THREE-STEP ANALGESIC LADDER
• According to the World Health
Organization (WHO, n.d.) guideline
Cancer Pain Relief (2nd ed.), pain
treatment for cancer and noncancer
chronic pain should be prescribed in
three steps
• The WHO first developed the pain
ladder in 1986 and updated it in
1996 as a framework for the
management of cancer-related pain.
It is not an evidence-based guideline
(WHO, 2012).

21. ROUTES FOR OPIOID DELIVERY
 Opioids can be given in the
following routes: oral,
transnasal, transdermal,
transmucosal, rectal, topical,
subcutaneous, intramuscular,
IV (bolus and continuous),
and intraspinal (epidural and
intrathecal) and as
continuous local anesthetics.

22. ADMINISTRATION OF PLACEBOS
A placebo is “any sham medication or procedure designed
to be void of any known therapeutic value”.
An example would be a sugar pill or an injection of saline.
In contrast, the placebo effect is “the positive response
some patients/participants experience after receiving a
placebo”

23. PATIENT-CONTROLLED ANALGESIA
 Patient-controlled analgesia (PCA) is an
interactive method of pain management that
permits clients to treat their pain by self-
administering doses of analgesics. The IV
route is the most common in an acute care
setting. Its use for postoperative pain has
been well documented. It is also helpful
when oral pain management is not possible.
 PCA can be effectively used for clients with
acute pain related to a surgical incision,
traumatic injury, or labor and delivery, and
for chronic pain as with cancer.

24. NURSING GUIDLINES
 In the home setting, the nurse needs to inform the client’s support people to
monitor for signs and symptoms of oversedation such as excessive drowsiness,
slowed respiratory rate, or change in mental state. No one should adjust settings
without consulting the appropriate primary care provider.
 The caregiver should tape the following emergency contact numbers to the
back of the pump:
 emergency medical services, primary care provider, home care agency, and
pump manufacturer.

25. ORAL MEDICATION ON DEMAND
(MOD)
Oral medication on demand (MOD) is another electronic
delivery device that permits client-controlled access to oral
medications prescribed on a prn basis, within preset time
intervals.
The patient controlled oral analgesia device is placed on an
IV pole within easy reach of the client. It has functions
such as keypads allowing clients to input their pain
intensity rating before swiping a radio frequency
identification (RFID) wristband individual to each client.

27. PATIENT-CENTERED CARE: PAIN MANAGEMENT
NURSING GUIDLINES
At discharge or in the home setting, the nurse can provide
helpful information to the client and the caregiver about pain
management. Examples include teaching the client:
• To keep a pain diary to monitor pain onset, activity before
pain, pain intensity, use of analgesics, or other relief measures
and effectiveness of each measure.
• To contact a healthcare professional if planned pain control
measures are ineffective.
• To use preferred and selected nonpharmacologic techniques
such as relaxation, guided imagery, distraction, music therapy,
and massage.

28. CONTI……
• To use pain control measures before the pain becomes
severe.
• The effects of untreated pain.
• Appropriate information about how to access community
resources, home care agencies, and associations that offer
self-help groups and educational materials.