Pain Management
INTRODUCTION
Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (Merskey 1994, IASP).
Acute pain is of recent onset and could be due to illness, injury or surgical procedures. If it persists beyond the time of healing, then it is termed as Chronic pain.
Physiological pain includes nociceptive or inflammatory pain; Pathological or mal-adaptive pain includes neuropathic pain. This classification could help in mechanism-based management of pain though both pains usually exist together in some proportion.
In critically ill surgical patients, pain can be complex and needs integrated multidisciplinary approach. Proper
…show more content…
Various neuropeptides modulate the transmission of these signals in the spinal cord. Ascending spinal pathways project to the sensory cortex, while some of these pathways also tract to medulla and midbrain linked with homeostatic and autonomic responses as well as the emotional component of the pain. Descending projections inhibit the noxious control and modulate the pain response.
NEUROPLASTICITY OF PAIN
Rather than the pain pathways, pain specialists now talk about pain neuromatrix. Neuromatrix is a complex system formed due to pain memory, behaviour, cognition, environmental and genetic factors. This is a continuously evolving system based on the past and present events; both the input and output of this complex neuromatrix undergoes continuous plasticity.
WHY SHOULD ACUTE PAIN BE TREATED?
Pain causes sympathetic stimulation and increased heart rate, causes vasoconstriction and increased oxygen demand. It can impair lung function, cause myocardial ischaemia and reduce blood flow to other vital organs. Major laparotomies and thoracic surgeries reduce the functional residual capacity of lung and impair the coughing ability, predisposing to chest infections. Lack of diaphragmatic movements lead to atelectasis and pneumonia. Pain restricts mobility and increases chances of deep vein thrombosis.
Acute pain
acute pain-a protective mechanism that alerts the individual to a condition or experiece that is immediately harmful
The perception of pain and the emotions that control intensity differ in individuals. Since feeling pain is somewhat adaptive, when one experiences it, he or she becomes aware of an injury and tries to remove oneself from the source that caused the injury. For this reason, pain is considered neuropathic or inflammatory in nature. Thus, when pain is the outcome from the damage caused to the neurons of the peripheral and central nervous system, then that pain is neuropathic. However, if the pain signals any kind of tissue damage, then the pain is inflammatory in nature. Due to various types of pain, the interpretation of pain by neurons and the source of that pain
Pain can be categorized as acute or chronic pain. Chronic pain is described as pain that is both long-term and continuous, or is pain that persists after the expected healing time following an injury (British Pain Society, n.d.) Acute pain can provide a warning signal that an illness or injury has occurred. It is defined as pain that lasts less than three months and lessens with healing (Briggs, 2010). Acute pain can then be described in more detail by the following categories; somatic, visceral and neuropathic pain. Somatic pain is a localized pain described as sharp, burning, dull, aching or cramping. It is seen with incisional pain and orthopedic injuries or procedures. Visceral pain refers to an injury to the organs and linings of the body cavities. It produces diffuse pain and can be described as splitting, sharp or stabbing. This is pain that be described from patients with appendicitis, pancreatitis or intestinal injuries and illnesses. Injuries to the nerve fibers, spinal cord and central nervous system cause neuropathic pain. This pain can be described as shooting, burning, fiery, sharp, and as a painful numbness. This can be seen after an
Pain can be acute or chronic. Acute pain is intense, short in duration and generally a reaction to trauma. Chronic pain does not go away, and can range from a dull ache to excruciating agony. Terminal and non-terminal illnesses can both be causes of chronic pain. Tissue damage is not always found in chronic pain, but those who suffer from it are rendered "nonfunctional by incapacitating pain," (Murphy, 1981).
First pain is an everyday experiences that is expressed through the use of language and is then legitimized (Waddie, 1996). If a patient as a history of depression or chronic pain they have pain every day and the concept is used to help explain their pain. As nurse we use the concept of pain to find a base line of the pain and to assess new pain. In surgical patients they may have multiple types of pain from the incision, emotional, and history. The concept educates the nurse of the different form that pain can present itself. Pain can also guide how we treat the patient. Emotional pain would not be treated with the “so know pain pills”, but with talking or listening to patient. Concept of pain also address the different form of patient and how the nurse and patient response to it. If a patient is having somatic pain from an incision the nurse could react by applying heat or ice. Pain is what the patient says it is.
“Pain is much more than a physical sensation caused by a specific stimulus. An individual's perception of pain has important affective (emotional), cognitive, behavioral, and sensory components that are shaped by past experience, culture, and situational factors. The nature of the stimulus for pain can be physical, psychological, or a combination of both.” (Potter, Perry, Stockert, Hall, & Peterson, 2014 p. 141) As stated by Potter et al, the different natures of pain are dealt with differently depending on many factors. Knowing this, treating pain can be very difficult as there is no single or clear cut way of measuring it; “Even though the assessment and treatment of pain is a universally important health care issue,
Average pain is processed by nociceptors via two sets of neural pathways. The ascending neural pathway is activated by painful stimuli like extreme temperature, pressure, and impact. The ascending pathway sends nociceptive signals to send neurotransmitters
This essay will aim to look at the main principles of cancer pain management on an acute medical ward in a hospital setting. My rational for choosing to look at this is to expend my knowledge of the chosen area. Within this pieces of work I will look to include physiological, psychological and sociological aspects of pain management.
The major concepts of this theory are defined theoretically since the use of these definitions is from a broader theoretic concept. Therefore, an operational concept could be developed from them. There is consistency in the use of these concepts throughout the theory of acute pain management with examples given using the same language as well as maintaining the integrity of the concepts.
‘Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage’ (International association for the study of pain 2014). Pain can be made up of complex and subjective experiences. The experience of pain is highly personal and private, and can not be directly observed or measured from one person to the next (Mac Lellan 2006). According to the agency for health care policy and research 1992, an individuals self-report of pain is the most reliable indicator of its presence. This is also supported by Mc Caffery’s definition in 1972, when he said ‘Pain is whatever the experiencing patient says it is, existing whenever he says it does’.
In this brochure, we are going to talk about three different types of pain management that do not use medication to help with pain. This type of management is called Nonpharmacological. Nonpharmacological pain management gives you a different way to control pain. It helps you to think and
Chronic pain is a defined as a continuous pain response over a long period of time, of which
Pain is something that connects all of us. From birth to death we can identify with each other the idea and arguably the perception of it. We all know we experience it, but what is more important is how we all perceive it. It is known that there are people out there with a ‘high’ pain tolerance and there are also ones out there with a ‘low’ pain tolerance, but what is different between them? We also know that pain is an objective response to certain stimuli, there are neurons that sense and feel pain and there are nerve impulses that send these “painful” messages to the brain. What we don’t know is where the pain
The reception of pain in the peripheral nervous system to the perception of the same in the brain, and the corresponding generation of response behaviours, is achieved through several pathways. These different nociceptive pathways kick-off in a similar manner in which a pain signal coming from the skin, for instance, travels up a sensory nerve fibre made up of axons of the spinal ganglion. The axons then enter the spinal cord, upon which they immediately divide into the upward and downward segments of the spinal cord (Purves, 2012; Hughes, 2008).
Based on the duration of persistence, pain is often divided into two broad categories as mentioned below.