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📖 Fundamentals Chapter 44 – Pain Management

🧬 Scientific Knowledge Base

Nature & Physiology of Pain

  • Phases of pain:
    • Transduction → painful stimulus converts to electrical impulse.
    • Transmission → signal travels to spinal cord & brain.
    • Perception → conscious awareness of pain.
    • Modulation → body releases endorphins & neurotransmitters to inhibit pain.

Gate-Control Theory of Pain

  • Pain perception can be modified by closing/opening “gates” in the nervous system.
  • Influenced by:
    • Physiological responses (autonomic signs like ↑HR, sweating).
    • Behavioral responses (grimacing, guarding, moaning).

Types of Pain

  • Acute/transient pain → protective, short-term.
  • Chronic/persistent noncancer pain → lasts >6 months, not protective.
  • Chronic episodic pain → occurs sporadically (e.g., migraines).
  • Cancer pain → can be acute, chronic, or both.
  • Idiopathic pain → pain without known cause.

🧠 Nursing Knowledge Base

Knowledge, Attitudes, Beliefs

  • Pain is subjective → patient’s report = gold standard.

Factors Influencing Pain

  • Physiological: age, fatigue, genetics, neurological status.
  • Social: prior experiences, family support, spiritual beliefs.
  • Psychological: attention, anxiety/fear, coping style.
  • Cultural: expression of pain varies by norms/expectations.

Impact of Pain

  • Quality of life
  • Self-care & ADLs
  • Work/school participation
  • Social support

🧠 Psychological Factors Influencing Pain

🔹 Attention

  • The more attention a patient gives to pain, the more intense it feels.
  • Distraction techniques (music, guided imagery, conversation) can reduce perception of pain.

🔹 Anxiety & Fear

  • Pain often causes anxiety, and anxiety can make pain feel worse → creates a cycle.
  • Fear of the cause of pain (e.g., “Is this cancer?”) may intensify the experience.
  • Addressing emotional distress is key in pain management.

🔹 Coping Style

  • Internal locus of control (patients believe they can influence their pain) → often cope better.
  • Passive coping (feeling helpless) → tends to worsen pain outcomes.
  • Teaching patients active coping strategies (relaxation, self-talk, pacing activities) improves pain tolerance.
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📌 Quick Example

👉 Two patients with the same injury:

  • One focuses on the pain and fears the worst → higher pain rating.
  • The other distracts themselves and uses relaxation → reports lower pain rating.

🔍 Critical Thinking in Pain Management

  • Anticipate pain → Nurses should predict the likelihood and intensity of pain based on the patient’s clinical condition.
    • Example: Post-op abdominal surgery → anticipate moderate–severe pain, especially with movement.
  • Dynamic process → A patient’s condition is always changing; pain must be reassessed frequently.

🧾 Nursing Process

Assessment

  • Through patient’s eyes → pain is what the patient says it is.
  • Consider environment, stressors.
  • Physical examination
  • Characteristics of pain (PQRST + scales):
    • Timing (onset, duration)
    • Location
    • Severity (0–10 scale)
    • Quality (sharp, dull, throbbing, burning, etc.)
    • Aggravating/relieving factors
    • Associated symptoms
  • Effects on patient: behavior, ADLs, sleep, mobility.
  • Concomitant symptoms: nausea, dizziness, depression.

Nursing Diagnoses (examples)

  • Difficulty coping with pain
  • Inadequate pain control
  • Fatigue
  • Impaired mobility
  • Impaired sleep
  • Social isolation

Planning

  • Set priorities.
  • Identify measurable outcomes.
  • Collaborate with interdisciplinary team.

🛠 Implementation

Health Promotion

  • Maintaining wellness.
  • Nonpharmacological interventions:
    • Relaxation & guided imagery
    • Distraction
    • Music therapy
    • Cutaneous stimulation (massage)
    • Herbals
    • Cognitive-behavioral strategies

Acute Care: Pharmacological

  • Analgesics:
    • Nonopioids (acetaminophen, NSAIDs)
    • Opioids (morphine, hydromorphone)
    • Multimodal analgesia (combination therapies)
    • Adjuvants (antidepressants, anticonvulsants)
  • Other methods:
    • Patient-controlled analgesia (PCA)
    • Topical & transdermal patches
    • Local anesthesia injections
    • Perineural infusions
    • Epidural analgesia
  • Nursing implications: monitor for oversedation, respiratory depression, constipation, nausea.
  • Invasive interventions: nerve blocks, spinal analgesia.
  • Cancer & chronic pain management: breakthrough pain treatment, palliative approaches.

Barriers to Pain Management

  • Fear of addiction or side effects.
  • Lack of provider knowledge.
  • Cultural/communication barriers.
  • Placebos (ethically not recommended).

Restorative & Continuing Care

  • Pain clinics.
  • Palliative care.
  • Hospice care.
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📊 Evaluation

  • Always evaluate through the patient’s eyes.
  • Assess outcomes: improved comfort, function, quality of life.

⚠️ Safety Guidelines

  • Only the patient should press the PCA button.
  • Monitor for oversedation & respiratory depression.
  • Watch for opioid side effects (constipation, nausea, sedation, itching).
⚠️ Attention

These notes focus on tested essentials (pain physiology, types, assessment, interventions). Not all details from the slides are included.