... Acute Pain in the High-Acuity...
...multidimensional nature of pain. 2. Discuss issues...
...under treatment of pain. 3. Describe potential...
...and effects of pain. 4. Assess acute...
...4. Assess acute pain in the high-acuity...
...effective management of pain for the high-acuity...
...considerations associated with pain management in special...
...Multifaceted Nature of Pain A. A working...
...definition of acute pain 1. The International...
...the Study of Pain (IASP) defines pain...
...Pain (IASP) defines pain as “An unpleasant...
...Differentiating nociception and pain. a) Nociception (1)...
...or injury b) Pain (1) Involves psychosocial...
...to injury (2) Pain is a subjective...
...Patient’s report of pain must be believed....
...be believed. (5) Pain is real to...
...3. Defining acute pain (1) Acute pain...
...pain (1) Acute pain continually changing and...
...multifaceted model of pain 1. The multifaceted...
...multifaceted conceptualization of pain is based on...
...overlapping spheres: nociception, pain, suffering, and pain...
...pain, suffering, and pain behaviors 2. The...
...activation of special pain sensory receptors called...
...called nociceptors. Noxious (pain causing) stimuli that...
...b) Transmission (1) Pain transmission refers to...
...conduction of the pain impulse through the...
...are myelinated, conducting pain impulses rapidly along...
...causing sharp, pinprick-like pain to be conducted....
...person reacts to pain. (i) Periventricular and...
...magnus nucleus (iii) Pain inhibitory complex (3)...
...decrease the patient’s pain threshold, causing a...
...the duration of pain. (b) Central sensitization...
...to modulate (altering) pain transmission in response...
...events, such as pain and stress. (2)...
...opioid peptides) modulate pain transmission: (a) Enkephalins...
...(d) Perception (3) Pain perception refers to...
...experience surrounding the pain. 3. The second...
...The second facet: Pain a) Pain impulses...
...facet: Pain a) Pain impulses are transmitted...
...tract (1) Delta pain fibers primarily transmit...
...thermal and mechanical pain. (2) Pain impulses...
...mechanical pain. (2) Pain impulses travel along...
...c) Person perceives pain only when (1)...
...ability to perceive pain remains intact: (1)...
...meaning of the pain. c) Clinician’s assessment...
...restricted to observing pain behaviors. d) Suffering...
...associated with chronic pain. 5. The fourth...
...The fourth facet: Pain behaviors a) Pain-expressing...
...Pain behaviors a) Pain-expressing behaviors (1) Those...
...intended to communicate pain b) Pain-controlling behaviors...
...communicate pain b) Pain-controlling behaviors (1) Those...
...or control the pain PowerPoint Slides 1....
...the Study of Pain (IASP) defines pain...
...Pain (IASP) defines pain as “an unpleasant...
...Differentiating nociception and pain Nociception Physiological response...
...damage or injury Pain Involves psychosocial as...
...Patient’s report of pain must be believed....
...Modulation Perception 4. Pain conduction Impulses are...
...rapidly (sharp, pinprick-like pain) C fibers: Slow...
...person’s reaction to pain. Periventricular and periaqueductal...
...Raphe magnus nucleus Pain inhibitory complex 6....
...stimulation Persistent peripheral pain. Persistent central pain...
...pain. Persistent central pain can result in...
...Analgesic substances modulate pain transmission: Enkephalins Beta-endorphins...
...The Second Facet: Pain: impulses are transmitted...
...meaning of the pain Clinician’s assessment is...
...is restricted Chronic pain 10. The Fourth...
...The Fourth Facet: Pain behaviors Pain-expressing behaviors...
...Facet: Pain behaviors Pain-expressing behaviors Pain-controlling behaviors...
...behaviors Pain-expressing behaviors Pain-controlling behaviors II. Acute...
...behaviors II. Acute Pain in the High-Acuity...
...Potential sources of pain 1. Potential sources...
...Potential sources of pain a) Acute pain...
...pain a) Acute pain of the initial...
...back or arthritic pain B. Types of...
...Types of acute pain 1. Somatic pain...
...pain 1. Somatic pain a) Arises from...
...tendons 2. Visceral pain a) Arises from...
...viscera 3. Neuropathic pain a) Due to...
...of stress and pain on the body...
...Potential sources of pain Acute pain of...
...of pain Acute pain of the initial...
...major types of pain Somatic pain Visceral...
...of pain Somatic pain Visceral pain Neuropathic...
...Somatic pain Visceral pain Neuropathic pain 3....
...Visceral pain Neuropathic pain 3. Factors that...
...that can increase pain Anxiety that can...
...can accompany acute pain Stress associated with...
...stimulus. Initial acute pain Prolonged pain 6....
...acute pain Prolonged pain 6. Immobility can...
...thrombosis (DVT) III. Pain Assessment A. Pain...
...Pain Assessment A. Pain history 1. Pain...
...Pain history 1. Pain history provides valuable...
...regarding: a) Preexisting pain experiences. b) Treatment...
...history. d) Usual pain behaviors. e) Usual...
...behaviors. e) Usual pain relief methods used...
...Unidimensional and multidimensional pain assessment 1. Unidimensional...
...assessment 1. Unidimensional Pain Assessment tools rate...
...rate a single pain dimension (e.g., intensity),...
...Effective measurement of pain intensity. (2) Line:...
...end labeled “no pain,” opposite end labeled...
...end labeled “worst pain Imaginable.” (3) Patient...
...the level of pain along this line...
...0 = “no pain” and 10 =...
...10 = “worst pain imaginable.” c) Verbal...
...any of the pain dimensions (2) Useful...
...to rate their pain using numeric rating...
...best describes the pain: (a) E.g., sensory...
...current level of pain 2. Adapting the...
...Adapting the Unidimensional Pain Assessment Tool for...
...the level of pain: (1) 0 fingers...
...fingers = “no pain,” 10 fingers =...
...fingers = “worst pain imaginable.” 3. Multidimensional...
...imaginable.” 3. Multidimensional Pain Assessment provides the...
...aspects of the pain experience. a) Most...
...sensory and affective pain. b) Measures four...
...four aspects of pain experience: sensory, affective,...
...miscellaneous. c) Each pain category is measured...
...which category the pain is originating C....
...C. Assessment of pain in the adult...
...status 1. Assessing pain in adults with...
...a) Use alternative pain assessment tools for...
...unable to self-report pain level. b) Patients...
...does not preclude pain. (1) Patients with...
...Patients with chronic pain adapt to the...
...patient’s self-report of pain. b) Nurses’ attitudes...
...the assessment of pain. c) This is...
...misinterpreted. 3. Behavioral pain scales use patient...
...the presence of pain. a) Vocal: crying,...
...tapping 4. Acute pain is associated with...
...assessing short-term acute pain b) Loses validity...
...PowerPoint Slides 1. Pain history provides valuable...
...information regarding: Preexisting pain experiences. Treatment modalities....
...Medication history. Usual pain behaviors. Usual pain...
...pain behaviors. Usual pain relief methods used...
...home. 2. Unidimensional pain assessment tools Patient...
...rates a single pain dimension (e.g., intensity)...
...aspects of the pain experience. Work best...
...with more complex pain (e.g., unknown origin,...
...Effective measurement of pain intensity. Line: one...
...end labeled “no pain,” opposite end “worst...
...opposite end “worst pain imaginable.” Patient self-reports...
...the level of pain along this line....
...any of the pain dimensions. Useful for...
...to rate their pain using numeric rating...
...best describes the pain. Potential disadvantages. 7....
...current level of pain 8. Adapt the...
...the level of pain. 9. McGill Pain...
...pain. 9. McGill Pain Questionnaire (MPQ) Most...
...sensory and affective pain. Measures four aspects...
...four aspects of pain experience. Each pain...
...pain experience. Each pain category is measured...
...which category the pain is originating. 10....
...originating. 10. Assessing pain in adults with...
...status Use alternative pain assessment tools for...
...unable to self-report pain level. Patients rely...
...does not preclude pain. 11. Behavioral pain...
...pain. 11. Behavioral pain scales use patient...
...the presence of pain. Vocal: crying, moaning,...
...tapping 12. Acute pain is associated with...
...assessing short-term acute pain. Use of the...
...Management of Acute Pain A. Pharmacologic pain...
...Pain A. Pharmacologic pain management 1. The...
...approach to effective pain management b) Suggests...
...b) Suggests general pain management choices based...
...the level of pain: (1) Mild, mild-to-moderate,...
...choices 2. Pharmacologic pain management modulates pain...
...pain management modulates pain transmission at different...
...NSAIDs can relieve pain by working peripherally...
...Nonopioid therapy a) Pain management can be...
...certain types of pain: (1) Indirect assistance...
...Corticosteroids for cancer-related pain. (b) Antidepressants or...
...treatment of neuropathic pain. 5. Opioid therapy...
...balanced approach to pain treatment. b) Targets...
...b) Targets multiple pain-signaling pathways, matching treatment...
...to type of pain. c) Preemptive pain...
...pain. c) Preemptive pain treatment is treatment...
...path transmitting the pain is located) (1)...
...the point of pain origin. (2) Duration...
...nonpharmacologic interventions to pain. PowerPoint Slides 1....
...the level of pain Provides step-by-step approach...
...approach 2. Modulating pain—pharmacologic pain management Opioids...
...2. Modulating pain—pharmacologic pain management Opioids bind...
...peripherally. 3. Combination therapy—pain management enhanced by...
...assist in reducing pain Indirect assistance (decrease...
...analgesia) Targets multiple pain-signaling pathways Preemptive pain...
...pain-signaling pathways Preemptive pain treatment initiated prior...
...to point of pain origin. Duration depends...
...Treatment of Acute Pain A. Undertreatment of...
...A. Undertreatment of pain 1. Undertreatment problem...
...Inadequate attention to pain education in many...
...risk for chronic pain (4) Needless suffering...
...Results from inadequate pain management, not psychological...
...Dependence. (2) Undertreated pain behaviors frequently are...
...different or more pain medications that escalates...
...Preoccupation with obtaining pain medications (d) Anger...
...aberrant behaviors when pain is relieved. C....
...opioid undertreatment of pain 1. Oligoanalgesia—practice of...
...Oligoanalgesia—practice of treating pain with minimal drug...
...b) Nurses undertreat pain. (1) Administering less...
...own undertreatment of pain. (1) Not requesting...
...requesting as-needed (PRN) pain medications (2) Taking...
...of undertreatment of pain. b) Opiophobia: fear...
...approach in acute pain management 1. Preventive...
...patient complains of pain. b) Maintain a...
...of undertreatment of pain. 2. Titration approach...
...desired level of pain relief with minimum...
...1. Undertreatment of pain—a persistent challenge Multifactorial...
...Inadequate attention to pain education Consequences 2....
...Results from inadequate pain management, not psychological...
...psychological dependence. Undertreated pain behaviors are frequently...
...aberrant behaviors when pain is relieved. 4....
...Oligoanalgesia—practice of treating pain with minimal drug...
...opioids. Nurses undertreat pain. Patients contribute to...
...own undertreatment of pain. 5. Fear of...
...of undertreatment of pain. Opiophobia. Very few...
...response. 9. Effective pain management—preventive approach Analgesics...
...are administered before pain. Maintain a consistent...
...of undertreatment of pain. 10. Effective pain...
...pain. 10. Effective pain management—titration approach Adjusting...
...having. Goal: Gain pain relief with minimum...
...be in extreme pain. c) The exact...
...sedative use VII. Pain Management in Special...
...factors influence acute pain management: a) Age...
...with superimposed acute pain 1. Management of...
...with superimposed acute pain. a) Long-term opioid...
...therapy for chronic pain can result in...
...incidence of acute pain. d) The continuous...
...effects of chronic pain on the CNS...
...Characterized by increasing pain despite repeated upward...
...only makes the pain worse. d) Treatment...
...ethical code a) Pain management of an...
...challenge. b) Treating pain in this population...
...harm”). c) Should pain be treated using...
...the fields of pain and addiction answer...
...the right to pain relief. e) Relief...
...e) Relief of pain temporarily overrides the...
...differentiate drug-seeking from pain relief–seeking behaviors. (1)...
...relief–seeking behaviors. (1) Pain relief–seeking and drug-seeking...
...behaviors cease when pain relief is achieved....
...in behavior during pain relief interventions closely....
...for Patients with Pain (SOAPP) E. Major...
...Major considerations in pain management  1. Clinical...
...to treat chronic pain g) Use a...
...opiates for breakthrough pain. d) Avoid naloxone...
...factors influence acute pain management: Age Concurrent...
...with superimposed acute pain. Long-term opioid therapy...
...therapy for chronic pain can result in...
...incidence of acute pain. The continuous dose...
...titrated upward. 7. Pain management of an...
...a challenge. Treating pain in this population...
...ethical dilemma. Should pain be treated using...
...the right to pain relief. Relief of...
...relief. Relief of pain temporarily overrides the...
...differentiate drug-seeking from pain relief–seeking behaviors. Pain...
...pain relief–seeking behaviors. Pain relief–seeking and drug-seeking...
...behaviors cease when pain relief is achieved....
...in behavior during pain relief interventions. 9....
...for Patients with Pain (SOAPP) 10. Clinical...
...to treat chronic pain Use a multimodal...
...opiates for breakthrough pain. Avoid naloxone. Administer...
...signs. c) Assess pain, wounds, nausea, vomiting,...
...might not control pain. a) Often a...
...patient’s level of pain should be assessed...
...using a behavioral pain rating scale. d)...
...vital signs. Assess pain, wounds, nausea/vomiting, intake/output,...
...Fentanyl Midazolam 9. Pain medication is also...
...might not control pain. Often a combination...
...Patient’s level of pain should be assessed....
...the undertreatment of pain, other than what...
...the undertreatment of pain—and who they believed...
...their definition of pain and then of...
...and then of pain management. Ask for...
...who regularly treats pain. Ask about the...
...etc. Obtain the pain management policies for...