 Separate anatomically consistent pains

from multifocal pains

 Identify important psychosocial risk
factors
 Blend heuristic learning with
individualized pain assessment
• “An unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described in
terms of such damage.”
- IASP 1979
(international association for the
study of study of pain)
• “Pain is whatever the experiencing person says it is
and existing whenever the person says it does.”

- MARGO McCAFFERY
( NURSING PAIN PIONEER)

Protective reflex
• PAIN THRESHOLD
It is defined as the lowest intensity of a painful
stimulus that is perceived by a person as pain.

• TOLERANCE
It is defined as the amount of pain a person is
willing to endure.
HYPERALGESIA :
Increased sensation of pain in
response to a normally painful stimulus

ALLODYNIA :
Sensation of pain from a stimulus
that normally does not produce pain
• TRANSDUCTION
• TRANSMISSION
• PERCEPTION
• MODULATION
• AFFECT THEORY

• SPECIFICITY THEORY

• PATTERN THEORY

• GATE THEORY OF PAIN

• Pain assessment is 5th vital sign.

QUESTIONS TO BE ASKED TO PATIENT….

• Are u experiencing any discomfort right

now??????
• Do you have any complaints of pain???????
• Do you have any discomfort to report??????
 Acute pain
 Chronicpain
 Cutaneouspain
 Deepsomaticpain
 Visceralpain
 Referredpain
 Neuropathicpain
 Phantompain
Acute Pain: Pain lasting < 6
weeks
– A delta & C fibers
– Usually cause-effect

Chronic Pain: daily pain

lasting longer than 3 months
or past the time for normal
tissue healing
• Psychological history
• Opiate exposure?
• Cognition
• Context
• Individual differences
• Mood
Cognition:
• Attention
• Distraction
• Hypervigilance
• Catastrophising
Context
• Beliefs
• Placebo
• Motivation
INDIVIDUAL
DIFFERENCES
• Genetics
• Gender
Mood
• Depression
• Anxiety
• Emotional context
• Causation
• Prognosis
• 95% benign
• 90% last for < 6
weeks
• Recognize red flags
 Superficial pain: pain arising from skin and
mucous membranes.
 Deep (somatic) pain: pain originating from
somatic structures deep to the skin are known as
deep pain. (muscles, bones, tissues)
 Visceral pain: pain arising from different
internal organs or viscera
 Form of visceral pain.
 Felt in an area distant from the site of
stimulus.
 It occurs when nerve fibers serving an area
of the body distant from the site of the
stimulus pass in close proximity to the
stimulus.
1) Heart pain is
referred to
left arm.
2) Diaphragm
atic pain to
the tip of
the
shoulder
3) Gall
bladder
pain
referred to
epigastric
region.
• NEUROPATHIC PAIN
1. It is caused by damage/ injury to
nerve fibers (periphery/CNS ).
 Noxious electrical impulses are
generated at the site of the injury.
 Pain is felt as numbness,
burning, stabbing, needles,
and electric shock.
• BREAK THROUGH PAIN
 Transient increase in pain from moderate to severe which
occurs against background of persistent pain.

 It comes on suddenly for

short period of time.
Eg . in case of cancer patients
• PSYCHOGENIC PAIN
 Also called psychalgia or somatoform
pain.
 It is caused or increased or prolonged by mental,
emotional, or behavioral factors.
 Headache, back pain, and stomach pain are sometimes
diagnosed as psychogenic.
 SYMPATHETHETIC RESPONSES
• Pallor
• Increased blood pressure
• Increased pulse and respiration
• Skeletal muscle tension
• Dilated pupils
• Diaphoresis

 PARASYMPATHETIC RESPONSES
• Decreased blood pressure
• Decreased pulse
• Nausea , vomiting
• Weakness, pallor
• Loss of consciousness
 BEHAVIOURAL CHARACTERISTICS
• Assumes a posture that minimizes pain.
• Moans, sighs, grimaces, clenches jaws, or fist,
becomes quiet or withdraws from others.
• Blinks rapidly.
• Crying, appears frightened, exhibit restlessness.
• Has a drawn facial expression.
• Has twitching muscles
• Withdraws when touched
• Holds or protects affected areas or remains
motionless.
• Onset and duration
• Location
• Exacerbating or alleviating factors
• Quality
• Intensity
• DURATION
• RELIEF
• RADIATION
DESCRIPTIVE WORD HOW PAIN MAKES PERSONS FEEL

 Sharp  Horrible
 Piercing  Annoyed
 Shooting  Miserable
 Crushing  Frightened
 Tender  Suffocated
 Hurting  Tortured
 Aching  Overwhelmed
 Dull  Depressed
 Sore  Defeated
 Cramping  Anxious
 Prickly  Victimized
• Age
• State of consciousness
• Physical state ( fatigue, lack of sleep, prolonged
suffering).
• Emotional state (worry, fear, anxiety)
• Medication history
• Pain acceptance
• Pain anxiety
• Impact on patients daily activities or quality of life.
• Patients expectations and goals
• MULTIDIMENSIONAL ASSESSMENT TOOLS
eg. – McGill – Melzack pain questionnaire
- Initial pain assessment tool

• SINGLE ITEM ASSESSMENT TOOL

eg. - visual analog scale, descriptor scales (It measures
both physical and psychological distress)

• PICTORIAL SCALES
• PAIN DISTRESS SCALES
• PAIN INTENSITY SCALES
 More of a
puzzle than
a snapshot!
• ACUTE PAIN
• CHRONIC PAIN
PAIN MAY ETIOLOGY FOR OTHER NURSING DIAGNOSIS
LIKE…..
• INEFFECTIVE AIRWAY CLEARANCE
• HOPLESSNESS
• ANXIETY
• INEFFECTIVE COPING
• SELF CARE DEFICIENT
• DEFICIENT KNOWLEDGE
• IMPAIRED PHYSICAL MOBILITY
• INSOMNIA
Pain Behavior

Suffering

Pain

Nociception