MANAGEMENT PAIN

By :
Group 6

Dinna Lestari
Ghea Asmarandhana
Irfani Ikram
N. Wini Apriliyani
Tofan Mutaqin

JURUSAN D-III
KEPERAWATAN
POLTEKKES KEMENKES
BANDUNG
Dr. Otten Number 32 Street

RI

CHAPTER I
INTRODUCTION

1.1 Background
Pain management encompasses various types of pain experiences throughout an
individuals life cycle from birth to the end of life. Pain experiences may include acute and
chronic pain, painfrom a chronic deteriorating condition, or pain asone of many symptoms of
the patient receiving palliative care. Pain is not exclusively physiologi -cal but also includes
spiritual, emotional and psychosocialdimensions. The goal of pain management throughout
the life cycle is the same to address the dimensions of pain and to providemaximum pain
relief with minimal side effects.Review of the literature, anecdotal reports and dialogue with
colleagues reveals that the majority of patients do not receive adequate pain management. A
wide variety of factors including inaccurate information, myths, rumors, fear and
culturalissues contribute to inadequate pain management.For example, a prevailing rumor in
the nursing profession is that a nurse can lose his/her nursing license for causing a patients
respiratory depressionby frequent administration or by giving highdoses of opioids, even
though there is no documente devidence to substantiate this fear. The literature shows that
adequate assessment inconjunction with opioid titration based on patientresponse can provide
maximum pain relief without adversely affecting respiratory status. Therefore, it is
unwarranted to under-utilize or with hold opioids from a patient who is experiencing pain
based on fear of causing respiratory depression. Due to multiple advances in the field of pain
management (i.e. pain assessment, pharmacological and non-pharmacological interventions),
licensed nurses may have incomplete or inaccurate information about the following variables
which contribute to ineffective pain management:
1. What is pain and how do patients demonstrate their pain?
2. How is pain assessed and managed?
3. Is there a difference between psychological dependence, addictionand physical
dependence?
4. Does aggressive use of opioids causeaddiction?
5. How does the patients cultural background effect pain expression andmanagement?

Myths and misinformation also contribute to ineffective pain management. Some

common myths include:
1. Too much pain medication too frequently constitutes substance abuse, causes
addiction, will result in respiratory depression or will hasten death;
2. Pain should be treated, not prevented;
3. People in pain always report their pain to their health care provider;
4. People in pain demonstrate or show that they have pain - pain can be seen in the
patients behavior;
5. The level of pain is often exaggerated by the patient;
6. Generally a patient cannot be relieved of all pain;
7. Some pain is good so that the patients symptoms are not masked;
8. Newborn infants do not have pain; and,
9. It is expected that the elderly, especially the frail elderly, always have some pain.
So for reason above, Our group made a paper entitled Pain Management.
1.2 Purpose
The purpose my group to make this task is to explain about management pain in a general
1.
2.
3.
4.
5.
6.

and in particular about ;

To know definition of pain management
To know purpose of pain management
To know type of pain management
To know the benefits of pain management
To know advantages & disadvantages
To know about method demonstration management pain

1.3 Benefit
So that people in society understand about management pain in a general, knows to method
demonstration and can practice about that

CHAPTER II
2.1 Definition of Pain Management
Pain is an unpleasant sensory and emotional experience associated with actual or
potential tissue damage or described in terms of such damage. Pain is always subjective and

is whatever the person says it is, existing whenever the person says it does. The clinician
must accept the patients report of pain.
Management is the use of pharmacological and non-pharmacological interventions to
control the patients identified pain. Pain management extends beyond pain relief,
encompassing the patients quality of life, ability to work productively, to enjoy recreation, to
function normally in the family and society, and to die with dignity. Pain management
encompasses various types of pain experiences throughout an individuals life cycle from
birth to the end of life. Pain experiences may include acute and chronic pain, pain from a
chronic deteriorating condition, or pain as one of many symptoms of the patient receiving
palliative care. Pain is not exclusively physiological but also includes spiritual, emotional and
psychosocial dimensions.
Categories of pain include but are not limited to:
1. Acute Pain: A normal, predicated physiologic response to an adverse clinical, thermal or
mechanical stimulus. It is generally time-limited and responsive to opioid and non-opioid
therapy. Acute pain responses may vary between patients and between pain episodes
within an individual patient. Acute pain episodes may be present in patients with chronic
pain.
2. Chronic Pain: Malignant or nonmalignant pain that exists beyond its expected time frame
for healing or where healing may not have occurred. It is persistent pain that is not
amenable to routine pain control methods. Chronic pain is often present with no
physiologic signs, which may lull the clinician into falsely believing the patient is not in
pain. Chronic pain may result in a look of sadness, depression, or fatigue causing the
clinician to misinterpret the picture and not identify that the patient may also be
experiencing pain. Patients with chronic pain may have episodes of acute pain related to
treatment, procedures, disease progression or reoccurrence.

2.2 Purpose of Pain Management

The purpose of pain management through out the life cycle is the same to address
the dimensions of pain and to provide maximum pain relief with minimal side effects.
1. Relaxation techniques give people control them selves when there is discomfort or
pain, physical and emotional stress on pain. Relaxation techniques can be used when
the individual is in good health or illness. The relaxation techniques are necessary
precautions to help the body refreshed and regenerate every day and is an alternative
to alcohol, smoking, or overeating.
2. Skeletal muscle relaxation is believed to reduce pain by relaxing the muscles that
support keteganggan pain. Relaxation techniques may need to be taught a few times
in order to achieve optimal results. With the relaxation of patients could change the
perception of the pain.
3. Relaxation is an effective method, especially in patients with chronic pain. Breathing
exercises and relaxation techniques lowers oxygen consumption, respiratory rate,
heart rate, and muscle tension, which is to stop the cycle of pain-anxiety-tension
(McCaffery, 1989)
4. The technique of distraction is diversion of focus of attention to pain stimulus to
another. Distraction techniques can overcome the pain based on the theory that the
reticular activation inhibits pain stimulus. if someone receives sensory input overload
can cause delays of pain impulses to the brain (the pain is reduced or not perceived by
the client),. Pleasant stimulus from outside also can stimulate the secretion of
endorphins, so that a painful stimulus is perceived by clients to be reduced. Pain relief
is generally in direct contact with the active participation of individuals, many
sensory modalities used in the stimulation and individual interest, therefore,
stimulation of sight, sound and touch may be more effective in reducing pain than
stimulation of the senses alone (Tamsuri, 2007).
5. Guided Imagination is a relaxation technique that aims to reduce stress and increase
feelings of peace and quiet as well as a sedative for the difficult situation in life.
Guided imagery or mental imagery is a technique for assessing the power of mind
when consciously or unconsciously to create the image that brings tranquility and
stillness (National Safety Council, 2004). Asks the client to imagine imagining things
that are fun, this action requires a quiet atmosphere and rooms as well as a

concentration of clients. If the client is experiencing anxiety, the action must be

stopped. This action is done when the client feels comfortable and not in acute pain.
6. Massage is one of the non-pharmacological methods undertaken to reduce pain is
usually done to help childbirth. Under pain impulses by nerve that causes the small
diameter cord dispinal control gate open and impulses transmitted to the cerebral
cortex so that it will cause pain. But this pain impulses can be blocked is to provide
stimulus to the large diameter nerve that causes the control gate will be closed and no
pain stimuli can be passed on to the cerebral cortex. In principle nerve stimulation in
the form of a sweep in which a lot of large diameter on the skin should be done before
the beginning of the pain or the pain impulses carried by the small-diameter nerve
reaches the cerebral
2.3 Type of Pain Management
Nonpharmacological Interventions
Psychological and physical interventions can be seen as an adjunct to
pharmacological therapies. Nonpharmacological interventions may or may not be totally
effective on their own as an analgesic, but their use is frequently beneficial for the
patients.
Choice of nonpharmacologic intervention is determined by (1) the nature of each
case, (2) what works for a specific patient and (3) the skills of the clinician.
Nonpharmacologic interventions are relatively noninvasive, and may present less risk to
the patient than invasive or pharmacologic measures. They often are more time
consuming for the patient and the nurse, and they usually place the patient in a more
active role. A nurse needs to consult the individual institutional/agency policies and
procedures about implementation of nonpharmacologic interventions and the need for
physician's orders or the necessity to involve a more skilled practitioner.
Psychological Modalities
1. Distraction
Distraction can be useful by changing the patient's attention to stimuli other than
the pain sensation. It usually makes pain more bearable (i.e., reduces pain intensity),
though it does not eliminate the pain. Distraction topics need to be interesting to the
patient and consistent with the patient's energy level and ability to concentrate. The effect
of distraction can change with a change in the patient's pain. The presence of pain or the

return of pain at the end of the distraction technique is real and is an indicator only of
how effective the distraction was in interfering with the pain perception. Types of
distraction include watching TV, listening to music, engaging in imagery, and visiting
with friends and family; patients automatically engage in these activities to reduce pain.
2. Controlled breathing
Controlled breathing increases oxygenation and improves the elimination of
carbon dioxide. This is an extremely useful technique for patients in labor and when
transferring patients, for example, from bed to stretcher or from bed to chair.
3. Active listening
Active listening, as a nursing intervention, conveys support of the patient and trust
in the patient. It offers the patient reassurance and allows the patient the opportunity to
discuss other issues, which may be increasing the stress of hospitalization or illness, such
as financial concerns, childcare issues, or employment issues. Research indicates that
stress influences pain, so efforts to reduce stress may dramatically decrease pain.
4. Patient education
Patient education, depending upon the patient's anxiety level, may or may not be
beneficial for any given patient. Let the questions the patient asks guide the amount and
type of patient education. Patient education in pre- and postoperative care, procedural
events, and in discharge planning is beneficial when anxiety is reduced and pain,
therefore, lessens.
Reinforce or modify pain control behaviors by observing patients to see what they do to
reduce or control pain. Such observation may provide important information for tailoring
nursing interventions to a specific patient. Reinforce use of a given activity if it is
beneficial for the patient. Recommend modifications of the activity if it may be causing
additional problems. Patients often use techniques of rubbing, positioning, splinting, and
limping to decrease their pain or to limit the pain they may experience with a given
activity.
Relaxation strategies are indicated in the presence of muscle tension. Patients can be
trained to use relaxation strategies relatively easily. No special equipment is required and
the nurse does not need extensive training. There are different styles of relaxation
training, including progressive muscle relaxation, autogenic training, and biofeedback.
Relaxation can be as simple as a brief quieting response.
Consultants are resources for nurses as they consider nonpharmacologic interventions as
adjuncts treatments of pain. If necessary, there are many supportive services that can be

obtained through the use of social workers, psychologists, psychiatrists, massage

therapists, biofeedback therapists, therapeutic touch practitioners, music therapists, and
physical therapists.
Physical Modalities
Beds are often overlooked as a pain control strategy. Nurses often are in the position to
recommend use of different mattresses to physicians for improved patient comfort.
Mattress options include fluidized, air, and foam overlays. Bedding itself often can be
wrinkled or irritating. Pillows can be used to stabilize a joint, to prevent deformity, and to
help splint an incision for improved coughing effort. A pillow, brought from home, can
provide psychological comfort to some inpatients.
Massage can decrease muscle tension and can break the cycle of tension --> increased
pain --> increased tension. Massage may activate large diameter fibers, inhibit pain
messages carried by smaller fibers, increase endorphins, and cause decreased sensitivity
to pain. Massage produces variable and unpredictable results, but there is usually a
reduction in the intensity of pain during massage and for a short period after.
Unpredictable results may be associated with the presence of hyperalgesia (exaggerated
pain sensation) or allodynia (nonpainful stimulus perceived as painful, e.g., touch) and
may be contraindications for massage. Massage may change the character of the pain or
may change the pain to a more acceptable sensation. It can help bring about mental and
physical relaxation, and it strengthens the nurse-patient relationship. Massage can be
incorporated into routine nursing care: apply lotion, give a back rub, or give a neck rub.
More sophisticated massage techniques can be learned.
Heat application helps to reduce striated muscle spasm, relax smooth muscles, reduce
peristalsis, and reduce gastric acidity. It causes vasodilation resulting in increased blood
flow. Nurses can apply heat through the use of warm blankets, electric heating pads, or
moist hot packs, and by assisting the patient to shower or bathe.
Cold application can also reduce muscle spasm by reducing muscle spindle response. It
causes vasoconstriction resulting in reduction in bleeding and edema. It is felt to have a
longer lasting effect than application of heat. Cold can decrease inflammation and results
in increased peristalsis of the stomach, small bowel, and colon. Nurses can use ice packs,
ice cubes, and cool wash clothes to apply cold therapy to patients.

Positioning is another simple strategy for pain control. Simply assisting a patient to
change position in the bed or chair or while ambulating can improve comfort.
Additionally, appropriate body alignment and support of extremities can improve patient
comfort and outlook. Keeping items within reach also makes a patient more comfortable.
Ensuring that the over-bed table, the telephone, the nurse call button, and the PCA control
button are all within a patient's reach not only decreases repeat demands from the patient,
but also decreases patient anxiety.
Exercise programs have been shown to reduce fatigue. The value of exercise is becoming
known. Complete rest, even following orthopedic injuries, is no longer advocated
because of the potential for progressive shortening of muscle fibers, muscle atrophy, and
deterioration of bones and joints. Although exercise is most often the responsibility of a
physical therapist, nurses can assist their patients in active or passive range of motion and
encourage general conditioning and strengthening exercises. Some patients report an
improvement in comfort when joints are kept active.
1.4 The benefits of pain management
Pain management as it had earlier described the type has many benefits to be able to
cope with pain, among others:
1. Relaxation will reduce the anxiety associated with pain or stress.
2. Can reduce pain
3. Helping people to forget the pain by way of distraction
4. Increase the period of rest and sleep.
5. Improving the effectiveness of other pain therapies that such aid in
pharmacological pain management. Jadse
6. Reduces feelings of helplessness and depression arising from pain
7. speed healing and help the body reduce various illnesses such as depression,
allergies and asthma.

1.5 Advantages & Disadvantages

Advantages

Disadvantages

1. It can reduce pain and anxiety 1. The client must always be

without the use of drugs that can motivated to use self-management
cause side effects

strategies

2. Can reduce pain, inflammation,

or muscle spasm
3.

(self-management

strategies)
2. Requires special time to teach

Can be used or be used as interventions to clients

additional

therapy

(adjuvanty

teraphy) with other modalities of

therapy
4.

Can increase patient control of

pain

5.

The cost is not expensive, do not

require special tools and easy to
do

1.6 Demonstration
Initial step:
1) create the environment that is quiet, safe, and away from the noise
2) maintain privacy by closing curtains / doors and windows
3) preparation:
a. The position of the body reclining, leaning, or sitting
b. limp and relaxed body position
c. breathe normally and quiet
d. position the right hand over the chest and the left hand on the abdomen or
vice versa
e. Core activities:
f. breathe deeply and slowly through your nose and hold for 3-5 seconds, then
exhale slowly through your mouth (mouth position pout)
g. do 10 times
h. Repeat steps to step activities

CHAPTER III
CLOSING
3.1 Conclusion
So management pain is the use of pharmacological and non-pharmacological interventions to
control the patients identified pain. Pain management extends beyond pain relief, encompassing
the patients quality of life, ability to work productively, to enjoy recreation, to function normally
in the family and society, and to die with dignity. Purpose of Pain Management is control them
selves when there is discomfort or pain, physical and emotional stress on pain. Type of Pain
Management are Nonpharmacological and pharmacological Interventions. Some Advantages
pain management are It can reduce pain and anxiety without the use of drugs that can cause side
effects, Can reduce pain, inflammation, or muscle spasm and etc. and some Disadvantages pain
management are the client must always be motivated to use self-management strategies (selfmanagement strategies) and requires special time to teach interventions to clients .
3.2 Advice
So my group think this management pain is important because can decrease of patient pain and
this task just give little about management pain and we accept advice from other to make this
task more good