BY : SARIKA YADAV ASST.

LECTURER

DEFINITION
Is the unpleasant sensory and emotional experience resulting from actual or potential tissue damage. It is a subjective response to both physical and psychological stressors.

 An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

VALUES AND BELEIFS ABOUT PAIN

Pain can be experienced only by the person affected; that is, pain has a personal meaning. If the client says he/she has pain, the client is in pain. All pain is real. Pain has physical, emotional, cognitive, socio-cultural, and spiritual dimensions.

TYPES OF PAIN
NOCICEPTIVE NEUROPATHIC

Somatic
bones, joints connective tissues muscles

Visceral
Organs heart, liver, pancreas, gut, etc.

Deafferentation

Sympathetic Maintained

Peripheral

Somatic Pain
Aching, often constant May be dull or sharp Often worse with movement Well localized

Eg/ Bone & soft tissue chest wall

Visceral Pain
Constant or crampy Aching Poorly localized Referred

Eg/ CA pancreas Liver capsule distension Bowel obstruction

FEATURES OF NEUROPATHIC PAIN

COMPONENT
Steady, Dysesthetic

DESCRIPTORS
Burning, Tingling Constant, Aching Squeezing, Itching Allodynia Hypersthesia

EXAMPLES
Diabetic neuropathy Post-herpetic neuropathy

Paroxysmal, Neuralgic

Stabbing Shock-like, electric Shooting Lancinating

trigeminal neuralgia may be a component of any neuropathic pain

TYPES OF PAIN
ACUTE PAIN is usually temporary, has a sudden onset and is localized. It is the pain that lasts for less than 6 months and has an identified cause. It most often results from tissue injury, from trauma. It serves as a warning of actual or potential injury to tissues. It initiates the fight or flight autonomic stress response. Characteristic physical responses occur including tachycardia, rapid and shallow respirations, increased BP, dilated pupils, sweating and pallor

 Chronic pain prolonged usually recurring or persisting over 6 mnths or longer and interfere in functioning. Cancer pain result from the direct effects of the disease and its treatment ,or it may be unrelated to the disease.

PAIN ASSESSMENT
A complete history should include all aspects of the PQRST mnemonic.

Precipitating factors

Movement/spontaneous onset /stress/food intake, etc

Quality

Sharp/dull/diffuse/stabbing/pressing/ deep/surface, colicky, ill defined, etc

Note any radiation (left shoulder, neck, jaw, left arm, etc) Using the pain scale ask pain to rate pain. Associated symptoms (e.g. anorexia, nausea, SOB, hematochezia, hematuria, etc) Onset of pain/sudden or gradual/constant or intermittent/frequency

R S

Radiation Severity/signs & symptoms

Time/onset

Pain Assessment
P recipitating/Alleviating Factors:
What causes the pain? What aggravates it? Has medication or treatment worked in the past?

Q uality of Pain:
Ask the patient to describe the pain using words like sharp, dull, stabbing, burning

R adiation
Does pain exist in one location or radiate to other areas?

S everity
Have patient use a descriptive, numeric or visual scale to rate the severity of pain.

T iming
Is the pain constant or intermittent, when did it begin, and does it pulsate or have a rhythm

Physiology of pain
Transduction Transmission Modulation Perception

Gate control theory

According to Melzak and Walls gate control theory, small diameters (A-delta , or C) peripheral nerve fibres carry signals of noxious stimuli to the dorsa horn.

These signals are modified when they ae exposed to the substantia gelatinosa that may be imbalanced in an excitatory or inhibitory direction.

 Ion channels on pre and post synaptic membranes serve as gates that when open permit positive charged ions to rush in to second order neuron .

Sparking and electrical impulses and sending signals of pain ti the thalmus

 Peripheral large diameters (A-delta ) nerves fibres, which typically send messageof touch