Pain Management◦Effective pain management includes the use of pharmacological and nonpharmacological pain management therapies. ◦Clients have a right to adequate assessment and management of pain. Nurses are accountable for the assessment of pain. Professional organizations and The Joint Commission have mandates requiring pain assessment and management. The nurse’s role is that of an advocate, member of the health care team, and educator for effective pain management.◦Nurses have a priority responsibility for the continual assessment of the client’s pain level and to provide individualized interventions. They should assess the effectiveness of the interventions 30 to 60 min after implementation◦Assessment challenges can occur with clients who are cognitively impaired, critically ill, or on a ventilator.
PHYSIOLOGY◦Transduction is the conversion of painful stimuli to an electrical impulse through peripheral nerve fibers (nociceptors). ◦Transmission occurs as the electrical impulse travels along the nerve fibers, where neurotransmitters regulate it. ◦Perception or awareness of pain occurs in various areas of the brain, with influences from thought and emotional processes ◦Modulation occurs in the spinal cord, causing muscles to contract reflexively, moving the body away from painful stimuli. ◦The pain threshold is the point at which a person feels pain. ◦Pain tolerance is the amount of pain a person is willing to bear.
Pain Management◦Substances that increase pain transmission and cause an inflammatory response include substance P, prostaglandins, bradykinin, and histamine. ◦Substances that decrease pain transmission and produce analgesia include serotonin and endorphins
ASSESSMENT◦Pain is whatever the person experiencing it says it is, and it exists whenever the person says it does. The client’s report of pain is the most reliable diagnostic measure of pain. Self-report using standardized pain scales is useful for clients over the age of 7 years. Specialized pain scales are available for use with younger children◦Assess and document pain (the fifth vital sign) according to the client’s condition and agency guidelines. Pain is categorized by duration (acute or chronic) or by origin (nociceptive or neuropathic)◦Use a focused assessment to obtain subjective data
Pain CategoriesAcute painAcute pain is protective, temporary, usually self‑limiting, and resolves with tissue healing. Physiological responses (sympathetic nervous system) are fight‑or‑flight responses (tachycardia, hypertension, anxiety, diaphoresis, muscle tension). Behavioral responses include grimacing, moaning, flinching, and guarding. The nurse should be aware that a client not exhibiting physiological or behavioral responses does not mean that pain is absent. Interventions include treatment of the underlying problem.
Chronic painChronic pain is not protective. It is ongoing or recurs frequently, lasting longer than 3 months and persisting beyond tissue healing. Physiological responses do not