PAIN MANAGEMENT

Pain
A noxious stimulation of actual or
threatened / potential tissue damage

Categories of Pain according to Origin

Cutaneous
o Skin
Deep Somatic
o Tendons, ligaments
o Bones
o Blood Vessels
Visceral Pain
o Organs of the body

Categories of Pain based on Cause

Acute
o Due to trauma or surgery
o Persists for less than six (6)
months
Chronic Malignant Pain
o Related to cancer
o On and off
o Persists for more than six (6)
months
Chronic Non-malignant Pain
o Persists for more than six (6)
months

Categories of Pain according to Where It

o Felt on the source and is

extending to nearby tissues
Referred Pain
o Felt on other parts detached
from the source
o Example:
o Pain on a lacerated liver may
be felt on the right shoulder
and not on the right upper
quadrant
Intractable Pain
o Highly resistant to pain-relief
methods
Phantom Pain
o Pain that is felt on a
MISSING BODY PART or a
PART
THAT
IS
PARALYZED by SPINAL
CORD INJURY.

Pain Threshold
Amount of pain stimulation that is
required in order to feel pain

Pain Tolerance
Maximum amount of pain and
duration that a person is willing to
endure

Gate Control Theory

Concept!
This is the most widely used theory
in pain management

Is Experienced
Radiating Pain

Concepts!

The R.A Gapuz Review Center Inc. makes no representations about the accuracy, authenticity, and reliability of this compilation. It declaims any and all
responsibility or liability for plagiarism, copyright infringement and violation of related laws in connection with the contents of the materials. It had no
participation and compilation thereof such being sole responsibility of the reviewer concerned. This disclaimer serves as a notice to the public that R. A.
Gapuz Review Center Inc. shall not be liable for any complaints, actions or suits in connection with the contents of the materials of this compilation.

 At the dorsal horn of the spinal cord

is a gate.
This
gate
is
called
the
SUBSTANCIA GELATINOSA
A series of nerves pass through this
gate
Small diameter nerve fibers pass
through the substancia gelatinosa
o Pain signals are carried to the
spinal cord by the small
diameter nerve fibers
Large diameter nerve fibers also pass
through the substancia gelatinosa
o Large diameter nerve fibers
close the gate prevents the
transmission of impulses
through the spinal cord
o Therefore, when LARGE
DIAMETER
NERVE
FIBERS
ARE
STIMULATED, THE GATE
IS CLOSED
Pain management operates on the
principle of how to stimulate the
Large Diameter Nerve Fibers to
close the gate.

Pain Management Strategies

Pharmacologic Methods
Narcotics
NSAIDs
Adjuvants or Co-analgesics

Non-Pharmacologic Methods
Physical Interventions
Cognitive / Behavioral Interventions

Non-Pharmacologic Physical
Interventions
1. Cutaneous Stimulation
Massage
o Effleurage
o Soft massage
o Gentle stroking
Petrissage
o Hard massage
o Large and quick pinches
o Also done by striking
Application of Counter-Irritant
o Bengay
o Menthol
o Omega Pain Killer
o Flax Seeds
o Poultices
Heat and Cold Application
o Nursing Alert!
o Rebound Phenomenon
When you apply heat
(usually done for 20
minutes), vasodilation
is produced
If heat is applied for
more than 20 minutes,
there
is
vasoconstriction
This is an inherent
defense mechanism
from
burning
of
tissues
Cold Application
o Maximum vasoconstriction is
reached when skin reaches
15C
o If there is further drom in
temperature,
there
is
vasodilation (skin becomes
reddish)
o This is the inherent defense
mechanism
from
being
frozen

The R.A Gapuz Review Center Inc. makes no representations about the accuracy, authenticity, and reliability of this compilation. It declaims any and all
responsibility or liability for plagiarism, copyright infringement and violation of related laws in connection with the contents of the materials. It had no
participation and compilation thereof such being sole responsibility of the reviewer concerned. This disclaimer serves as a notice to the public that R. A.
Gapuz Review Center Inc. shall not be liable for any complaints, actions or suits in connection with the contents of the materials of this compilation.

 Accupressure
o Pressure on certain points of
the body
o Stimulates
release
of
endorphins, which have
natural analgesic effects
o This started in Ancient China
Accupuncture
o Insertion of long slender
needles on certain chemical
pathways
o Origin is also Ancient china
Contralateral Stimulation
o Example: Injury on left side
and massage is done on the
right side
o Useful when patient cannot
be accessed:
For patients in a cast
For patients with
burns
For patients with
phantom pain

2. Immobilization
Application of splints

3.Transcutaneous Electrical Nerve

Relieves pain because of its intent

and not because of physical or
chemical properties

Cognitive or Behavioral NonPharmacologic Interventions

Purpose:
o To alter pain perception
o To alter pain behavior
o To provide client with a
greater sense of control over
the pain

Specific Interventions
1.Distraction
Purpose is to divert attention from
pain
Slow Rhythmic Breathing
o Stare at a certain object
o Take deep breath slowly
o Release or exhale slowly
o Concentrate on breathing
o Picture a peaceful scene
o Establish a rhythmic pattern

Stimulation
2.Massage and Slow Rhythmic Breathing
Composed of electrodes
Operated by battery
Electrodes are applied on painful site
or over the spinal cord

4.Administration of a Placebo

3.Rhythmic Singing and Tapping

Key Concept!
o Faster beat music is more
preferable
3

The R.A Gapuz Review Center Inc. makes no representations about the accuracy, authenticity, and reliability of this compilation. It declaims any and all
responsibility or liability for plagiarism, copyright infringement and violation of related laws in connection with the contents of the materials. It had no
participation and compilation thereof such being sole responsibility of the reviewer concerned. This disclaimer serves as a notice to the public that R. A.
Gapuz Review Center Inc. shall not be liable for any complaints, actions or suits in connection with the contents of the materials of this compilation.

4.Guided Imagery
Imagine that you are walking along a
peaceful shore
Eyes are closed and suggestions are
given

5.Hypnosis
The success of hypnosis depends on
the ability of the patient to
concentrate and the capacity of the
hypnotist to suggest
Based on suggestion
Progressive relaxation

4
The R.A Gapuz Review Center Inc. makes no representations about the accuracy, authenticity, and reliability of this compilation. It declaims any and all
responsibility or liability for plagiarism, copyright infringement and violation of related laws in connection with the contents of the materials. It had no
participation and compilation thereof such being sole responsibility of the reviewer concerned. This disclaimer serves as a notice to the public that R. A.
Gapuz Review Center Inc. shall not be liable for any complaints, actions or suits in connection with the contents of the materials of this compilation.