Pain has never been satisfactorily defined or understood. Pain is a complex, multidimensional experience. It is an unpleasant feeling, entirely subjective, which only the person experiencing it can describe. For many people, it is a major problem that causes suffering and reduces quality of life. Pain is one of the major reasons that people seek healthcare. A thorough understanding of the physiologic and psychological dimensions of the pain is important for effective assessment and management of patients with pain. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP – International Association for the Study of Pain 2009).
CLASSIFICATION OF PAIN
Most commonly pain is classified based on its duration, etiology and source or location.
1) Classification of pain based on duration
- Acute Pain : Pain associated with rapid onset of varying intensity
- Chronic Pain : Pain that continues past the expected point of healing for injured tissue.
2) Classification based on etiology
- Nociceptive : Pain due to activation of the A delta fibers and C fibers by noxious stimuli
- Neuropathic : Pain due to malfunctioning of the peripheral or central nervous system.
3) Classification of pain based on source or location
- Somatic – The pain that is originates from either the skin, tissues or muscles is somatic pain
- Visceral – The pain that originates from the internal organs is visceral pain
Use the following key for a comprehensive effective pain assessment. A – ask about pain regularly, B – believe the client, C- choose pain control option, D – deliver intervention timely, E – empower the client and other family members Clients expression, Classification of pain experience, Characteristic of pain – Onset and duration, Location, Severity, Pain pattern, Quality, Relieving factors
PAIN ASSESSMENT SCALES
When experiencing pain, people express pain through many different behaviors. A patient may grimace, cry, rub the affected area, guard the affected area, or immobilize it. Others may moan, groan, grunt or sigh. Not all patients exhibit the same behaviors, and there may be different meanings associated with the same behavior. The following are the examples of pain intensity scales
WONG-BAKER FACES PAIN SCALE
- The Wong-Baker FACES Pain Scale (WBF), consisting of graduated facial expressions of pain, will be used for adult patients’.
Pain management is crucial for early recovery. Commonly pain management can be classified as,
Non-pharmacological pain relief methods: It includes Physical pain relief strategies like massage, exercise, Transcutaneous nerve stimulation, Percutaneous electrical nerve stimulation, acupuncture, heat therapy, cold therapy and cognitive therapies which include distraction, hypnosis and relaxation strategies like Guided imagery, biofeedback, thought stopping, Positive self talk
Pharmacological management: In 1988 WHO(World Health Organisation) declared Cancer Pain management a worldwide emergency and adopted the Canadian 3-step ladder of analgesic agents for control of nociceptive pain. This ladder provides a useful tool for illustrating and summarizing generally accepted approaches to conventional systemic analgesics.
Surgical or Interventional therapy: It includes Therapeutic nerve blocks, Neuroablative techniques, Neuroaugumentation.
Therapeutic nerve blocks: Nerve blocks generally involve one time are continuous infusion of local anesthetics into a particular area to producing pain relief. These techniques are also referred to as regional anesthesia.
Neuroablative techniques: These techniques destroy nerves there by interrupting pain transmission and performed for severe pain that is unresponsive to all other therapies. It includes, Neurectomy – severing of nerve fibers from the cell body, Rhizotomy- resection of posterior nerve route before it enters spinal cord, Cordotomy- severing of ascending anterior lateral pain conducting pathways of spinal cord, Sympathectomy – excision or destruction of one or more sympathetic ganglia or nerves.
It involves electrical stimulation of the brain and spinal cord.
Pain management is based upon standards of care from a variety of sources from professional organizations. Patients and significant others will receive ongoing reinforcement update regarding the patient’s response to pain management therapy by the physician, anesthesia providers, staff nurses, and/or other appropriate staff. Pain management will be discontinued / weaned off when the patient and/or physician determine(s) that it is no longer necessary for maintenance of pain control. This decision will be based on the patient’s progress and pain rating. If needed, appropriate pain management will be continued post-discharge. The patient will receive appropriate post discharge education on pain management.
Pain is subjective leading to under treatment. Early diagnosis of pain helps in better healing. Always it is wise to use alternate pain relief measures. Use measures that have been successful with previous pain and know about the potential side effects of analgesics and their management.
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