Overview
This lecture covers the multidimensional nature of pain, barriers to effective pain management, types and mechanisms of pain, and pharmacological and non-pharmacological interventions for pain in nursing care.
Understanding Pain
- Pain affects physical, emotional, spiritual, and social aspects of life.
- Nurses play a key role in pain management but may undertreat pain due to concerns over medication harm.
- Pain is defined as whatever the experiencing person says it is, existing whenever they say it does.
- According to the International Association for the Study of Pain, pain includes both sensory and emotional experiences related to tissue damage.
Types and Purposes of Pain
- Acute pain is short term, often with obvious physical signs, and serves as a protective warning.
- Chronic pain persists for over three months, often without clear physical signs, and may not be immediately believed.
- Suffering is closely tied to persistent, untreated pain and lowers quality of life.
Risks of Uncontrolled Pain
- Untreated pain triggers harmful stress responses, tissue breakdown, immune suppression, and impairs recovery.
- Patients may avoid self-care, leading to complications like pneumonia and delayed bowel function.
Cultural and Ethical Considerations
- Cultural backgrounds influence pain expression, family involvement, spirituality, and treatment preferences.
- Ethical care requires assessing each patient individually and honoring patient autonomy.
Myths and Barriers in Pain Management
- Myths include: people laughing or talking aren't in pain, opioids mostly cause respiratory depression, injections are best, teens become addicted easily, and pain is normal in aging.
- Fact: Accept patient reports of pain regardless of behavior; respiratory depression is rare with proper use; oral route is preferred; addiction is rare if no prior abuse; pain is not a normal part of aging.
Opioid Addiction, Dependence, and Tolerance
- Tolerance: Needing more drug for same effect—normal biological response.
- Physical dependence: Withdrawal symptoms if stopped suddenly.
- Addiction: Compulsive use despite harm; not the same as dependence or tolerance.
- Pseudoaddiction: Drug-seeking behavior due to inadequate pain control, which resolves with adequate pain relief.
Mechanisms and Types of Pain
- Pain transmission involves transduction, transmission, perception, and modulation (endorphin release).
- Nociceptive pain (normal pathway): can be somatic (localized, throbbing) or visceral (diffuse, cramping).
- Neuropathic pain: from nerve injury, often poorly localized, described as shooting or tingling.
Pharmacological Management
- Analgesics include opioids, non-opioids (NSAIDs, acetaminophen), and adjuvants (antidepressants, anticonvulsants, steroids).
- Non-opioids are preferred for mild pain and have a ceiling effect; NSAIDs can cause GI bleeding.
- Opioids for moderate-severe pain; have no ceiling effect but require monitoring for side effects (e.g., constipation, sedation).
- Adjuvants treat neuropathic pain or enhance analgesia.
Nursing Implications
- Monitor vital signs, sedation, and respiratory status with opioid use.
- Educate patients and families on pain management plans and medication safety.
- Prevent and treat opioid-induced side effects, especially constipation.
Key Terms & Definitions
- Acute pain — Short-term pain from injury/surgery.
- Chronic pain — Pain lasting over three months.
- Nociceptive pain — Pain from tissue injury: somatic or visceral.
- Neuropathic pain — Pain from nerve injury.
- Analgesic — Medication for pain relief.
- Opioid — Drug that binds opioid receptors to relieve pain.
- Tolerance — Needing increased drug for same effect.
- Physical dependence — Withdrawal when stopping a drug suddenly.
- Addiction — Compulsive drug use despite harm.
- Pseudoaddiction — Drug-seeking due to inadequate pain management.
Action Items / Next Steps
- Review pain assessment scales and practice culturally sensitive interviewing about pain.
- Read about opioid antagonists and non-pharmacological interventions (next lecture/chapter section).
- Study Table 10.1 for analgesic side effects and nursing implications.
- Reflect on myths and biases that may impact your pain management approach.