pain management

5/19/2018 Pain Management

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Pain and its management

Yuni Permatasari istanti


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What is Pain??


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Introductory Ideas

Sensation of the aected level of unpleasantness

Perception of actual or threatened damage

Perception based on expectations, pastexperience, anxiety, suggestions, cognitivefactors

Acute

Chronic

Pain is Subjective

Simple Spinal Reex Arc


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Significance of Pain

Pain

A clear example of the mindbody

!"PS# model !and most common problemassociated $ith going to %CP#

Adaptive as a biological $arning signal

!e&g&, congenital insensitivity to pain)


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The Physiology of Pain

'%o$ you (no$ that you stubbed yourtoe) handout Receptor

*& +ociceptor a speciali-ed neuron thatperceives and responds to painful stimuli

.& Special pain nerve /bers

A01elta 2ibers 00 3arge, myelinated !fast#

nerve /bers that transmit sharp, stinging pain C02ibers 00 Small, unmyelinated nerve /bers

that carry dull, aching pain


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The Physiology of Pain

'%o$ you (no$ that you stubbedyour toe) handout

4& 1orsal %orn pain5s 'arrival) to theC+S

6& "rain perception of pain& %eavilyinuenced by emotion, context,expectations, etc& !illustration nextslide#


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Pain Pathways

PAG area of midbrain (next slide)


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Pain Pathways

Peria7ueductal

8ray !PA8#midbrainregion00

activates adescendingneural pathwaythat uses

serotonin to'


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Gate Control Theory

Proposed by 9el-ac( : ;all !*#

A neural 'gate) in the spinal cord

regulates the experience of pain Pain is not the result of a straight0

through sensory channel


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The Gate Control Theory

of Pain


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The Biochemistry of Pain

Substance P !pain +?#

+?s !e&g&, serotonin# that alter 'gate)

@n(ephalins, endorphins, dynorphins!endogenous opioids#


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Psychosocial Factors in the

Experience of Pain

Stress

pain perception is inuenced by stress!emotionality and pain experience#

stress leads people to engage in behaviors!i&e&, grinding teeth, tensing muscles#, $hich inturn lead to pain

8ood ne$s Stress0Bnduced Analgesia !SBA# a stress0related increase in tolerance topain, mediated by the body5s endogenousopioids


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Experience of Pain

3earning

modeling

secondary gain reinforcement culturally learned 00 groups establish

norms for the degree to $hich sueringshould be openly expressed and theform that pain behaviors should ta(e


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Experience of Pain

Cognition

anticipation of pain is often $orse than

pain itself placebo and pain !e&g&, child $ho gets ear

examined feels better#

expectations of ability to cope !e&g&,

control and pain PCA morphine#


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Pain Management

Dvervie$

?he 2ifth Eital sign

"ody ?emp, Pulse, "P, Resp Rate, Pain

9easuring pain

Chronic pain issues

?reatment


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PI! SSESSME!T
http://pengukuran%20nyeri.ppt/http://pengukuran%20nyeri.ppt/


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Chronic Pain Management

Acute vs& Chronic pain

;ho becomes a chronic pain patientF

+ot necessarily related to pain intensity 9ore important are reactions

Physical !postural changes#

2unctional disability !pain interferes $ith life activities#

Reactions to pain episodes and to stress

?he toll of chronic pain !video clips from 'Psychology ofPain)#


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The toll of chronic pain

Dysfunction report high levels of pain, feel they have little

control over their lives, and are extremely inactive

Interpersonal distress perceive little social support and feel other people

in their lives don5t ta(e their pain seriously

often poor communication

sexual relationships deteriorate

Cost %uge medical bills

Gndergone many treatments !e&g&, multiplesurgeries# and rely on pain(illers

Hob lossdisability


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Treating Pain

Pharmacological ?reatments

Analgesic !pain0relieving# drugs are the

mainstay of pain control Bnclude 'central acting) opioid drugs

and 'peripherally acting) nonopioiddrugs


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"pioid nalgesics

2ormerly called narcotics

Agonists !excitatory chemicals e&g&,

morphine# act on receptors in thebrain and spinal cord

Patient controlled analgesia

addresses control andundermedication


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!onopioid nalgesics

+onsteroidal Anti0Bnammatory1rugs !+SAB1s#

Aspirin, ibuprofen 00 relieve pain andreduce inammation at the site ofinjured tissue


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"ther Medical Inter#entions

Counterirritation

Analgesia in $hich one pain is relieved by

creating another, counteracting stimulus ?ranscutaneous @lectrical +erve

Stimulation !?@+S#

A counterirritation form of analgesiainvolving electrically stimulating spinalnerves near a painful area


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Cogniti#e$Beha#ioral Therapy

Cognitive0"ehavioral ?herapy !C"?#

A multidisciplinary pain0management

program that combines cognitive,physical, and emotional interventions

used by I4J of clinicians $ho treat chronicpain


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Cogniti#e$Beha#ioral Therapy

Components Education and goal-setting component is

used to clarify client5s expectations

Cognitive interventionsto enhancepatients5 self0eKcacy and sense of controlover pain

Teaching new skillsfor responding to paintriggers

Promote increased eercise and activitylevels


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Cogniti#e$Beha#ioral

Inter#entions

!iofeed"ack # muscle relaation

Cognitive distraction

Imagery # virtual reality therapy $see %ciAmerican Aug &''()

ypnosis

Cognitive restructuring * tochallenge illogical beliefs andmaladaptive thoughts !next slide#


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%eshaping Pain Beha#ior

Bdentify the events !stimuli# thatprecede pain behaviors !responses#

as $ell as the conse7uences thatfollo$ !reinforcers#


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&hich pproach to Pain

Control &or's Best(

Bt depends on $hich type and aspect of pain

Dverall, the most eective programs aremultidisciplinary in nature, combining the

cognitive, physical, and emotionalinterventions of C"? $ith the judicious useof analgesic drugs

@ective programs also encourage patients

to develop !and rehearse# a speci/cpain-management program

+roup settings are pro"a"ly most e,ective


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!)%SI!G C%E P*!

Assessment

+ursing 1iagnosis

+DC dan +BC
http://nursing%20diagnosis.doc/http://nursing%20diagnosis.doc/


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C"!T"+ ,S)S

Seorang la(i0la(i 6>thdiba$a (e RSdengan (eluhan nyeri pinggang seja(

. bulan yang lalu& +yeri hilangtimbul, apabila nyeri datang pasientida( bisa bera(tivitas sama se(ali&

Ri$ayat pe(erjaan pasien sebagai(uli bangunan seja( .> tahun yanglalu&


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T)GS

"uat (elompo( dengan anggotama(simal > orang

"uat rencana asuhan (epera$atanpada pasien tersebut

?ugas di(umpul(an pada tanggal .L

9ei .L**

pain management

Documents

experience of pain pain

significance of pain

physiology of pain

pain experience

pain behaviors

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