Pain management

5
Pain management

Diagram shows effects of untreated acute pain as CNS, GI and GU, Respiratory, et cetera. It shows causes of neuropathic pain, dimensions of pain, three steps of pain ladder, et cetera.

Effectively managing pain remains a challenge for acute care nurses, with about 40% of hospital patients and 50% of surgical patients reporting pain, described as moderate or severe.1 Pain should be anticipated in the acute care setting, although reports suggest that many nurses underestimate the levels of pain experienced. Poor pain relief has adverse physiological consequences (Figure 5.1) impacting on patient function, such as the ability to breathe deeply, cough, or mobilise sufficiently, and this affects patient outcome. To meet the challenges presented in the acute care setting, sufficient training and structured management guidelines are required to ensure effective pain relief, minimising complications and improving patient experience.2


Types of pain


Pain can be divided into two types:



  • Nociceptive pain is associated with tissue damage and is one of the five features of the inflammatory process. This is also often referred to as protective pain.
  • Neuropathic pain is associated with a primary lesion of the nervous system or damage to the nerves themselves.

The differences in the aetiology of the two types of pain are significant in terms of assessment, manifestation and treatment.3


Nociceptive pain


The primary event in the production of nociceptive pain is cell damage or necrotic death, which may be caused by trauma and ischaemia for example. The damage leads to the release of a range of chemicals which can stimulate the pain receptors (Box 5.1). The effect that these chemicals have can be modulated by the production of prostaglandins as a consequence of cell wall damage. The prostaglandins reduce the threshold of the pain receptors and are therefore hyperalgesic

Apr 8, 2019 | Posted by in NURSING | Comments Off on Pain management
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