Chapter 19: Pain Management, Rest and Restorative Sleep

Classifications of Pain
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Classifications of Pain
Acute, Chronic, Intractable, Referred, Radiating
Acute Pain
Sudden onset, less than 6 month duration
Chronic Pain
Pain lasting longer than 6 months
Intractable Pain
Pain that cannot be relieved; incurable, resistant to treatment
Referred Pain
Pain felt in an area other than where it was prodused
Radiating Pain
Pain that begins at a specific site and shoots out to a larger area beyond the site of origin
Neuropathic Pain
occurs from damage to the nerves. Burning, stabbing, or sometimes deep ache that Pt. describes when there is nerve compression caused by pressure from tumors, lymphedema, or compression fractures of spine.
Nociceptive Pain
Occurs from the stimulation of nerve pain receptors, generally localized within a specific area.
Stimulation of Nerve Fibers in Gate Control Theory
Broad nerve fibers close the gate. They are stimulated by exercise, heat, cold, massage and TENS.
Narrow fiber open the gate, directly stimulated by injury or damage to tissue
Types of Nociceptive Pain
Cutaneous, Visceral, Deep Somatic
Cutaneous Painmore superficial or pertaining to skin surface and underlying subcutaneous tissue. ex. paper cut, mild burnVisceral Pain (soft tissue pain)Soft-tissue pain caused by stimulation of deep internal pain receptors. Described as achey or cramping type pain and can be continuous or intermittent ex. pain resulting from traumatic injury/surgery, metastatic invasion of soft tissues such as skin, muscles and organs.Deep Somatic (osteogenic) painBone, ligament, tendon, and blood vessel pain. May be diffuse and of longer duration than cutaneous pain. Described as pain with movement ex. bone cancer, fractures, arthritic-type diseasesFactors that affect pain perception-Cultural and ethnic beliefs -developmental stage -individual values -previous pain experience -personal support system -emotions -stress level -fatigueBody Responses to Pain-Physiological, Psychological, Behavioral. -Pulse, respiratory rate, B/P may rise. -Pupils and cerebral blood vessels dilate, delivering more blood to brain to increase awarenessPain Assessment-Level or extent; be consistent with pain scale -Site; be specific; R or L side, location; which quadrant -characteristics; it is sharp, dull, intermittent, constant, burning, cramping, stinging, aching, pressure. what does it feel like?; vice grip, knifelike, pulling, tension/tightness, spasmodic -whether acute or chronic; when did it begin? -what elicits the pain; what makes it worse, triggers is. does anything make it better -patients desires in relation to the pain; want meds or nonpharmaceutical methodsNonpharmaceutical Pain Relief Measures-Hot and cold packs -massage / effleurage -TENS -acupunture / acupressure -relaxation; progressive relaxation, guided imagery -distraction; visual, auditory, tactile, intellectualPharmaceutical Pain Management-NSAIDS -Nonopioids -Opioid narcotics -Adjuvant drugsNSAIDSReduce inflammation and pain. Useful in relieving cutaneous pain, visceral pain, and deep somatic pain ex. ibuprofen, naproxen, aspirinNonopioidsNon-narcotic pain relievers for mild to moderate pain ex. acetaminophenOpioid narcoticsfor moderate to severe pain. Relieve visceral and deep somatic pain. Considered controlled substances. ex. meperidine, codeine, hydromorphone, morphine, fentanylAjuvant drugsProduce pain relief from another method or increase effects of opioids, opiates, and non-opioid drugs. ex. anticonvulsants (gabapentin, carbamazepine) antidepressants (amitriptyline)Restorative SleepAllows individual to awaken feeling rested, refreshed and energized. Partial loss of consciousness; more difficult to arouseRestingMay or may not involve sleep; anytime individual feels relaxed and free from anxietyComplications from lack of restorative sleep-Healing is slow and incomplete -immunity decreases -pain tolerance decreases -fragile emotions and impatience -cognitive functions are impaired -work performance suffers -accidents increase dramaticallyAmount of sleep needed for young adults and older adults-young adults: 7.5 - 8 hours -older adults: 5.5 - 6 hoursFactors that affect sleep-lifestyle -stress and anxiety -environment -illness and health problems -sleep disordersInterventions to promote sleep-Prepare environment -promote comfort and relaxation -provide pain relief and sleep medicationsendorphinsnatural body chemicals produced by the brain in response to pleasant thoughts or feelings, exercise, laughter, sex, massagesphantom limb pain is aneuropathic painEndorphins blocktransmission of painsubstance Pplays a role in eliciting localized tissue reactions similar to inflammationPatient-controlled analgesia (PCA)Drugs that are administered, within preset boundaries, by the patient, who controls the frequency and administration of his or her pain medication. It uses a computerized IV infusion device consisting of a pump, a large syringe containing the analgesic, IV tubing, and a push button the patient presses for delivery of the analgesic.Adjuvantto assist or aid another treatment, therefore increasing the effectivenesscircadian rhythmthe biological clock; regular bodily rhythms that occur on a 24-hour cycleEffleuragerepetitive, gentle, gliding stroking of your fingertips over the surface of the skinProstaglandinshormones that act in the immediate area to initiate inflammation by sensitizing local pain receptorsprogressive relaxationa systematic process of using the mind to actually relax the patient's muscles from the top of the head to the toes.guided imageryusing the mind to help control the body and guide the Pt. toward more relaxed stateHepatotoxicitydamage to the liverAKAAbove Knee AmputationBKABelow Knee Amputationbruxismgrinding teethSleep disordersBruxism, insomnia, narcolepsy, night terrors, restless leg syndrome, sleep apnea, somnambulism, sundowninginsomniachronic inability to fall asleepnarcolepsycondition causing uncontrollable, recurrent daytime episodes of sleepiness; can hinder driving and operating dangerous equipmentnight terrorsnightmares in children causing awakening and fearrestless leg syndromecrawling or tingling sensation in the legs; irresistible urge to move legssleep apneainability to maintain breathing while sleeping. Pt. usually snores, accompanied by periods of apnea lasting from 10 seconds to 2 minutes; can be life threatening. Intervention- BiPAP/CPAPsomnambulismsleepwalkingsundowningConfusion and disorientation in elderly patients that occurs in the evening hours; the patient is at higher risk for injuryPain is derived in one of two ways:1. from the stimulation of nerve pain receptors, called nociceptors 2. from damage to the nerves themselvesTypes of neuropathic pain-diabetic neuropathy; sharp, jagged, knifelike pain, burning, prickly pins and needles, and even numbness -phantom limb painCPAPcontinuous positive airway pressureBiPAPbilevel positive airway pressurePain serves as warning sign for body thatdamage has occurredThalamus can open and closethe gate; gate control theory