Pain is a complex, multidimensional phenomenon. Everyone has experienced some types or degrees of pain. Pain is the most common reason for physician and also common problems faced by nurses when they are dealing with the patients. The word pain is derived from the Latin word ‘Poena’ which means punishment. It is a major symptom in many medical conditions, and can significantly interfere with a person's quality of life and general functioning. Pain motivates us to withdraw from potentially damaging situations, protect a damaged body part while it heals, and avoid those situations in the future. Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease. The International Association for the Study of Pain's widely used definition states: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". The processes in the body that are involved in the perception of pain are called "nociception." Mount castle defined pain as “that sensory experiences evoked by stimuli that injure or threaten to destroy tissue, defined introspectively by every man as that which hurts”. The International Association for the Study of Pain (IASP) classification system describes pain according to five categories: Duration And Severity, Anatomical Location, Body System Involved, Cause, And Temporal Characteristics (Intermittent, Constant, Etc) Acute pain lasts a short time, or is expected to be over soon. The time frame may be as brief as seconds or as long as weeks.  Chronic pain may be defined as pain that lasts beyond the healing of an injury, continues for a period of several months or longer, or occurs frequently for at least months and is more difficult to manage.eg-rheumatoid arthritis Cutaneous or superficial pain- it is directly precised &readily localized i.e. patient can indicate exactly where it hurt. Referred pain- pain felt at a site distinct from site of pain. eg-cardiac pain is present in the heart, but felt in the left arm Intractable pain- persistent, severe pain that cannot be effectively controlled by the usual medication is referred to as “Intractable pain”. Localized pain- Localized pain arises directly from the site of the disturbance. Differentiation of neurolapatic pain- severs pain caused by nervous system damage, when the flow of afferent nerve impulse has been partially or completely interrupted. eg accident. Pain of muscular or bonny origin- the muscular ischemia of intermittent claudication(a in commonly in the legs or arms that comes on with walking or using the arms.) & occlusion vascular induce pain in the extrimities. eg joint pain

1. NAME: MISS VEDANTI PATEL
DESIGNATION: ASSI. PROFESSOR

2. INTRODUCTION
Pain is a complex, multidimensional
phenomenon. Everyone has experienced
some types or degrees of pain. Pain is the
most common reason for physician and
also common problems faced by nurses
when they are dealing with the patients.

3. The word pain is derived from the Latin word
‘Poena’ which means punishment. It is a major
symptom in many medical conditions, and can
significantly interfere with a person's quality of
life and general functioning.

4. Pain motivates us to withdraw from potentially
damaging situations, protect a damaged body part
while it heals, and avoid those situations in the
future.
Most pain resolves promptly once the painful
stimulus is removed and the body has healed, but
sometimes pain persists despite removal of the
stimulus and apparent healing of the body; and
sometimes pain arises in the absence of any
detectable stimulus, damage or disease.

5. DEFINITION:
The International Association for the Study of Pain's
widely used definition states:
"Pain is an unpleasant sensory and emotional
experience associated with actual or potential tissue
damage, or described in terms of such damage".
The processes in the body that are involved in the
perception of pain are called "nociception."
Mount castle defined pain as “that sensory
experiences evoked by stimuli that injure or
threaten to destroy tissue, defined introspectively
by every man as that which hurts”.

6. CLASSIFICATIONOFPAIN
The International Association for the Study of Pain
(IASP) classification system describes pain according to
five categories:
Duration And Severity,
Anatomical Location,
Body System Involved,
Cause, And
Temporal Characteristics (Intermittent, Constant, Etc)

7. Acc. To Duration
Acute pain lasts a short time, or is expected to
be over soon. The time frame may be as brief
as seconds or as long as weeks.
Chronic pain may be defined as pain that lasts
beyond the healing of an injury, continues for a
period of several months or longer, or occurs
frequently for at least months and is more
difficult to manage.eg-rheumatoid arthritis

8. Acc to Region and system
Cutaneous or superficial pain- it is directly precised
&readily localized i.e. patient can indicate exactly
where it hurt.
Referred pain- pain felt at a site distinct from site of
pain. eg-cardiac pain is present in the heart, but felt in
the left arm

9. Intractable pain- persistent, severe pain that
cannot be effectively controlled by the usual
medication is referred to as “Intractable pain”.
Localized pain- Localized pain arises directly from
the site of the disturbance.

10. Differentiation of neurolapatic pain- severs pain
caused by nervous system damage, when the flow
of afferent nerve impulse has been partially or
completely interrupted. eg accident.
Pain of muscular or bonny origin- the muscular
ischemia of intermittent claudication(a in
commonly in the legs or arms that comes on with
walking or using the arms.) & occlusion vascular
induce pain in the extrimities. eg joint pain

11. Vascular pain- Vascular pain is pain that
develops when there is interruption in
blood flow to a tissue, organ or nerves
Eg. Migraine

12. Acc. toCause
Nociceptive Pain: Nociceptive pain is believed to be
caused by the ongoing activation of pain receptors in
either the surface or deep tissues of the body and
may be classified according to the mode of noxious
stimulation; the most common categories being
"thermal" (heat or cold), "mechanical" (crushing,
tearing, etc.) and "chemical" (iodine in a cut, chili
powder in the eyes).
It is a type of pain caused by damage to body tissue. It feels sharp, like stubbing
the toe, having a sports injury, or a dental procedure

13. There are two types:
"somatic"pain:
pain emanating from muscles, skeleton, skin; pai
n in the parts of the body other than the viscera.
“visceral" pain. Visceral pain is pain that results
from the activation of nociceptors of the thoracic,
pelvic, or abdominal viscera (organs).

14. Neuropathic Pain: Neuropathic pain is believed to be
caused by changes in the nervous system that sustain
pain even after an injury heals.
In most cases, the injury that starts the pain involves
the peripheral nerves or the central nervous system
itself. It can be associated with trauma or with many
different types of diseases, such as diabetes.
There are many neuropathic pain syndromes,
◦ such as diabetic neuropathy,
◦ trigeminal neuralgia,
◦ post-stroke pain, and
◦ Some patients who get neuropathic pain describe it as
unfamiliar pain, which may be burning or like electricity.
The pain may be associated with sensitivity of the skin.

15. Psychogenic Pain: Most patients with chronic pain
have some degree of psychological disturbance.
Patients may be anxious or depressed, or have trouble
coping. Psychological distress may not only be a
consequence of the pain, but may also contribute to
the pain itself. "Psychogenic" pain is a simple label for
all kinds of pain that can be best explained by
psychological problems.
Phantom pain
Phantom pain is pain from a part of the body that has
been lost or from which the brain no longer receives
signals. It is a type of neuropathic pain. Phantom limb
pain is a common experience of amputees.

16. DIFFERENCE BETWEEN ACUTE PAIN, CHRONIC PAIN &
CANCER PAIN-

17. Characteristicsof pain
Intensity (severity)
Timing : onset, duration, frequency, cause.
Location (region): radiation, Referred pain
Quality : dull,sharp,crushing, burning, aching,
thrombing,
Personal meaning,
Aggravating & alleviating factors (Provoking
factor): what makes the pain worse or relieve
it.

18. EFFECTSOFPAIN
Sympathetic Pain Effects :-
◦ pallor
◦ Elevated B.P.
◦ increase respiration
◦ Increase H.R.
◦ diaphoresis ( increase
sweating)
Parasympathetic Pain Effects
o pallor
odecrease B.P. & H.R.
oNausea, vomiting
o Weakness & fainting
o Prostration (extreme
exhaustion)
o Possible loss of
consciousness

19. BEHAVIOURAL RESPONSE:-
o Hold or protect painful area
owithdraw when touch
oassume posture that minimize pain
o have twisting muscles

20. FACTOR INFULECING PAIN
Age- Children, Older clients
Sex
Culture
Attention
Anxiety
Fatigue
Previous experience

21. MANAGEMENT OF PAIN
Assessment
Nursing
Diagnosis
Expected
Outcome
Interventio
n
Evaluation

22. Nursingassessment-
History
Location-where, internal or external
Onset & pattern
Constant, intermittent, rhythmic, pulsating or throbbing.
Duration, character &quality- dull, sharp, throbbing,
burning, electric or shooting
Precipitating, aggravating & alleviating factors:-
a) Trigger pain: - smoking, eating, alcohol etc.
b) alters pain:- rest , sleep, heat application

23. Associates symptoms:-nausea restlessness, loss of appetite etc.
Effects on activities of daily living:-driving, work, eating, house
work
Methods of pain relief:-medication, meditation, invasive or non-
invasive methods
Previous experience:-previous experience does not necessarily
means, that a person will accept pain more easily in the future,
but find solution that will minimize his pain
Coping style: - a) family support
b) Exercise
c) Singing (hobby)

24. INSTRUMENTS OF ASSESSMENT OF
PAIN
VISUAL ANALOG SCALE

25. INSTRUMENTS OF ASSESSMENT OF PAIN

26. NURSINGDIAGNOSIS
Discomfort R/T pain
Anxiety R/T unrelieved pain
Hopelessness R/T chronic malignant pain
Ineffective individual coping R/T chronic pain
Impaired physical mobility R/T musculoskeletal
pain
Self care deficit R/T incisional pain
Sleep pattern disturbance R/T low back pain
Knowledge deficit R/T pain management

27. INTERVENTION
NON- PHARMACOLOGICAL MANAGEMENT
1. Relieves anxiety
◦ stay with the person for a while
◦ Empathy communication.
◦ Therapeutic touch.
2. Distraction & diversion
◦ reading, TV, radio
◦ Meditation, self hypnosis(an unconscious state
where somebody’s mind & actions can be controlled
by another person.)

28. 3. Physical aspect of intervention
Treatment of local irritation & inflammation.
immobilizing decreases pain.
change position.
gentle massage.
Hot or cold application.
check drainage tubes

29. 4. Radiation therapy :
to relive pain caused by pressure from
neoplasm by shrinking a tumor in size.
5. Hypnosis:
After the character of pain or individuals
attitude towards it by disorientation & dissociation.
6. Behavioural techniques
a) Meditation
b) Relaxation
c) Yoga
d) Autogenic training
e) Progressive relaxation training.

30. 7. Operant conditioning : by praising a person for
performing a task that previously was not done
because of pain.
8. Bio- feedback : techniques that provide person with
information about changes in bodily function of
which the person is usually unaware.
9. Placebos : they are pharmacologically inactive substance e.g.
vit. , distilled water
The person believes & trusts that a pain –relieving medication is
being administrated.

31. PHARMACOLOGICAL MANAGEMENT
It includes
Analgesics
 NSAIDs:
◦ It blocks the impulses mainly in the periphery and
decrease inflammatory related pain
◦ Eg. Ibuprofen, sodium salicylate, indomethacin.
 Opioid analgesic :
 morphine acts mainly on CNS to alter pain perception.

32. Anesthetic agent
Local Anaesthetic Agent
◦ It reduces pain associated with thoracic or abdominal surgery
when injected by the surgeon intercostals .local anaesthetic agent
are rapidly absorbed into the blood stream.example.EMLA
(emulsion of local anesthaticcream), lidocaine5%
 Intraspinal administration-
 intermittent or continuous administrator local anaesthetic
agent through an epidural cather has been used for years to
produce anaesthesia during surgery

33. Biologicalbasedtechnique
1. Acupuncture: through the acupuncture pins
vital energy flows. Acupuncture is used as
analgesic. Needle stimulation elicits biochemical
changes due to release of endorphins.
2. Transcutaneous electrical nerve stimulator
(TENS) It’s a battery operating unit with
electrodes to the skin. It produces vibration
tingling & buzzing sensation in area of pain &
reduces pain.

34. THE NEW TRENDS IN PAIN MANAGEMENT
Nerve blocks: nerve blocks are performed by injecting
various substances close to nerve, thereby blocking
their conductivity.
-stimulation procedures
-interruption of pain pathway
Neuro surgical procedures:
Cordotomy
Rhizotomy

35. Neuro surgical procedures:
 Cordotomy
 is a surgical procedure that
disables selectedpain-
conducting tracts in
the spinal cord, in order to
achieve loss of pain and
temperature perception.
This procedure is
commonly performed on
patients experiencing
severe pain due
to cancer or other diseases
for which there is currently
no cure

36.  Rhizotomy
 Rhizotomy is a surgical
procedure to sever
nerve roots in the
spinal cord. The
procedure effectively
relieves chronic back
pain and muscle
spasms.
 Sensory nerve roots
are destroyed where
they enter spinal cord