Pain is a complex, subjective experience that can affect people of any age. It is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain can be acute or chronic and results from various causes including disease, injury, and medical procedures. It is influenced by factors like age, gender, cognitive ability, temperament, previous pain experiences, family/culture, and current situational factors. Proper pain management is important for comfort and has benefits like reduced anxiety and need for restraints during medical procedures.

1. Pain Management
Prepared by: Reñalyn Gregorio
Shionie Hechona
Jinky Lorenzo
Gio Lebuna

2. Pain Management:
• Pain is a highly individualized, subjective experience that
can affect any person of any age.
–A complex phenomenon that involves multiple
components and is influenced by myriad factors.
• Defined as an unpleasant sensory and emotional
experience that is associated with actual or potential
tissue damage.
• As whatever the person say it is, existing whenever the
person says it does – that is, pain is present when the
person says that it is. The person experiencing the pain is
the only one who can identify pain and know what the
pain is like.
• A universal experience.
What is PAIN?

3. Pain Management:
• Can result from numerous causes, including disease processes,
injuries, procedures and surgical interventions.
• It is the “fifth vital sign” according to American Pain Society
(1995).
– Goal: encourage health care professionals to assess pain every time
that temperature American Pain Society, pulse, respirations and blood
pressure are assessed and to institute measures to manage the pain.
• Children may lack the verbal capacity to describe their pain
accurately.
• Many caregivers and health care providers have
misconceptions about pain in children.
What is PAIN?

4. Pain Management:
–Reduces anxiety during procedures and decreases
the need for physical restraints,
–Reduces anxiety regarding subsequent procedures,
and
–Prevents short- and long-term consequences of
inadequately treated pain.
Treating pain:

5. The sensation of pain is a complex phenomenon that
involves a sequence of physiologic events in the
nervous system.
1.Transduction
2.Transmission
3.Perception
4.Modulation
Physiology of pain:

6. Types of pain:
1. Duration:
a.Acute pain:
» Associated with a rapid onset of varying intensity.
» Indicates tissue damage and resolves with healing of the
injury.
» Serves as a protective function.
» Examples of causes of acute pain include trauma, invasive
procedures, acute illness such as sore throat or appendicitis,
and surgery.
» Generally lasts a few days.

7. b.Chronic pain:
» Pain that continues past the expected point of healing for
injured tissue.
» Provides no protective function.
» May be continuous or intermittent, and without periods of
exacerbation, or remission.
» Often interferes with sleep and performance of activities of
daily living.

8. b. Chronic pain:
» Result in loss of appetite and depression impairing a
person’s ability to function
» Influenced by environmental and psychological factors.
» In children, chronic, recurrent pain is most commonly
associated with abdominal pain, nonspecific headache, limb
pain or chest pain.
» May not exhibit the same physical or emotional responses
as seen with acute pain.
» As pain becomes prolonged and continuous, the autonomic
nervous system response tends to diminish.

9. 2. Etiology:
a.Nociceptive pain:
» Reflects pain due to noxious stimuli that damages normal
tissue or has the potential to do so if the pain is prolonged.
» Often correlates closely with the degree or intensity of the
stimulus and the extent of real or possible tissue damage.
» Nervous functioning is intact.
» Pain ranges from sharp or burning, to dull, aching, or
cramping, and to deep aching or sharp stabbing.
» Examples include chemical burns, sunburn, cuts,
appendicitis, and bladder distention.

10. b.Neuropathic pain:
» Pain due to malfunctioning of the peripheral or central nervous
system.
» May be continuous or intermittent and is commonly described
as burning, tingling, shooting, squeezing, or spasm-like pain.
» Examples include posttraumatic and postsurgical peripheral
nerve injuries, pain after spinal cord injury, metabolic
neuropathies, phantom limb pain after amputation, and
poststroke pain.

11. 3. Source or location:
a.Somatic pain:
» Refers to pain that develops in the tissues.
» Two groups:
1)Superficial somatic pain, often called cutaneous pain,
involves stimulation of nociceptors in the skin,
suncutneous tissue or mucous membranes.
» Pain is well localized and described as a sharp,
pricking or burning sensation.
» May be due to external mechanical, chemical or
thermal injury or skin disorders.
» Tenderness commonly present.

12. 2)Deep somatic pain typically involves the muscles,
tendons, joints, fasciae and bones.
» Localized or diffuse and is usually described as dull,
aching or cramping.
» May be due to strain from overuse or direct injury,
ischemia, and inflammation.
» Tenderness and reflex spasm may be present.
» The person may exhibit sympathetic nervous system
activation such as tachycardia, hypertension,
tachypnea, diaphoresis, pallor and papillary dilation.

13. b. Visceral pain:
» Pain that develops within organs such as the heart, lungs,
gastrointestinal tract, pancreas, liver, gall bladder, kidneys or
bladder.
» Often produced by disease.
» Diffuse and poorly localized and is described as a deep ache
or sharp stabbing sensation that may be referred to other
areas.
» May be due to distention of the organ, organ muscular
spasm, contraction, pulling, ischemia, or inflammation.
» Tenderness, nausea, vomiting and diaphoresis may be
present.

14. Factors influencing pain:
 Children experience neurologic events that result in the
perception of pain.
 Research has found that environmental and psychological
factors may exert a greater influence on the child’s perception
of pain.
 Certain factors such as age, gender, cognitive level,
temperament, previous pain experiences, and family and
cultural background cannot be changed.
 Certain situational factors can intensify pain and distress,
whereas others can eventually trigger pain episodes, prolong
pain-related disability or maintain the repeated pain episodes in
recurrent pain syndrome”.

15. Factors influencing pain:
1. Age and gender:
– The nervous system structures needed for pain impulse
transmission and perception are present by the 23rd week
of gestation.
– Children of any age are capable of experiencing pain.
– Children can interpret pain as an unpleasant sensation,
but this interpretation is based on their comparison with
other sensations.
– As they get older, they learn to use words to describe
their pain more fully.
– Gender and sex may also play a role in a child’s perception
of pain.

16. Factors influencing pain:
2. Cognitive level:
– A key factor affecting a child’s pain perception and response
and usually goes hand in hand with the child’s age.
– Cognitive level typically increases with age influencing the
child’s understanding of the pain and its impact and his or
her choices for coping strategies.
– As the child’s cognitive level increases, his or her ability to
communicate information about pain increases. However it
may not apply to the child experiencing developmental
delays.
– Health care providers need to be cognizant of this
difference when caring for the child in pain.
– Young children often describe pain in concrete terms,
whereas older children use more abstract terms that
involve both physical and psychological components.

17. Factors influencing pain:
3. Temperament:
 Plays a role in predicting distress and pain levels in a child
during painful events.
 Midwives can personalize interventions in the clinical
environment and during the pain experience to better fit
the child’s temperament and other personality traits of the
child and family.

18. Factors influencing pain:
4. Previous pain experience:
– A child identifies pain based on his or her experiences with
pain in the past.
– The number of episodes of pain, the type of pain, the
severity or intensity of the previous pain experience, the
effectiveness of treatment of pain, and how the child
responded all affect how the child will perceive and
respond to the current experience.
– Previous pain experiences with inadequate pain control
may lead to increased distress during future painful
procedures.

19. Factors influencing pain:
5. Family and culture:
 The child’s cultural and family background will influence
how he or she will express and manage pain.
 The parents have a strong influence on the child’s ability to
cope.
6. Situational factors:
 Involve factors or elements that interact with the child and
his or her current situation involving the experience of pain.
 Highly variable and dependent on the specific situation.

20. Factors influencing pain:
6. Situational factors:
 Result from the context in which the child is experiencing
pain and include cognitive, which is what the child
understands and believes about the pain experience;
behavioral, which is how the child and family react and
what they do about the pain experience; and emotional,
which is how the child and family feels about the pain
experience.
 Due to children’s limited experience with pain, situational
factors may affect them more than adults.
 A thorough assessment must include assessment for
situational factors that may exacerbate pain.

21. Thank you!