Pain Assessment and Management ,Analgesic Ladder

1. Pain Management
•By : Iman Qasim Alhussein

2. Pain
Pain is defined as an unpleasant sensory and emotional
experience associated with actual or potential tissue
damage.
Pain is a complex, subjective phenomenon that involves
biological, psychological, cultural, and social factors.

3. Types of Pain
Pain is categorized according to its duration, location, and
etiology. Three basic categories of pain are generally
recognized:
** acute pain
** chronic (nonmalignant) pain
** and cancer- related pain.

4. Categorizing pain by duration
Acute pain
Acute pain commonly accompanies tissue damage from
injury or disease. It varies from mild to severe in intensity
and typically lasts for a brief period (less than 6 months).
Acute pain is considered a protective mechanism, alerting
the individual to tissue damage or organ disease

5. Chronic pain
**Chronic pain can stem from prolonged disease or
dysfunction, as in cancer and arthritis, or it can be
associated with a mental disorder such as posttraumatic
stress syndrome.
** It can be intermittent, limited, or persistent and usually
lasts 6 months or longer. It's also strongly influenced by
the patient’s emotions and environment.

6. Pain Classified by Location
Pain can also be categorized according to location (eg,
pelvic pain, headache, chest pain). This type of
categorization aids in communication about and treatment of
the pain.
For example, chest pain may suggest acute coronary
syndrome (ACS) and indicates the need for diagnostic
evaluation and treatment according to cardiac care
standards as appropriate.

7. Pain Classified by Etiology
Pain can also be categorized by etiology. Burns pain are
examples of pain described in terms of their cause.
Clinicians often can predict the course of pain and plan
effective treatment using this categorization.

9. The Nurse’s Role in Assessment
and
Care of Patients with Pain

10. Importance of Pain Assessment and
Management
Pain management is considered such an important part of
care that it is referred to as “the fifth vital sign” to emphasize
its significance and to increase the awareness among health
care professionals of the importance of effective pain
management.

11. Assessment
Characteristics of Pain
Intensity
Timing
Location
Quality
Personal Meaning
Aggravating and Alleviating Factors
Pain Behaviors

12. There is no correlation between reported intensity and the
stimulus that produced it. The reported intensity is influenced
by:
** the person’s pain threshold,
** the smallest stimulus for which a person reports pain,
** and pain tolerance, the maximum amount of pain a
person can tolerate

13. Examples of
pain intensity
scales.

14. Faces Pain Scale–Revised. This pain scale is especially suited for helping children
describe pain .
** Score the chosen face 0, 2, 4, 6, 8, or 10, counting left to right, so 0 no pain and
10 very much pain.
** Do not use words like “happy” or “sad.”

15. In addition to verbal communication, look for nonverbal
messages communicated through gestures, posture, body
movements, and facial expressions. During your physical
examination, assess the patient’s respiratory rate, blood
pressure, pulse, and skin color and condition.

16. Pain Management Strategies
Pain management strategies include both pharmacologic
and nonpharmacologic approaches:-

17. ** Opioid Analgesic Agents: (Morphine ,Codeine…)
** Nonsteroidal Anti-inflammatory Drugs: (Ibuprofen
,Aspirin,…)
** Local Anesthetic Agents : ( lidocaine 5% )
** Tricyclic Antidepressant Agents and Antiseizure Medications
Agents Used to Treat Pain (pharmacologic)

19. Nursing care of the patient in pain
NURSING DIAGNOSIS: Pain
GOAL: Relief of pain or decrease in intensity of pain

20. Nursing Interventions
1. Reassure patient that you know pain is real and will assist
him or her in dealing with it.
2. Use pain assessment scale to identify intensity of pain.
3. Assess and record pain and its characteristics: intensity,
location, quality, frequency, and duration.
4. Administer balanced analgesic agents as prescribed to
promote optimal pain relief.

21. 5 . Administer pain medication around-the-clock, as ordered.
6 . Provide comfort measures, such as back massage,
positioning, linen changes, and oral or skin care.
7 . Teach noninvasive techniques to control pain, such as
relaxation, guided imagery, distraction, and cutaneous
stimulation.

22. 8. Explain the role of sleep and the importance of being well
rested.
9. Document severity of patient’s pain on chart..
10. Instruct patient and family about potential side effects of
analgesic agents and their prevention and management.