PAIN IN ENGLISH

                                              

                                              PAIN IN ENGLISH

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PAIN

•        Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is the most common reason for seeking health care. Example backache toothache headache etc.

TYPES OF PAIN

•        Pain is classified into three categories

•        Acute pain

•        Chronic pain

•        Cancer related pain

ACUTE PAIN

•        Acute pain is of recent onset and commonly associated with a specific and recent injury. Acute pain indicates that  damage or injury has occurred just now . Acute pain usually decreases as healing occurs. acute pain can last from seconds to 6 months.

CHRONIC PAIN

•        Chronic pain is constant or intermittent pain that persists beyond the expected healing time (6 months) and normally is difficult to associate the pain to a specific cause or injury. Frequently, nurses come across such patients in community based settings.

CANCER RELATED PAIN

•        Pain associated with cancer may be acute or chronic. Pain in patients with cancer can be directly associated with the cancer or as a result of cancer treatment (surgery, chemotherapy or radiation therapy)

HARMFUL EFFECTS OF PAIN

•        Effects of acute pain-

•        Unrelieved acute pain can affect our whole body. The pulmonary, cardiovascular, gastrointestinal, endocrine, and immune systems are affected by acute pain .

•        The stress response (Neuro-endocrine response to stress) occurs with severe pain. The widespread endocrine, immunologic, and inflammatory changes that occur with stress response can have significant negative effects on our body.

•        The stress response occurred due to severe pain may increase the risk of physiologic disorders such as myocardial infarction, pulmonary infection, venous thrombo-embolism and prolonged paralytic ileus .

•        Patients with severe pain and associated stress may be unable to take deep breaths and may experience increased fatigue and decreased mobility.

•        Effects of chronic pain-

•        Chronic pain also affects our body in same manner as acute pain. In addition to that chronic pain leads to Suppression of the immune function associated with chronic pain may promote tumor growth.

•        Chronic pain often results in depression and disability. Patients with a number of chronic pain syndromes may report depression, anger, and fatigue. Disabilities may range from an impaired ability to participate in physical activities to an inability to take care of personal needs, such as dressing or eating.

PATHOPHYSIOLOGY OF PAIN-

•        Pain experience involves activity of nociceptors. Nociceptors are neuronal receptors involved in the transmission of pain perceptions to and from the brain that respond to biochemical mediators or noxious stimuli.

•        Nociceptors are free nerve endings in the skin that respond only to intense, potentially damaging stimuli. Such stimuli may be mechanical, thermal, or chemical in nature. When these fibers are stimulated, histamine is released from mast cells, causing vasodilation.

•        The coetaneous nerve fibers further branch and communicate with the para-vertebral sympathetic chain of the nervous system and with large internal organs. As a result of the connections among these nerve fibers, pain is often accompanied by vasomotor, autonomic, and visceral effects.

•        Nociception continues from the spinal cord to the reticular formation, thalamus, limbic system, and cerebral cortex. The involvement of the reticular formation, limbic, and reticular activating systems is responsible for the individual variations in the perception of pain.

•        The descending control system is a system of fibers that originate in the lower and mid portion of the brain and terminate on the inhibitory inter-neuronal fibers in the dorsal horn of the spinal cord.

•        This system is always active; it prevents continuous transmission of painful stimuli, partly through the action of the endorphins. Cognitive processes may stimulate endorphin production in the descending control system.

•        The  gate control theory of pain, described by Melzack and Wall in 1965. This theory proposed that stimulation of the skin evokes nervous impulses that are then transmitted by three systems located in the spinal cord- The substantia gelatinosa, the dorsal column fibers, and the central transmission cells

•        The noxious impulses are influenced by a “gating mechanism.” Stimulation of the large-diameter fibers inhibits the transmission of pain, thus “closing the gate.” Conversely, when smaller fibers are stimulated, the gate is opened.

FACOTRS AFFECTING PAIN RESPONSE

•        The factors which affect pain response includes past experiences with pain, anxiety, culture, age, gender, genetics, and expectations about pain relief etc. These factors may increase or decrease perception of pain.

•        Past experience-

•        The people who have had multiple or prolonged experiences with pain will be less anxious and more tolerant of pain than those who have had little experience with pain. However,  individual variations may be there.

•        Anxiety and depression-

•        Anxiety that is relevant or related to the pain may increase the patient’s perception of pain. Anxiety that is unrelated to the pain may distract the patient and may actually decrease the perception of pain

•        Culture-

•        Understanding about pain and how to respond to it differ from one culture to the another. Early in childhood, people learn from those around them what responses to pain are acceptable or unacceptable.

•        Aging-

•        A gradual reduction in endoneural blood flow with increasing age, which may contribute to reduced peripheral nerve function and diminished pain perception. Old age people are reluctant to seek help even when in severe pain because they consider pain to be part of normal aging.

ASSESSMENT OF PAIN-

•        Assessment is an essential step in pain management following parameters may be used pain assessment-

•        Location

•        Intensity

•        Timing

•        Quality

•        Aggravating and Alleviating Factors

•        Location-

•        First parameter is location of the pain. In this  assessment a form may be used which includes drawings of human figures, on which the patient is asked to shade in the area involved. This is especially helpful if the pain radiates (referred pain). This data may help in making a diagnosis or cause of the pain.

•        Intensity-

•        Pain intensity is very subjective. The reported intensity is influenced by the person’s pain threshold, the smallest stimulus for which a person reports pain, and pain tolerance.  Pain intensity may have a range as No pain,   moderate pain or excruciating pain.

•        Timing-

•        Under this parameter the nurse inquires about the onset, duration, relationship between time and intensity (eg, at what time the pain is the worst), and changes in rhythmic patterns.

•        Quality-

•        Under this parameter the nurse asks the patient to describe what the pain feels like. The nurse must record all words in the answer. If the patient cannot describe the quality of the pain, the nurse can suggest words such as burning, aching, throbbing or stabbing.

•        Aggravating and Alleviating Factors-

•        Under this parameter the nurse asks the patient about what makes the pain worse and what makes it better and asks specifically about the relationship between activity and pain. This helps detect factors associated with pain.

PAIN MANAGEMENT-

•        Pain management is the process of relieving the pain and increasing comfort level for the patient. It is essential part of patient care.

•        Pain management requires two types of strategies-

•        Pharmacological management and

•        Non-pharmacological management

•        Pharmacological management –

•        There are a lot of pain medications which are prescribed by treating health professional to relieve pain. These medications are to be administered as per prescribed route , dose and schedule only

•         Non-pharmacological management-

•        Non pharmacological management of pain includes massage, thermal techniques such as hot and cold applications, Transcutaneous electrical nerve stimulation, distraction, hypnosis, music therapy and relaxation  techniques. These therapies are to be used under guidance of a physiotherapist only.