Hi! My name is Jill Beavers-Kirby. And today, we’re
going to be talking about pharmacological
pain management. So, we’re going to be covering
the theories of pain, nursing assessment,
nursing diagnosis, nursing plans, and interventions
for pain management, nursing assessment of
the pain relief techniques. So, what is pain?
Pain is whatever the experiencing person says
it is. Pain often goes untreated and unrecognized.
Healthcare professionals often think that
the client is going to become addicted to
pain medication. A client’s response to
pain is often determined by several factors.
Pain is either acute or chronic.
So, theories of pain. There are basically two
theories of pain. One is the gate control
theory. This involves the peripheral nerves
and the spinal cord. Pain is sensed by the
peripheral nerves, travels along the impulses
through these nerve fibers, and picked up
by the synapses of the dorsal horn of the
spinal cord. These synapses act like gates.
When closed, they block the pain impulses.
When open, they allow the impulses to be felt.
Large nerve fibers, like those stimulated
by the head such as things like cold or when
you get a back rub, are those that sense these
pain fibers. A bombardment of these large
fibers is what makes us feel this pain.
The other theory of pain is the endorphin
and enkephalin theories. Endorphins are naturally
occurring stimulis that occur inside of us
all. You’ve often of the runner’s high.
People that run long distance often release
the endorphins. Runners get these endorphins
that act like opioids stimuli and block certain
pains. These are the body supply of natural
neuropeptides which are opioid-like substances,
and they are composed of amino acids. When
our body releases endorphins, they block pain.
These are secreted in the central nervous
system and help us prevent us feeling pain
and a trauma situation also. So for example,
if you’ve had a sudden traumatic
injury such as cutting off your finger, your
body releases endorphins and you don’t feel
that pain immediately. These endorphins are
controlled by your central nervous system.
Enkephalins are also naturally occurring opioid-like
stimuli that occur in our body. These are
found in the dorsal horn of our central nervous
system. So, how do we assess someone with
pain? First, we want to ask the location of
the pain, and maybe localizing as when you
cut your finger off, and maybe radiating like
when you hurt your back and it radiates down
your leg. Or it may be what we call a
This is common in the abdominal area. Sometimes
a person will have a gallbladder pain but
it radiates down to the other side of the
body across the belly over through the belly
button. Then we want to ask about the intensity
of the pain. How bad is it? You want to ask
the person on a zero to ten score, zero being
no pain, ten being the worst pain you felt
in your life. Or if it’s a younger client,
you want to maybe give them a scale of happy
faces. One with a very, very sad face and
one with a very happy face, and say, “On
this happy face scale, where is your pain?”
Then you want to ask about comfort. What makes
the pain better? Does lying down make the pain
better? Does putting a warm compress make
the pain better? Does curled up in a little
ball make the pain better? You also want to
ask them about the quality of the pain. Is
it sharp? Is it stabbing? Is it cramping?
Is it throbbing? Allow the patient to also
use their own terms to describe the pain.
You want to ask about the chronology of the
pain. When did it start? Does it go on forever?
Does it come and go? How often does this happen?
Then you want to ask the patient their subjective
terms. So, what have you done for this pain?
What symptoms have you noticed with this pain?
Does it happen when you eat a certain type of
food? And you want to make sure you document
all of this. So then, what kind of nursing
you document with this pain? So for example,
with the cutting off of the finger, you might
want to say acute pain related to traumatic
amputation of a finger. Or if it’s a chronic
back pain injury, chronic pain related to
work-related back injury. Or impaired comfort
related to abdominal cramps, secondary to
pancreatitis. Or activity intolerance related
to chronic pain. Or, you know, there are some
patients who have such chronic pain, they can’t
bath themselves anymore. So you could even have
impaired activities of daily living intolerance
because of their chronic pain. So, what are
nursing interventions for pain
management? Well, there are things like nonsteroidals.
These are very common. These are things like
ibuprofens, advils. There are also nonnnarcotics.
These act as opioids and they bind with the
opioid receptors. These are things like Ultram,
also known as tramadol. But they can, all
medications, whatever they are, even prescription,
non-prescription, even oxygen, every medication
has a side effect. So, most of these medications,
nonnarcotics and nonsteroidals have certain
common side effects. Nausea, vomiting, diarrhea,
constipation, big, big side effect. And they
can cause some depression of your central
Narcotic pain medications, such as oxycodone,
oxycontin, morphine, hydromorphone, these
can also cause depression of your central
nervous system, also have big complication
with constipation. And as we all know, there
is a potential for addiction and abuse potential.
They can also have, with the addiction and
abuse potential, withdrawal symptoms.
So, what are some nursing interventions for pain
management? There are some noninvasive methods
such as relaxation, destruction. This can
simply mean just asking the patient to imagine
that they’re laying on a warm beach, feeling
the warmth of the sun, listening to the birds
fly overhead, helping that patient just think
about something else other than being in pain.
Or there are adjuvant medications to go along
with analgesic medications, such as Cymbalta,
also goes along with pain medication to help
block these nerve impulses. There is lidoderm
patches that go along with pain medications
to help block pain in a topical way.
There are invasive methods that physicians give,
but nurses are also on hand to help with these
invasive methods. Some of these methods include
nerve blocks, radio frequency nerve root ablations
or joint injections of steroids. Some other
routes of administration for pain
medications include oral such as just giving
a patient a pill, intramuscular, rectal, IV,
patient-controlled analgesics, this is a great
way to give a patient medication.
Studies have found that when a patient has a PCA,
they actually end up using less pain medication
and they are more satisfied with their pain
control. Subcutaneous and fusions, these are
also great for people with chronic long-term
pain issues. Epidurals, this is often used
in childbirth and labor, and transdermals
such as a fentanyl patch. This is also a great
route for a patient with a chronic
Some other nursing interventions for pain
management. We would also want to note the
response to the pain. We don’t want to keep
giving a patient Tylenol if it’s not helping.
So, we would want to ask the patient, how
is that medication? Did it work? We want to
readdress the pain score. Before, you rated
your pain an eight out of ten. An hour later,
how do you rate your pain now? So, we always
need to follow up and assess our intervention.
We also want to assess the client for physical,
emotional, and mental. Is the patient feeling
better overall? Oftentimes with pain comes
So, we also want to see if the patient is
asking for more doses. Is the patient saying,
“This didn’t help at all, give me something
stronger”? That obviously is a sign that
what we gave them before didn’t help. And we also
need to evaluate the client’s understanding
of the pain. If the client is saying, “I
want my pain totally gone,” that’s not
feasible. We need to educate the patient that,
“At this time, let’s try to just make
your pain tolerable.” That’s maybe a goal
that you and the patient can come to together.
So, pain, as a review. It’s whatever the
client says it is. There’s the gate theory
of pain, there’s the endorphin and enkephalin
theories of pain. Pain can be influenced by
a patient’s background and past experiences.
Nursing assessment needs to include the location,
the intensity, the quality, the chronology,
and the subjective. Nursing diagnosis can
include acute or chronic pain related to,
impaired comfort related to, activity and
tolerance related to. Nursing interventions
would include pharmacological
interventions, noninvasive methods, invasive
methods, and adjuvants to analgesics.
Routes of administration include oral, IM, epidural,
topical, rectal, IV, PCA, subcutaneous.
The nursing assessment of pain relief techniques
includes: the response to the interventions,
the client objective and subjective measures.
Do the adjustments help?