Pharmacological Pain Management (Nursing)

00:02 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.

00:45 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.

01:10 When closed, they block the pain impulses. When open, they allow the impulses to be felt.

01:17 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.

02:12 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.

02:33 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 referred pain.

03:01 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.

03:59 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 diagnosis would 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 nervous system.

06:06 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.

06:27 They can also have, with the addiction and abuse potential, withdrawal symptoms.

06:33 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.

06:58 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.

07:20 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.

07:57 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 long-term pain.

08:23 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.

08:34 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.

08:52 We also want to assess the client for physical, emotional, and mental. Is the patient feeling better overall? Oftentimes with pain comes depression.

09:04 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.

09:35 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.

10:23 Routes of administration include oral, IM, epidural, topical, rectal, IV, PCA, subcutaneous.

10:33 The nursing assessment of pain relief techniques includes: the response to the interventions, the client objective and subjective measures. Do the adjustments help?