social ‎cognitive ‎theory ‎(bandura ‎ ‎theory)

 

Pain Management

Pain management is the alleviation of pain or reduction in pain to level of comfort that is acceptable to the patients. Effective management of long term pain, however, frequently requires the coordinated efforts of the management team.

The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners

    It includes two basic types of nursing interventions:

ü    Pharmacologic intervention.

ü    Non-pharmacologic intervention.

I.      Pharmacologic Interventions

Using pharmacological method to control pain requires attention to four "Rights" right drug right does right rout and right time. There are two primary groups of pain medications: non opioid and opioid. A third group of drugs called adjuvant or analgesics, address symptoms that often accompany pain, such as insomnia, anxiety, muscle spasm, anorexia, and depression.

 

(A) Non opioid Analgesics

Non opioid analgesics relieve pain by acting on peripheral nerve endings at the injury site to decrease the level of inflammatory mediators. This group of analgesics includes drugs such as acetaminophen (Tylenol) and non steroidal anti-inflammatory-drugs (NSAIDs) such as acetylsalicylic acid (aspirin) and ibuprofen (Motrin). The specific actions and dosages of these analgesics vary. Generally speaking, however, they have analgesic, antipyretic, and anti-inflammatory effects and are useful for mild to moderate pain With the exception of acetaminophen, most non opioid are potent anti-inflammatory agents. These drugs are especially effective when the primary cause of pain is inflammation, as occurs in rheumatoid arthritis and bone cancer.

 (B) Opioid Analgesics

Opioid (narcotic, CNS-acting) analgesics are derivatives of opium and include   such drugs as morphine, codeine, and methadone. These Opioid works at the level of the central nervous system, decreasing the perception of pain. The primary action of opioid (narcotics) is to alleviate moderate to severe pain. Many of the unwanted effects of this class of drugs are related to their actions on systems of the body other than the CNS, causing such effects as constipation and respiratory depression drug tolerance, chemical dependency, and addiction may occur

II.   Non pharmacologic Interventions

There are many non pharmacologic interventions to give pain relief, especially when used in conjunction with pharmacologic measures. Described as physical and cognitive-behavioral interventions, many of these approaches are non invasive, low-risk, inexpensive, easily performed and taught, and within the scope of nursing practice.

 
1) Comfort measures:

Such as clean, smooth sheets, soft, supportive pillows, warm blankets, and a soothing environment have been used by nurses through out history to relieve pain and suffering.

2) Position change and movement:

We are well-known pain-relieving interventions. Moving the body, even a small amount, relieves muscle spasm and provides a degree of pain relief

3) Massage:

Relieves muscle spasm, improves circulation, and provides cutaneous stimulation. While there are many different massage techniques, they all involve rubbing the skin in various patterns and degrees of pressure.

 

 

 

4) Applications of hot and cold:

Are effective pain-relieving measures when used appropriately, hot decreases muscle spasm and increases blood flow to an area. Cold decrease blood flow, edema, and inflammation and may decrease muscle spasm and pain

5) Transcutaneous electrical nerve stimulation (TENS):

Provides a continuous, mild electric current via 2 to 4 electrodes placed on the skin near a painful site. The stimulator is a small, battery operated devise worn by the patient. Experienced as a tingling sensation, TENS works by stimulating large nerve fibers to close the "gate" in the spinal cord. It also may stimulate endorphin production. TENS may be used for acute postoperative pain or for chronic conditions, such as low back pain, phantom limb pain, and neuralgia.

6) Distraction:

Distraction can be helpful particularly for babies, by using colorful, moving objects. Singing songs, telling stories or looking at books or videos can distract preschoolers. Older patients find watching TV or listening to music helpful. Distraction should not be a substitute for explaining what to expect.

7)             Touch:

        Nurses, when using touch, are usually trying to convey understanding, support, warmth, concern, and closeness to the patient. Touching not only contributes to the patient’s sense of well-being, but also promotes physical recovery from disease.

8) Imagination:

        Guiding a patient through an imaginary mental image of                  sights, sounds, tastes, smells, and feelings can often help shift attention away from the pain.

      9)    Relaxation:

Patient can be guided through relaxation exercises such as deep breathing and Stretching to reduce discomfort. Relaxation exercises are useful ways to reduce anxiety, decrease muscle tension, and lower blood pressure and heart rate. They induce a state of altered consciousness and give patient a sense of control and peace of mind. Meditation, Zen, yoga, and other such interventions may effectively relieve pain. One such exercise involves controlled breathing.

10)  Acupuncture

Is based on the belief that life forces or energy move through the body in specific paths. These paths are called meridians. With acupuncture, a needle is put into the meridian that runs to the area where you have pain. This needle blocks the meridian which stops or decreases the pain.

11) Aromatherapy:

Is a way of using good smells to help you relax and decrease pain? Candles, massage oils, scented bubble baths and even baking cookies are all ways that smells are used. Scientists are learning that good smells may change your mood and help you relax. It may also help your brain makes special chemicals like endorphins .Endorphins are a natural body chemical like morphine that decrease pain..

12) Laughter:

It has been said that "10 minutes of belly laughter gives 2 hours of pain-free sleep!" Laughter helps you breathe deeper and your stomach digest (break down) food. It lowers blood pressure and may cause your brain to make endorphins. Laughter can also help change your moods. It helps you relax and let go of stress, anger, fear, depression, and hopelessness. These are all parts of chronic pain

13) Music:

  Music increases blood flow to the brain and helps you take in more air. Scientists are learning that it increases energy and helps change your mood. Music also may cause your brain to make special chemicals like endorphins. People who use music often say it decreases their need of medicines for pain and anxiety.

Nursing role in pain management

v The role of the nurse in assessment and management of pain varies according to :

§  Type of pain being cared e.g. age, sex, educational level, diagnosis, expected prognosis, medical management.

§  Setting in which care is delivered.

§  Educational background and experience of individual nurse.

v In acute care setting , the nurse occupies a central position in :

§  Assessing the individual with pain.

§  Administering prescribed selected pain management modalities.

§  Monitoring the condition of person in pain.

 

v for those individual s experiencing chronic pain who are being discharged from hospital , nurses are to :

§  Assess the congruence between person׳s condition and needs for care.

§  Link between the person's needs and the community resources.

§  Maintain the ongoing communication between the patient, family and other care providers.

v Nurses should start intervention before the level of pain becomes unbearable.

v Because pain is a subjective experience nurses should maintain good communication pattern with their patients.

v The nurse should respect and does not ignore patient's complain.

v Nurses should teach the patient and his family about pain and its management and scheduling medications in relation to patient׳s need

v Moreover, nurses should teach the patient and his family how to use the complementary pain relief methods in combination with medication to achieve effective relief.

v All persons who are experiencing pain are ought to be attended by the nurse who aims to relief their pain to the greatest possible extent.

v Fear of addiction to pain relief medications should not be a barrier in pain management.

v All people have the right to have their pain relived even with use of opioid, and even if they have a history of substance abuse.

v Nurses should continue pain management even if persons become unresponsive.

v Nurses should encourage continuity of care within and across health care setting for the achievement of effective pain management.

v An interdisciplinary approach to pain management should be reinforced by nurse advocacy for their patients.

v  Sedation is an acceptable mean of pain management when all other reasonable have failed.

 

 

 

 

 

 

v The nurse should assist in treatment modalities such as :

·        Range of motion exercises.

·        Position change.

·         Comfort measures.

·        Application of hot or cold packs.

·        Hydro therapy.

·        Paraffin wax therapy.

·        Cold laser.

·        Music therapy.

·        Peer support group.

·        Relaxation techniques.

·        Imagery , distractions