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Concept of Pain
(Different therapies)
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Faculty: Ms. Mussarat Fatima
Assistant Professor,
People’s school of Nursing, LUMHS
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24, 2024
3 Students’ Pre knowledge testing
Choose the best answer.
1.Pain is a signal in your nervous system that something may be___________
a) Right
b) Light
c) Heavy
d) Wrong
2. The best judge of your pain is_____________
a) Your doctor
b) Your nurse
c) You
d) No one
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4 Conti..
3. A pain message is transmitted to the brain by specialized nerve cells known as
a) Nociceptors
b) Chemoreceptor
c) Baroreceptor
d) Thermoreceptor
4. ______________ is the ability of CNS to control the pain permitting neurons.
a) Transduction
b) transmission
c) Modulation
d) Perception
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5 Conti..
5. The type of pain that can be continue even after the injury or illness that
caused it has healed or gone away is known as:
a) Acute pain
b) Referral pain
c) Back pain
d) Chronic pain
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6 Objectives
At the end of this presentation learners will be able to:
1. Define the process of pain.
2. Describe different theories of pain.
3. Differentiate between acute pain and chronic pain.
4. Discuss the non pharmacologic intervention for pain
management.
5. Identify pharmacologic management of pain.
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Pain
Pain occurs when something hurts, causing an uncomfortable or
unpleasant feeling.
The presence of pain often means that something is wrong.
The best judge of your pain is you
Pain is a signal in your nervous system that something may be
wrong.
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8 Conti..
It is an unpleasant feeling, such as a prick, tingle, sting, burn, or
ache. Pain may be sharp or dull. It may come and go, or it may be
constant.
You may feel pain in one area of your body, such as
your back, abdomen, chest, pelvis, or you may feel pain all over.
Pain can be helpful in diagnosing a problem.
If you never felt pain, you might seriously hurt yourself without
knowing it, or you might not realize you have a medical problem
that needs treatment.
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Process of pain
A pain message is transmitted to the brain by specialized nerve cells
known as nociceptors, or pain receptors.
When pain receptors are stimulated by temperature, pressure or
chemicals, they release neurotransmitters within the cells.
Neurotransmitters are chemical ‘messengers’ in the nervous system
that facilitate communication between nerve cells.
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Changes occurs during pain
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12 Pain theories
Gate control theory.
Intensive theory
Specificity theory
Strong’s theory
Pattern theory
Central summation theory
The fourth theory of pain
Sensory interaction theory
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13 Gate control theory
(neural pathway of pain)
Transduction- noxious stimuli lead to electrical activity in
appropriate sensory nerve endings.
transmission- neural events that carry nociceptive input
into CNS for processing.
Modulation- ability of CNS to control the pain permitting
neurons.
Perception – subjective experience of pain .
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14 Gate theory
In 1965, Melzack & Wall theorized that there were systems in place
that modified the passage of impulses that travel along afferent
(including nociceptive) pathways.
The basic concept of gate theory is that the activity of inhibitory
interneurons suppress the ascending nociceptive signals and act
like gates to decrease transmission. Sunday, March
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The small unmyelinated afferent fibers inhibit interneurons but excite cells of
the spinothalamic tract;
while larger afferent cells excite interneurons of substantia gelatinosa.
The substantia gelatinosa is believed to house interneurons that regulate
the transmission of pain by inhibiting transmission along both small and large
diameter afferent fibers.
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16 Gate control theory
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18 Differentiate between acute pain and
chronic pain
Acute pain Chronic pain
Acute pain usually comes on Chronic pain is pain that is ongoing
suddenly and is caused by and usually lasts longer than six
months.
something specific.
This type of pain can continue even
It is sharp in quality. after the injury or illness that caused
Acute pain usually doesn’t last it has healed or gone away.
longer than six months. Pain signals remain active in the
nervous system for weeks, months or
It goes away when there is no years.
longer an underlying cause for
Some people suffer chronic pain
the pain. even when there is no past injury or
apparent body damage
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Acute pain Chronic pain
Causes of acute pain include: Chronic pain is linked to conditions
that include:
Surgery.
Headache.
Broken bones.
Arthritis.
Dental work.
Cancer.
Burns or cuts.
Nerve pain.
Labor and childbirth.
Back pain.
Fibromyalgia.
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21 Non pharmacologic intervention for pain
management
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22 Non pharmacologic intervention for pain
management
Non-pharmacological therapies are ways to decrease
pain without medicine.
Non-pharmacological therapies may help decrease
your pain or give you more control over your pain. This
can improve your quality of life.
.
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23 Conti..
some common therapies to help control pain are:
Heat helps decrease pain and muscle spasms. Apply heat to the
area for 20 to 30 minutes every 2 hours for as many days as
directed.
Ice helps decrease swelling and pain. Ice may also help prevent
tissue damage. Use an ice pack, or put crushed ice in a plastic bag.
Cover it with a towel and place it on the area for 15 to 20 minutes
every hour, or as directed
Massage therapy may help relax tight muscles and decrease pain.
Physical therapy teaches you exercises to help improve movement
and strength, and to decrease pain.
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24 Conti..
Relaxation techniques can help you relax, relieve stress, and
decrease pain. Common relaxation techniques include any of the
following:
Aromatherapy is a way of using scents to relax, relieve stress,
and decrease pain. Aromatherapy uses oils, extracts, or
fragrances from flowers, herbs, and trees. They may be inhaled
or used during massages, facials, body wraps, and baths.
Deep breathing can help you relax and help decrease your pain.
Take a deep breath in and then release it slowly. Do this as many
times as needed.
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Tense your muscles and then relax them. Start with the muscles
in your feet then slowly move up your leg. Then move to the
muscles of your middle body, arms, neck and head.
Meditation and yoga may help your mind and body relax. They
can also help you have an increased feeling of wellness.
Meditation and yoga help you take the focus off your pain.
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Guided imagery teaches you to imagine a picture in
your mind. You learn to focus on the picture instead of
your pain. It may help you learn how to change the way
your body senses and responds to pain.
Music may help increase energy levels and improve
your mood. It may help reduce pain by triggering your
body to release endorphins. These are natural body
chemicals that decrease pain. Music may be used with
any of the other techniques, such as relaxation and
distraction
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Pharmacologic management of pain
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3 step ladder, Originally developed by the World Health
Organization (WHO) to improve management of pain.
1. Non-opioid medications: Step 1 - WHO Analgesic ladder
Mild to Moderate pain.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as
aspirin, ibuprofen, naproxen, diclofenac weaken and
reduce the levels of chemical mediators.
Paracetamol also known as acetaminophen. Although it
is the most widely used pain relieving medication
Aspirin also known as acetylsalicylic acid (ASA)
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2. Compound analgesics: Step 2 on the WHO analgesic
ladder – mild to moderate pain
Compound analgesics are a combination of drugs in a
single tablet usually including codeine (a weak opiate)
and aspirin or paracetamol.
3.Opioid medications: Step 3 on the WHO analgesic ladder
– severe pain
Medications derived from morphine (or synthetic
analogs) mimic the body’s own analgesic system and are
strongest and most effective painkillers currently available
Opioid medications include morphine, oxycodone,
codeine, tramadol, buprenorphine, fentanyl and Sunday, March
diamorphine (heroin) 24, 2024
29 Conti..
Topical analgesics
Topical analgesics include rubefacients, topical NSAIDs
and local anesthetics
Topical capsicum may be prescribed for chronic pain
conditions such as post herpetic neuralgia and diabetic
neuropathy
Topical NSAIDs ( including ibuprofen, naproxen and
diclofenac ) are used in acute and chronic pain
conditions
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35 References
Brennan T., Joo T., Kehlet H., Mekhai N., & Woolf C. (2016).
Unraveling the Mechanisms and Clinical Consequences of Pain:
Recent Discoveries and the Implications for Pain Management: A
Case-Based Interactive Expert Forum. WebMD LLC. (accessed
28/12/2021).
Kaye V. & Brandstater M. (2015). Transcutaneous Electrical Nerve
Stimulation. WebMD LLC. (accessed 28/12/2021).
Middleton, C. (2003). Understanding the physiological effects of
unrelieved pain. Nursing Times. (accessed 28/12/2021).
Snell, R. (2010). Clinical Neuroanatomy (7th ed.). Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.Standring, S. &
Gray, H. (2008).
Gray's Anatomy. [Edinburgh]: Churchill Livingstone/Elsevier.
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