The Challenge of Pain Control
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Transcript The Challenge of Pain Control
Marilyn Gripping
Sept. 18, 2010
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Disclaimer
The views and opinions I present today are entirely
my own. They do not necessarily reflect the views
of the Calgary Health Region, or either of
Norquest or Bow Valley Colleges.
My views and opinions should not be construed as
an official explanation or interpretation.
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Disclosure
I have no relationship that could be
perceived as placing me in a real or
apparent conflict of interest in the
context of this presentation.
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What is Pain?
“An unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage or
described in terms of such
damage.” (Jovey, page 9)
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“Whatever the person
experiencing it says it is and
exists whenever he says it
does.” (Linton, 202)
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Factors Influencing Pain
Experience
Pain Threshold
Pain Tolerance
Age
Physical Activity
Nervous System Integrity
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Surgery/Anesthesia
Culture
Religious Beliefs
Past Experiences/Anxiety
Situational Factors
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Perception of Pain
Afferent pathways
Nociceptors
CNS
Pain receptors
Spinal cord
Brain
Efferent pathways
Descending pathway
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Endorphins and Enkephalins
Body’s natural opioid-like substances
Block transmission of pain to spinal cord
Individuals produce different amounts
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Decrease Endorphins
Prolonged stress
Pain
Use of opioids
Alcohol
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Increase Endorphins
Brief stress
Pain
Laughter,
Exercise
Acupuncture
Transcutaneous Electrical Nerve Stimulation (TENS)
Massive Trauma
Sexual Activity
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Gate-Control Theory
Pain reflects both physical and
psychosocial factors
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Gate-Control Theory
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Gate-Control Theory – con’t
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Gate-Control Theory – con’t
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Types of Pain
Acute
Subacute
Chronic
Baseline Pain
Breakthrough Pain
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Categories of Pain
Nociceptive
Somatic
Visceral
Neuropathic
CNCP (Chronic Non-Cancer Pain)
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Pain Severity
Pain Scale
Pain is rated on a scale of 0-10
where “0” is no pain and “10” is the
worst pain imaginable or the worst
pain the person has ever had.
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Statistics
1/3 of all people suffering with chronic pain are treated
successfully with NSAIDs
Chronic pain in elderly is very common and is often
undertreated
Risk of addiction is usually less than the need to
control chronic pain
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The Treatment Continuum
Most efficient use of locally available
medical resources
More available, less expensive, less invasive,
fewer side effects
Less available, more expensive, more
invasive, more side effects
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Examples:
Physical
Psychological
Pharmacological
Invasive Therapies
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Prescribing of pain meds
Dose to effect
Exceptions:
NSAIDS
Antidepressants
Anticonvulsants
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Analgesic Ladder
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Adjuvants
Drugs primarily developed to
treat other conditions
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Bibliography
Dhalla, Irfan A, et al. (2009). Prescribing of opioid analgesics and related
mortality before and after the introduction of long-acting oxycodone. CMAJJAMC, 181 (12), 891-896.
Fischer, Benedikt, Rehm, Jurgen (2009). Deaths related to the use of
prescription opioids. CMAJ-JAMC, 181 (12), 881-882.
Jovey, Roman D. (Ed). (2008). Managing Pain – The Canadian Healthcare
Professional’s Reference. (2008 Edition). City: Purdue Pharma.
Kozier, B., Erb. G., Berman, A., Snyder, S., Bouchal, D.S.R., Hirst, S., et al.
(2010). Fundamentals of Canadian Nursing: Concepts, process and practice (2nd
Canadian ed.) Toronto: Pearson Education Canada.
Linton, A. (2007). Introduction to medical-surgical nursing (4th ed.).
Philadelphia, PA: Saunders.
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