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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