Pain

Is the sensation of physical or mental hurt or suffering that causes

emotional agony to the one experiencing it
An unpleasant sense caused by signals from some sense nerve
endings. It is a basic symptom of inflammation and is an important
clue to the cause of many disorders.
Pain may be mild or severe, chronic, acute, cutting, burning, dull, or
sharp, exactly or poorly located, or referred
Subjective response to physical and psychologic stressors
Considered as the 5th vital sign

Key Concepts

Subjective

Protective Response

Relevant Concepts
1. There are receptors that detect tissue injury, they are called
nociceptors
2. There are neurotransmitters involved in the processing of
pain perception.
These are:

Serotonin Also called 5-hydroxytryptamine.

A substance found naturally in the brain and
intestines. Serotonin is released from certain
cells when the blood vessel walls are damaged.
It acts as a strong vessel-narrowing substance.

Histamines

a compound, found in all cells, produced by the

breakdown of histidine.
It is released in allergic reactions and causes
widening
of capillaries,
decreased
blood
pressure, increased release of gastric juice, and
tightening of smooth muscles of the bronchi and
uterus.

Bradykinins
A chemical made by the body that widens the
blood vessels. (vasodilator)

Prostaglandin

One of several strong hormonelike fatty acids

that act in small amounts on certain organs.
They are made in tiny amounts and have many
different effects. Prostaglandins given by nasal
spray, in tablets, or dissolved in liquids cause
changes in smooth muscle tone, hormone
functions, and in the autonomic and central
nervous systems.
Prostaglandins are used to end pregnancy and to
treat asthma and too much stomach acid.

3. There are Polypeptides that binds with receptors in the

brain and Spinal cord which has morphine-like characteristics

Enkephalins

one of two pain-relieving substances made in

the body.
found in the pituitary gland, brain, and stomach
and bowels.
It is believed that enkephalins can slow nerve
activity through the central nervous system.
They slow nerve signals to indicate pain, which
reduces the mental and physical sensation of
pain

Endorphins
Endorphins are composed of amino acids.
They are made by the pituitary gland and act on
the nervous system to reduce pain.
They produce effects like that of morphine

Types of Pain
General Classification
I.

Acute Pain
1. Somatic Pain

Originates from the superficial structures like the skin and

deeper structures like muscles, usually sharp and
localized

2. Visceral pain
Originates from the viscera (the internal organs held within a
space in the body, mainly the stomach and intestines.)
Usually accompanied by autonomic symptoms like
vomiting
Usually poorly localized
3. Referred Pain
Pain felt in areas other than those stimulated or pain
perceived in an area distant from the site of the stimuli.
It occurs in response to visceral injury
II.

Chronic Pain- Prolonged pain usually more than 6 months

Categories of Chronic Pain

Recurrent Acute Pain

o Characterized by relatively defined episodes of
pin interspersed
with pain free episodes.
Example: migraine head aches

On going time limited pain

o Identified by a defined time period. Examples
are cancer pains, which ends with the control of
the disease or death, or burn pain which ends
with rehabilitation or death

Chronic Non-malignant pain

o Is a non threatening pain that nevertheless
persist beyond the expected time for healing.
Chronic lower back pain falls into this category

III.

Chronic intractable non malignant pain syndrome

o Is similar to simple chronic nonmalignant pain,
but is characterized by the persons inability to
cope well with pain and sometimes by physical,
social or psychologic disability resulting from
pain
Others Pains
4. Psychogenic Pain
Pain that occurs with no physiologic basis

It originates in the mind of the patient

5. Phantom Limb pain

Pain perceived that is occurring in an extremity that has
been amputated

6. Central Pain
Related to a lesion in the brain that may spontaneously
produce high frequency burst of impulses that are
perceived as pain
A vascular lesion, tumor , trauma or inflammation may
cause this
Example: Thalamic pain
Terms to remember

Trigeminal Neuralgia- Neuritis of the trigeminal (fifth cranial) nerve,

characterized by severe pain in the face occurring in sudden
paroxysms. Tic douloureux.

Causalgia- A burning sensation in the palms, soles or digits, thought

to be due to irritation or disease in the nerves supplying these areas.

Neuralgia- Pain along the route of a nerve. this is a result of damage

to the peripheral nerve caused by infection or disease

Dystrophies- characterized by continous severe burning pain.

These conditions follow peripheral nerve damage and present the
symptoms of pain, vasospasm, muscle wasting and vaso motor
changes( vasodilation followed by vasoconstriction)

Hyperesthesias- are conditions of oversensitivity to tactile and

painful stimuli. This results in diffuse pain that is usually increase by
fatigue and emotional lability

Myofascial pain syndrome- common condition by injury or disease

of muscle or fascial tissue results fro muscle spasm, stiffness and
collection of acid in the muscle

Theories of Pain
1. Pattern Theory

Contends that pain results from combined results from

intense stimulus and interpreted in the dorsal horns of the
spinal cord
States that pain is perceived if the stimulus is intense
enough

2. Specificity Theory

States that there are specific nerve recptors for a particular

stimulus
Nociceptors for pain; Thermoreceptors for heat and cold

3. Gate Control Theory

Contends that pain and pain perception result from the

interplay of three systems: 1) Substancia Gelatinosa,[dorsal
horn of the spinal cord] 2) Thalamus ( the Central Control), 3)
peripheral nerves [transmission]

Also contends that pain impulses are transmitted by2 types

of nerve fibers
1. A-delta fibers (myelinated)
2. C- Fibers (unmyelinated)

Proposes that a gate mechanism in the substancia

gelatinosa can be closed completely or partially to block the
pain impulse.

Assessment of Pain
Subjective Data

Characteristics and description of pain as to site severity,

duration,, intensity and type
Measures to relieve pain]
Factors that worsens pain]
Coping strategies
Medications being taken
Interference with the ADL, social, job and family

Objective Data

Physiologic

o Vital signs, pallor,diaphoresis, dilated pupils,

muscle tension, nausea and vomiting
Behavioral
o Restlesness, clenched teeth and fist, rigid body
posture, crying ,moaning and frowning
Nursing Care
1. Assist the client to find positions to relieve pain or that provide
comfort
a. There is frequent change of position
b. Moving the patient gently]
c. The use of pressure relieving aids
d. Backrub
2. Assist the patient with hygiene
3. Maintain comfortable temperature in the environment
4. Utilizes distraction to relieve pain