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16.1 The Pain Process

Pain can be classified and described in many different ways. The duration, location, and cause are all important factors when assessing and treating pain. The physiologic process of pain describes how the brain is alerted to painful stimuli and how it can modify and adjust the amount of pain that is felt in the body. Biological, psychological, and social factors can affect the perception of pain and impact how patients react. The central nervous system can also determine which pain signals are allowed through to the brain. This gate control theory can help nurses understand how pain is perceived under different circumstances.

Nurses must be aware of the factors that can affect pain and patients’ perceptions of pain. One patient may perceive pain differently than another patient does, but both are right in their assessment. Nurses must accept the pain as whatever the patient says it is and individualize pain management strategies for each patient.

16.2 Responses to Pain

Physiologic, behavioral, and emotional responses to pain are the brain’s way of keeping the body safe in signs of danger. The sympathetic and parasympathetic nervous systems allow the body to initiate responses that either fight or run away from a perceived threat. Behaviors, emotions, and vital sign changes such as elevated blood pressure, heart rate, and respiratory rate can all be ways that patients express signs of pain.

Behavioral and emotional responses to pain can vary among patients. Some patients may vocalize their pain or express body movements and social interactions that demonstrate pain. Some patients may experience negative emotions such as fear and anxiety when dealing with pain. Nurses must be aware of all physiologic responses to pain and know that these responses can vary greatly among patients. Physiologic responses to pain are involuntary and are often the first reaction a patient will have to pain. These responses can help healthcare providers assess pain and develop effective strategies for managing pain.

16.3 Factors Affecting Pain

There are many factors that play a role in pain. Psychosocial factors can influence a patient’s perspective on pain. A patient who associates pain with trauma may have a hard time coping with chronic pain. Physiological factors such as developmental level and age can change a patient’s perception and expression of pain over time. A patient’s psychological view of pain can influence how effective pain management strategies can be. A patient who catastrophizes their pain may have worse outcomes than a patient who expects their pain medication to be effective. Nurses play an important role in educating patients about these factors. Patients’ awareness of these factors and their effect on pain can make a big difference in pain management outcomes.

16.4 Pain Assessment

A comprehensive pain assessment must include subjective and objective data. Collecting subjective data involves choosing an appropriate pain rating scale, asking open-ended assessment questions, and accepting the pain is whatever the patient says it is. Collecting objective data involves performing a physical assessment, measuring vital signs, and assessing nonverbal behavior. Each pain assessment may have different ways of collecting subjective and objective data. The nurse should choose the pain assessment tools that are appropriate for each patient.

Pain assessments, interventions, and evaluations should be performed and documented in a timely manner to ensure adequate pain relief is achieved. Documentation of pain management ensures the patient receives timely and effective treatment. Pain management strategies cannot be deemed effective without comprehensive assessment and documentation. Pain management is an ongoing concern for patient care, and a quality pain assessment is the first step to effective pain relief.

16.5 Pain Management

There are many different types of interventions that can be used for pain management. Pain management should always include patient involvement and a combination of nonpharmacological and pharmacological interventions. Nurses have a responsibility to provide adequate pain management to all patients and will encounter pain in all types of healthcare settings.

Pharmacological therapy can be very effective in managing pain but must be used with caution. There are many risks and side effects, especially with opioid analgesics. Nurses must be aware of the risks and ensure patients are educated on appropriate dosing and monitoring when taking these medications. Patient-controlled analgesia (PCA) can also be an effective way to manage pain and involve the patient in their care. However, PCA is also not without risks. Nurses must be vigilant when monitoring a patient receiving PCA and ensure the patient meets criteria to be able to understand how to use PCA.

Nonpharmacological therapy can also be an effective pain management strategy, especially when paired with pharmacological therapy. Interventions such as physical therapy, guided imagery, and distraction can be effective pain management strategies without the same risks as pharmacological therapy. Nonpharmacological pain interventions have been shown to be effective in treating all types of pain and allow patients to avoid the side effects and risk of chronic issues such as addiction and overdose from opioid analgesics. Being aware of all types of pain management strategies is essential for all nurses and helps nurses effectively manage pain.


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