Pain/Comfort

Pain is whatever the experiencing person says it is, existing whenever the person says it does.

Scope

Intensity

Frequency

Location

Inferred pathology

Duration

• Acute

• Chronic (persistent)

• Combination (acute and chronic)

• Nociceptive

• Neuropathic

• Combination (nociceptive and neuropathic)

• Mixed pain syndromes

Pain classification

Inferred Pathology

• Nociceptive

• Neuropathic

• Combination (nociceptive and neuropathic)

• Mixed pain syndromes

Physiologic Processes and Consequences

• Triggers stress response

• Accelerated metabolic processes

• Impaired immunity

• Cardiovascular effect

• Respiratory system effects

Risk Factors

Populations at Greatest Risk

Older adults

neonates

Individual Risk Factors

• Chronic conditions (multiple)

• Acute or traumatic injury

• Medical procedures and treatments

Inability to communicate or speak (nonverbal)

Assessment

Patient Self-Report of Pain

• Location

• Intensity

• Quality

• Onset or duration

• Alleviating or relieving factors

• Effect of pain on quality of life and functional status

• Comfort function goal

Behavioral Signs of Pain

Breakthrough Pain

Reassessment

Assessment Challenges

Clinical Management

Hierarchy of Pain Measures

Obtain patient self-report.

Consider patient condition and exposure to painful procedures.

Observe for behavioral signs of pain.

Evaluate psychological indicators.

Conduct an analgesic trial.

Pharmacologic Strategies
to Treat Pain

• Non-opioid analgesics

• Opioid analgesics

• Adjuvant analgesics

Non-pharmacologic Strategies

• Massage

• Positioning and body alignment

• Splinting

• Thermal interventions (heat and cold)

• Mind–body therapies

Interrelated Concepts

• Cognition

• Mood and affect

• Functional ability

• Culture

• Development

• Functional ability

• Issue Integrity

• Mobility

• Fatigue

• Sleep

• Mood and affect