PAIN

DEFINITION
Pain is the complex multi dimensional experience that causes suffering and reduces the quality of life.

MECHANISM OF PAIN

• Transduction: It is the conversion of mechanical (injury), thermal (heat) or chemical stimulus into neuronal action potential (sensation felt by nerves)
• Transmission: It is the movement of pain impulses from the site of transduction to brain through the afferent nerve fibers (periphery to center)
• Perception: Perception occurs when the pain is recognized, defined and responded by the individual
• Modulation: It involves the activation of the efferent nerve fibers (center to periphery) to exert the action caused by the transmission of pain.

CLASSIFICATION OF PAIN

• Nociceptive Pain: Normal processing of the stimulus that damages normal tissue which results in pain
• Neuropathic Pain: It is the pain caused by abnormal processing of the peripheral & central nervous system
• Acute Pain: It is the sudden onset of pain that takes less than 3 months for normal healing to occur.
• Chronic Pain: It is the gradual onset of pain that may start as an acute injury or event but continues more than 3 months for recovery to occur.

ASSESSMENT OF PAIN

• Pattern of Pain: It involves finding out when the pain started, the cause of pain, the duration of pain and whether the pain is continuous or intermittent.
• Quality of Pain: It refers to the nature of pain described as numbing, shooting, stabbing or itching pain.
• Radiation of Pain: It refers to the pain that starts in one place and spreads or travels to another part of the body
• Area of Pain: the area or location of pain is identifying the possible site and mark the areas of pain
• Intensity of Pain: It is used to assess the severity or intensity of pain using pain scales like numeric scale & visual analogue scales
• Frequency of Pain: It refers to the duration of pain i.e the pain is constant or intermittent or the pain occurs at any particular time of day

MANAGEMENT OF PAIN

• COLLABORATIVE MANAGEMENT:
  • Hot & Cold application are applied to the area of pain
  • Acupuncture is the Chinese medicine used to identify the nerves causing pain and triggering the nerves to treat pain
  • Relaxation therapy like Imagery (drawing the attention of the patient by showing images) and massage therapy is done to treat pain
• PHARMACOLOGICAL MANAGEMENT
  • Aspirin- used to treat mild pain
  • Paracetamol - It is analgesic & antipyretic in action
  • NSAIDS like Ibuprofen to treat pain caused due to inflammation
  • Opioid analgesics like morphine to treat severe pain
  • Antidepressants like amitriptylline, doxepin are used to depress the CNS and thereby reduce the intensity of pain.
• INTERVENTIONAL THERAPIES FOR PAIN
  • Therapeutic Nerve block: This can be given as local anesthetics to desensitize the local ganglion that induces pain
    Neuro ablative techniques: These are procedure where radio frequency waves or heat energy is given to destroy the nerves causing pain.
  • Transcutaneous electrical nerve stimulation (TENS): this involves delivering electric current through electrodes which are applied on the skin surface over the painful regions and wires are connected to a battery operated stimulator which is found effective in treating chronic pain
  • Peripheral electrical nerve stimulation: this stimulates deeper peripheral tissues through insertion of needle to which a stimulator is attached near a peripheral nerve.
  • Patient control Analgesics: The analgesic agent like fentanyl and morphine are loaded in a syringe pump and connected to the patient and the control key is given to the patient which helps the client to operate himself in times of pain which is found to be effective.