BATAAN PENINSULA STATE UNIVERSITY

Main Campus, Balanga City

COLLEGE OF NURSING AND MIDWIFERY

MEDICAL SURGICAL NURSING (NRCM 103)

PAIN
- a defense mechanism when the normal functioning of the body is threatened by
internal or external sources or when our vital functions are impaired or there’s a
presence of pathologic organism
- it is what the client says it is when the client says it does.

FIVE COMPONENTS OF PAIN

1. Physiologic – transmission of nociceptive stimulus

a. Transduction – occurs at the level of the peripheral nerves; conversion of a

mechanic, thermal, or chemical stimulus into a neuronal action potential

b. Transmission – once primary afferent nociceptors (PAN) has been transduced,

the neuronal action potential must be transmitted to and through the CNS
before pain is perceived

c. Perception – nociceptive input is perceived as pain in the brain

d. Modulation – include inhibition and facilitation of nociceptive signals occurring

in the peripheral, spinal cord and brain levels

2. Affective –refers to the feelings and emotions that affect the experience of pain

3. Behavioral – refers to the actions and posturing of a patient to express the pain or to
control the pain

4. Cognitive – refers to the meanings, beliefs, attitudes, past experiences, and

expectations about the illness or disease and about the pain that influence the
patient’s response to pain therapy

5. Sensory – refers to the recognition of the sensation as painful

Neurophysiological Transmission of Pain

Major Events:

1. Peripheral Transmission

Types of Receptors

a. nocireceptors – found in the skin, meninges, periosteum and some internal organs
b. thermoreceptors – heat and cold
c. mechanoreceptors – stretching, cutting, tearing

2. Spinal Cord Transmission

3. Transmission in the Cortex or Thalamus

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 PAIN THEORIES

1. Gate Control Theory – there is a specialized system (gate control) that modulates sensory
input before evoking perception and response to the stimuli.
- Melzack and Wall (1965) proposes that the stimulation of fibers that transmit
nonpainful sensations can block or decrease the transmission of pain impulses
- stimulation of the large diameter fibers inhibits the transmission of pain, thus “closing
the gate”; when smaller fibers are stimulated, the gate is opened

2. Pattern Theory – any stimulus could be perceived as painful if the stimulation was intense
enough

3. Specificity Theory – holds that there are certain specific nerve receptors that respond to
noxious stimuli and that these noxious stimuli are always interpreted as pain

4. Affect Theory – pain is an emotion and its intensity depends on the meaning of the part
involved, does not include physiologic aspect

Types of Pain

● Threshold – refers to the intensity of the stimulus required to cause an individual to

experience pain. It is essentially the same for individuals

● Tolerance – refers to the point at which the individual reacts to the pain with verbal or
other responses. Each individual has a different pain tolerance. Can be influenced by
culture, age, pain experience and level of consciousness.

According to Causation

1. Pretended Pain – neither psychogenic nor physiologic in origin; maybe used as a means of
concentrating interest and sympathy upon oneself

2. Psychogenic Pain – pain that is independent of peripheral stimulation or of damages to

nervous system and due to emotional factor

According to Pattern

1. Constant pain – occurs continuously

2. Intermittent pain – occurs periodically
3. Intractable pain – not relieved by ordinary measures
4. Transient or Brief

According to Severity

1. no pain
2. mild
3. moderate
4. severe
5. worst

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According to Location

1. Superficial or Cutaneous Pain – usually produces sharp pain, localized, shorter duration

2. Deep or Somatic – long duration, diffuse, dull aching quality; associated autonomic
responses, musculoskeletal tension, nausea

3. Central Pain – autonomic reflex pain syndrome; sensation of pain arising from within the
nervous system itself, regardless of the location

a. Causalgia – lesion peripheral nerve; followed injury to the peripheral nerve

characterized by burning pain that is often severe, persistent, diffuse spontaneous and
aggravated by motion, touch or emotional stimuli

b. Phantom – after amputation; patient may feel various sensations in their limbs; a
paresthesia commonly comes feeling of itching in the palm of the missing hand or sole
of the foot, pressure sensation tingling feeling or the sensation described as “pins and
needles”

c. Central – lesion in CNS, affecting pain pathway

d. Neuralgia – sharp spasm like pain along the course of one or more nerves

4. Psychogenic – due to emotional factors without anatomic or physiological explanation

According to Duration

1. Acute – usually lasts for hours and days; temporary has immediate onset and eventually
subsides after treatment or often without treatment

2. Chronic – lasts longer than 6 months; continual, may begin gradually, persists or recurs for
an indefinite period and is more difficult to manage effectively

Sources of Pain

1. Physical Source – stimulation by injury, pressure or oxygen deprivation

2. Environmental Source – extreme loud noise, air pollution
3. Psychological – tension and stress

Characteristics of Pain (Quality)

1. Localized pain – confined to the site of origin

2. Projected Pain – occurs along distribution of nerve
3. Radiated Pain – extends to other sites aside from origin
4. Referred Pain – occurs at the other site other than source

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 Factors Affecting Perception and Interpretation of Pain

1. Culture
2. Gender
3. Experience
4. Age
5. Time
6. Level of Consciousness

RESPONSES TO PAIN

1. Physiologic Responses
a. response to activation
b. response to rebound
c. response to adaptation

2. Behavioral Responses
a. Verbal – describing the pain, expressed by crying or moaning
b. Non-verbal – grimaced, tensed body, posture, labored speech
c. Motor response – withdrawing from painful stimuli

3. Cognitive and Affective Responses

a. past experience
b. cultural values and expectation

Guidelines in Giving Medication for Pain Relief:

1. Using preventive approach

2. Individualizing the dose and the interval between doses is necessary
3. Gerontological consideration
4. Routes of administration for moderate to severe pain

NURSING CARE OF CLIENTS EXPERIENCING PAIN

I. Assessment

1. Objective Data – includes vital signs, nonverbal behavior

2. Subjective Data – obtained through interview

- Assess for type of pain

- Assess for onset of pain
- Assess location, where it originates and travels
- Evaluate intensity and character of pain
- Check precipitating factors
- Assess associated factors
- Assess duration of pain
- Evaluate previous experience of pain

II. Planning

Factors:
a. Age
b. Developmental stage of the client – includes cognitive development, sense of time and
psychomotor skills
c. Measures used previously by the client
d. Client’s choice of relief

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III. Implementation

1. Assess pain before treating

2. Give reassurance, reduce anxiety and fears

3. Offer distraction

4. Give comfort measures : positioning, rest, elevation, heat/cold application; protect from
painful stimuli

5. Cutaneous stimulation – touching, rubbing or massaging --- but never massage calf due to
danger of emboli

6. Acupuncture – insertion of needles into selected body sites to relieve forces that cause
distress

7. Nutrition and rest – bananas are source of serotonin, a chemical that modulates pain
transmission at the synapses. Avoid sugar, caffeine, nicotine, alcohol

8. Administer pain medication as needed : monitor therapeutic, toxic dose, and side effects

9. Monitor alternative methods to control pain

Surgical Destruction of Pain Stimuli

1. Rhizotomy – a division of the anterior or posterior spinal nerve roots between the ganglia
and the cord for abolition of pain; it is accomplished with a laminectomy

2. Neurectomy – removal of nerve; interrupts cranial or peripheral nerves; it is the division

of cranial and peripheral nerves in order to eliminate localized pain

3. Cordotomy – a division of certain tracts of the spinal cord which may be performed
transcutaneously, by the open method after laminectomy
- performed to interrupt the transmission of pain
- care must be taken to destroy only the sensation of pain, leaving motor function intact

Prepared By
Maria Caroline S. Lamira-Santos, RN, MAN
INSTRUCTOR

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